CHPN - Certified Hospice and Palliative Nurse Hospice and Palliative Nurse Basic 1 — Questions and Answers
Question 1: Which document allows a competent adult to designate another person to make healthcare decisions on their behalf if they become unable to do so?
- Living will
- Do-Not-Resuscitate order
- Durable power of attorney for healthcare (Correct answer)
- POLST form
Correct answer: Durable power of attorney for healthcare
A durable power of attorney for healthcare (also called a healthcare proxy or healthcare agent) legally designates a surrogate decision-maker for medical decisions when the patient loses decision-making capacity. A living will expresses the patient's own wishes but does not appoint a surrogate.
Question 2: In palliative care, the term 'total pain' (as coined by Dame Cicely Saunders) encompasses which dimensions?
- Physical and psychological dimensions only
- Physical, psychological, social, and spiritual dimensions (Correct answer)
- Physical, financial, and social dimensions
- Psychological and spiritual dimensions only
Correct answer: Physical, psychological, social, and spiritual dimensions
Dame Cicely Saunders, founder of the modern hospice movement, defined 'total pain' as a multidimensional concept encompassing physical, psychological, social, and spiritual suffering. Effective hospice nursing addresses all four dimensions rather than treating pain as purely a physical phenomenon.
Question 3: A hospice nurse is educating a family about the expected signs of imminent death. Which of the following is a hallmark physiological sign that death is likely within hours to days?
- Increased urine output with clear color
- Mottling of the knees and feet with Cheyne-Stokes respirations (Correct answer)
- Heightened appetite and restlessness
- Bradycardia with hypertension
Correct answer: Mottling of the knees and feet with Cheyne-Stokes respirations
Mottling (livedo reticularis) of the extremities combined with Cheyne-Stokes (irregular, periodic) respirations are classic signs of imminent death, reflecting circulatory shutdown and brainstem changes. Decreased urine output, anorexia, and hypotension are also expected findings.
Question 4: Under the Medicare Hospice Benefit, which level of care is designed to provide short-term inpatient symptom management that cannot be managed in the home setting?
- Routine home care
- Continuous home care
- General inpatient care (Correct answer)
- Respite care
Correct answer: General inpatient care
General inpatient care (GIP) is a Medicare Hospice Benefit level intended for short-term management of pain or other acute symptoms that cannot be controlled in the home. It is provided in a Medicare-approved inpatient facility and is not intended for custodial or long-term placement.
Question 5: Which ethical principle is MOST directly applied when a hospice nurse honors a patient's refusal of artificial nutrition and hydration?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Nonmaleficence
Correct answer: Autonomy
Autonomy is the ethical principle that upholds an individual's right to make informed decisions about their own care, including the right to refuse any treatment. When a nurse respects a patient's refusal of artificial nutrition and hydration, she is enacting that patient's self-determination.
Question 6: A palliative care nurse is assessing a patient's pain using the OPQRST mnemonic. What does the letter 'R' stand for in this assessment tool?
- Radiation
- Recurrence
- Relief/Relieving factors (Correct answer)
- Response to medication
Correct answer: Relief/Relieving factors
In the OPQRST pain assessment mnemonic (Onset, Provocation/Palliation, Quality, Radiation, Severity, Timing), 'R' stands for Radiation but in many palliative-care adaptations a second 'R' captures Relieving and aggravating factors. The most clinically applied meaning in symptom assessment tools is Relief/Relieving and aggravating factors, which guides interventions. Note: some frameworks place Radiation as the primary 'R'; when both are listed, relieving factors are the actionable nursing focus.
CHPN - Certified Hospice and Palliative Nurse Hospice and Palliative Nurse Basic 1
Which document allows a competent adult to designate another person to make healthcare decisions on their behalf if they become unable to do so?