CHPN Basic Questions 2 — Questions and Answers
Question 1: Which ethical principle is MOST central to hospice philosophy when a patient refuses a recommended intervention?
- Beneficence
- Autonomy (Correct answer)
- Justice
- Nonmaleficence
Correct answer: Autonomy
Autonomy — the patient's right to self-determination — is the cornerstone of hospice care and guides respect for treatment refusals.
Question 2: A patient's oxygen saturation is 84% but they report feeling comfortable. What is the priority hospice nursing action?
- Increase supplemental oxygen immediately
- Notify the physician for admission orders
- Assess and document the patient's subjective comfort level (Correct answer)
- Initiate dyspnea protocol regardless of symptoms
Correct answer: Assess and document the patient's subjective comfort level
In palliative care, symptom burden and subjective comfort are prioritized over objective vital-sign targets.
Question 3: What is the maximum Medicare Hospice Benefit continuous home care daily rate designed to address?
- Long-term custodial needs
- Short-term crisis management of acute symptoms at home (Correct answer)
- Skilled nursing facility placement
- Inpatient respite for caregiver burnout
Correct answer: Short-term crisis management of acute symptoms at home
Continuous home care provides intensive nursing during brief medical crises to keep the patient at home rather than in a facility.
Question 4: Which medication class is first-line for neuropathic pain in palliative care patients?
- NSAIDs
- Tricyclic antidepressants or SNRIs (Correct answer)
- Short-acting opioids alone
- Benzodiazepines
Correct answer: Tricyclic antidepressants or SNRIs
TCAs (e.g., amitriptyline) and SNRIs (e.g., duloxetine) are evidence-based first-line adjuvants for neuropathic pain.
Question 5: A family member insists the hospice nurse 'do something' when the patient stops eating near death. The BEST response is:
- Start a nasogastric tube to ensure nutrition
- Explain that decreased intake is a normal part of the dying process (Correct answer)
- Consult nutrition services for parenteral support
- Encourage forcing fluids to prevent dehydration
Correct answer: Explain that decreased intake is a normal part of the dying process
Educating families that anorexia near death is physiologic and normal reduces distress and prevents harmful interventions.
Question 6: Under the Medicare Hospice Benefit, which professional is responsible for certifying that the patient's life expectancy is six months or less?
- The hospice RN case manager
- The attending physician and hospice medical director (Correct answer)
- The patient's social worker
- A licensed clinical psychologist
Correct answer: The attending physician and hospice medical director
Medicare requires certification by both the attending physician and the hospice medical director before benefit enrollment.
Question 7: Which nonpharmacological intervention is MOST supported by evidence for reducing dyspnea in palliative care?
- Pursed-lip breathing exercises
- A fan directing cool air toward the face (Correct answer)
- Positioning in the prone position
- Chest percussion therapy
Correct answer: A fan directing cool air toward the face
A handheld fan directed at the face stimulates trigeminal nerve receptors and has strong evidence for reducing the sensation of breathlessness.
CHPN Basic Questions 2
Which ethical principle is MOST central to hospice philosophy when a patient refuses a recommended intervention?