CHPN Basic Questions 5 — Questions and Answers
Question 1: Which hospice level of care is provided in a Medicare-approved facility when pain or symptoms cannot be managed in the home setting?
- Routine home care
- General inpatient care (GIP) (Correct answer)
- Continuous home care
- Inpatient respite care
Correct answer: General inpatient care (GIP)
General inpatient care is the highest-intensity Medicare hospice benefit level, used for acute symptom management that cannot be controlled at home.
Question 2: A hospice nurse is assessing a nonverbal patient for pain. Which tool is MOST appropriate?
- Numeric Rating Scale (NRS 0-10)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Visual Analog Scale (VAS)
- McGill Pain Questionnaire
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
PAINAD evaluates breathing, vocalization, facial expression, body language, and consolability in patients who cannot self-report pain.
Question 3: When a patient's family disagrees about continuing hospice care, the FIRST action by the hospice nurse should be:
- Discharge the patient from hospice pending family agreement
- Facilitate a family meeting with the interdisciplinary team to clarify goals of care (Correct answer)
- Contact the patient's attorney
- Defer all decisions until the patient regains decision-making capacity
Correct answer: Facilitate a family meeting with the interdisciplinary team to clarify goals of care
A structured IDT family meeting facilitates communication, resolves conflict, and keeps decision-making patient-centered.
Question 4: Which of the following best describes anticipatory grief?
- Grief that is delayed until after the patient's death
- Grief experienced before the anticipated loss of a loved one (Correct answer)
- Grief complicated by a history of trauma
- Grief lasting more than 12 months post-death
Correct answer: Grief experienced before the anticipated loss of a loved one
Anticipatory grief begins before the death as family members mourn losses already occurring (function, role, future) and prepare emotionally.
Question 5: A patient with end-stage heart failure develops worsening ascites. The palliative intervention that MOST directly improves comfort is:
- Urgent cardiac catheterization
- Therapeutic paracentesis (Correct answer)
- Sodium restriction alone
- Daily furosemide dose adjustment by protocol
Correct answer: Therapeutic paracentesis
Therapeutic paracentesis provides rapid relief of abdominal distension, pain, and dyspnea caused by large-volume ascites.
Question 6: Which professional on the hospice interdisciplinary team is primarily responsible for addressing the patient's and family's spiritual needs?
- The hospice social worker
- The hospice chaplain (Correct answer)
- The attending physician
- The hospice registered nurse
Correct answer: The hospice chaplain
The hospice chaplain provides spiritual care and assessment, though all team members should conduct basic spiritual screening.
Question 7: A hospice patient receiving morphine for pain develops myoclonus (muscle jerking). The MOST appropriate intervention is:
- Discontinue all opioids immediately
- Rotate to an alternative opioid such as hydromorphone and ensure adequate hydration (Correct answer)
- Add a stimulant medication
- Increase the morphine dose to override the symptom
Correct answer: Rotate to an alternative opioid such as hydromorphone and ensure adequate hydration
Opioid-induced myoclonus is caused by accumulation of neuroexcitatory metabolites; opioid rotation and hydration reduce metabolite burden.
CHPN Basic Questions 5
Which hospice level of care is provided in a Medicare-approved facility when pain or symptoms cannot be managed in the home setting?