CHPN - Certified Hospice and Palliative Nurse Hospice and Palliative Nurse Guide 1

Question 1

A hospice nurse is assessing a patient with end-stage COPD who reports severe dyspnea at rest. The patient has a DNR order. Which intervention is most appropriate to relieve breathlessness?

Accepted Answer

Administer low-dose oral or IV morphine as ordered

Answer

Low-dose opioids such as morphine are the gold standard for relieving refractory dyspnea in palliative patients. They reduce the sensation of breathlessness without hastening death and are appropriate even in patients with a DNR order. Supplemental oxygen is only beneficial if the patient is hypoxic, and BiPAP would be inconsistent with comfort-focused goals of care.

Question 2

When performing a comprehensive pain assessment on a hospice patient who is non-verbal and cognitively impaired, which tool is most appropriate?

Accepted Answer

PAINAD (Pain Assessment in Advanced Dementia)

Answer

The PAINAD scale was specifically developed and validated for assessing pain in patients with advanced dementia or those who cannot self-report. It evaluates observable behaviors such as breathing, vocalization, facial expression, body language, and consolability. Self-report tools like the NRS or VAS require the patient to communicate their experience, making them unsuitable for this population.

Question 3

A palliative care nurse is educating a family about the goals of hospice care. Which statement by a family member indicates a need for further teaching?

Accepted Answer

'Enrolling in hospice means all treatments will be stopped immediately, including medications.'

Answer

Enrolling in hospice does not mean all medications are stopped. Comfort-focused medications (e.g., analgesics, anxiolytics, antiemetics) are continued and often intensified. What is typically discontinued are disease-modifying or curative treatments. Clarifying this misconception is essential to reduce fear and promote timely hospice enrollment.

Question 4

A hospice patient is experiencing intractable nausea and vomiting due to bowel obstruction. The oral route is no longer available. Which route of medication administration is most appropriate in the home hospice setting?

Accepted Answer

Subcutaneous continuous infusion

Answer

The subcutaneous route is preferred in home hospice when the oral route is unavailable. It is minimally invasive, does not require IV access, can be used for continuous infusions via a syringe driver, and is highly effective for delivering opioids, antiemetics, and anxiolytics. IV access in the home setting is complex and resource-intensive compared to subcutaneous delivery.

Question 5

A nurse is caring for a dying patient whose family is showing signs of anticipatory grief, including anger directed at the care team. What is the most therapeutic nursing response?

Accepted Answer

Acknowledge the family's feelings and provide a compassionate, non-defensive presence

Answer

Anticipatory grief often manifests as anger, guilt, or withdrawal, and family members may displace these emotions onto the care team. The most therapeutic response is to acknowledge and validate their feelings without becoming defensive. A compassionate, non-judgmental presence helps build trust and supports the family through the dying process. Avoidance or defensive responses escalate distress.

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Practice Test

CHPN - Certified Hospice and Palliative Nurse Hospice and Palliative Nurse Guide 1