CHPN Basic Questions 4 — Questions and Answers
Question 1: A patient with terminal cancer requests that cardiopulmonary resuscitation not be performed. Which document legally records this wish in most US states?
- Living will only
- POLST (Physician Orders for Life-Sustaining Treatment) (Correct answer)
- HIPAA authorization form
- Hospice admission consent
Correct answer: POLST (Physician Orders for Life-Sustaining Treatment)
A POLST form is a portable, signed medical order that is immediately actionable by EMS and medical personnel across care settings.
Question 2: When converting a patient from oral morphine to an equianalgesic dose of IV morphine, the correct conversion ratio is:
- 1:1 (same dose)
- 3:1 (oral to IV) (Correct answer)
- 2:1 (oral to IV)
- 1:2 (oral to IV, double IV dose)
Correct answer: 3:1 (oral to IV)
The equianalgesic ratio for oral to IV morphine is 3:1, meaning 30 mg oral morphine equals approximately 10 mg IV morphine.
Question 3: Which symptom cluster is MOST characteristic of the active dying phase in the final 24-48 hours of life?
- Fever, diaphoresis, and hypertension
- Mottling, Cheyne-Stokes respirations, and decreased consciousness (Correct answer)
- Bradycardia, diarrhea, and confusion
- Tachycardia, hyperventilation, and agitation only
Correct answer: Mottling, Cheyne-Stokes respirations, and decreased consciousness
Mottling of the extremities, irregular breathing patterns, and decreased consciousness are hallmark signs of imminent death.
Question 4: A hospice patient develops terminal restlessness (terminal agitation). The MOST appropriate pharmacologic intervention is:
- Haloperidol or midazolam (Correct answer)
- Stimulants such as methylphenidate
- High-dose corticosteroids
- Acetaminophen scheduled dosing
Correct answer: Haloperidol or midazolam
Haloperidol addresses delirium-related agitation and midazolam provides sedation for refractory terminal restlessness.
Question 5: Which statement BEST describes the goal of palliative sedation in refractory symptom management?
- To hasten death and relieve suffering simultaneously
- To reduce consciousness to the level needed to relieve intractable suffering (Correct answer)
- To eliminate all opioid use and replace with sedatives
- To maintain full alertness while controlling pain
Correct answer: To reduce consciousness to the level needed to relieve intractable suffering
Palliative sedation is titrated to the minimum level of sedation necessary to achieve patient comfort, not to cause death.
Question 6: An interdisciplinary team (IDT) meeting in hospice is required by Medicare at minimum how often?
- Weekly
- Every 15 days (Correct answer)
- Monthly
- Quarterly
Correct answer: Every 15 days
Medicare Conditions of Participation require the IDT to review and update each patient's plan of care at least every 15 days.
Question 7: A patient's family asks about using medical marijuana for pain control alongside the hospice plan of care. The BEST hospice nurse response is:
- Prohibit use as it violates federal hospice regulations
- Discuss state law, document use, and monitor for drug interactions with current medications (Correct answer)
- Encourage it as a replacement for all opioids
- Decline to discuss it as outside the nursing scope
Correct answer: Discuss state law, document use, and monitor for drug interactions with current medications
Nurses should educate families on state-specific legality, ensure transparent documentation, and monitor for interactions — a patient-centered, nonjudgmental approach.
CHPN Basic Questions 4
A patient with terminal cancer requests that cardiopulmonary resuscitation not be performed.
Which document legally records this wish in most US states?