CHPN Education, Support, and Advocacy 2 — Questions and Answers
Question 1: A hospice nurse is educating a family about the dying process. Which sign should the nurse explain as indicating death is likely within hours to days?
- Increased appetite and thirst
- Mottling of the extremities and Cheyne-Stokes respirations (Correct answer)
- Increased urine output and restlessness
- Bradypnea with regular rhythm and strong pulse
Correct answer: Mottling of the extremities and Cheyne-Stokes respirations
Mottling of the extremities and Cheyne-Stokes respirations are late signs indicating imminent death, typically within hours to days.
Question 2: Which approach best supports health literacy when educating a patient with low literacy about medication schedules?
- Provide detailed written instructions with medical terminology
- Use the teach-back method with simple language and visual aids (Correct answer)
- Give a pamphlet and ask if they have questions
- Explain the regimen once verbally and document education provided
Correct answer: Use the teach-back method with simple language and visual aids
The teach-back method combined with plain language and visuals is the gold standard for confirming understanding in patients with low health literacy.
Question 3: A caregiver expresses guilt saying 'I should be able to do more for my mother.' What is the MOST therapeutic response from the hospice nurse?
- Reassure them that they are doing everything possible
- Explore the feelings of guilt and validate the caregiver's experience (Correct answer)
- Redirect the conversation to practical care tasks
- Suggest the caregiver speak with a psychiatrist
Correct answer: Explore the feelings of guilt and validate the caregiver's experience
Exploring and validating the caregiver's feelings of guilt allows for therapeutic communication and identifies unmet support needs.
Question 4: When advocating for a hospice patient's right to refuse treatment, the nurse should FIRST:
- Contact the ethics committee immediately
- Ensure the patient has decision-making capacity and understands the consequences (Correct answer)
- Notify the physician and document the refusal
- Ask the family to persuade the patient to accept treatment
Correct answer: Ensure the patient has decision-making capacity and understands the consequences
Before acting on a refusal, the nurse must confirm the patient has decision-making capacity and comprehends the potential outcomes.
Question 5: A hospice patient's advance directive states 'no artificial nutrition.' The patient's adult child insists on a feeding tube. The nurse's BEST action is to:
- Defer to the family's wishes to avoid conflict
- Advocate for the patient's documented wishes and involve the interdisciplinary team (Correct answer)
- Ask the physician to order the feeding tube to keep peace
- Remove the advance directive from the chart temporarily
Correct answer: Advocate for the patient's documented wishes and involve the interdisciplinary team
The nurse's primary advocacy role is to uphold the patient's documented wishes and engage the interdisciplinary team and ethics resources as needed.
Question 6: Which educational topic is MOST important for a family caring for a hospice patient at home regarding medication safety?
- How to order refills online
- Proper storage, administration, and disposal of controlled substances (Correct answer)
- The pharmacological mechanism of opioids
- How to identify generic versus brand-name medications
Correct answer: Proper storage, administration, and disposal of controlled substances
Safe storage, correct administration, and proper disposal of controlled substances prevent diversion, accidental ingestion, and legal issues.
Question 7: A hospice nurse identifies that a patient's family speaks limited English. Which action BEST supports equitable education?
- Use the patient's bilingual teenage grandchild to interpret
- Arrange for a qualified professional interpreter and provide materials in the family's language (Correct answer)
- Speak slowly and use gestures to communicate
- Document that education was provided and move on
Correct answer: Arrange for a qualified professional interpreter and provide materials in the family's language
Professional interpreters ensure accurate communication and prevent the ethical issues that arise when minors or family members serve as interpreters.
CHPN Education, Support, and Advocacy 2
A hospice nurse is educating a family about the dying process.
Which sign should the nurse explain as indicating death is likely within hours to days?