CHPN Basic Questions 3 — Questions and Answers
Question 1: A patient on hospice develops new-onset seizures. Which medication is most appropriate for sublingual or buccal administration at home?
- Phenobarbital IV
- Lorazepam buccal or midazolam intranasal (Correct answer)
- Oral diazepam tablets
- Levetiracetam oral solution
Correct answer: Lorazepam buccal or midazolam intranasal
Buccal lorazepam or intranasal midazolam allows rapid seizure management at home when IV access is unavailable.
Question 2: Which is the MOST common complication of long-term opioid therapy requiring prophylactic treatment in hospice patients?
- Respiratory depression
- Constipation (Correct answer)
- Tolerance
- Pruritus
Correct answer: Constipation
Unlike most opioid side effects, constipation does not diminish with time and requires scheduled laxative prophylaxis.
Question 3: A patient with end-stage COPD reports air hunger rated 8/10. Their respiratory rate is 28 and O2 sat is 78%. The MOST appropriate intervention is:
- Increase oxygen to 6 L/min via nasal cannula
- Administer a low-dose opioid as ordered for dyspnea (Correct answer)
- Reposition and reassess in 30 minutes
- Transfer to the emergency department
Correct answer: Administer a low-dose opioid as ordered for dyspnea
Low-dose opioids are the most effective pharmacologic treatment for refractory dyspnea in end-stage disease and are a hospice standard.
Question 4: In the Kübler-Ross model, which stage involves the patient making deals with God or fate in hopes of prolonging life?
- Anger
- Depression
- Bargaining (Correct answer)
- Acceptance
Correct answer: Bargaining
Bargaining is characterized by 'if only' statements and attempts to negotiate more time, often with a higher power.
Question 5: A hospice nurse notices a caregiver has not left the home in two weeks and appears exhausted. The PRIORITY intervention is:
- Document caregiver fatigue in the patient chart
- Arrange inpatient respite care to relieve the caregiver (Correct answer)
- Refer the caregiver to a psychiatrist
- Schedule a family meeting for next month
Correct answer: Arrange inpatient respite care to relieve the caregiver
Inpatient respite care, covered by Medicare Hospice Benefit for up to 5 consecutive days, directly addresses caregiver burnout.
Question 6: Which scale is MOST commonly used in hospice settings to assess functional decline and estimate prognosis?
- Glasgow Coma Scale
- Palliative Performance Scale (PPS) (Correct answer)
- APACHE II
- Braden Scale
Correct answer: Palliative Performance Scale (PPS)
The Palliative Performance Scale measures ambulation, activity, self-care, intake, and consciousness to guide prognosis discussions.
Question 7: According to NHPCO standards, bereavement services for family members must be provided for at least how long after the patient's death?
- 6 months
- 12 months (Correct answer)
- 18 months
- 24 months
Correct answer: 12 months
Medicare Conditions of Participation require hospices to provide bereavement follow-up for at least 13 months (commonly rounded to 12-13 months) post-death.
CHPN Basic Questions 3
A patient on hospice develops new-onset seizures.
Which medication is most appropriate for sublingual or buccal administration at home?