CHPN Education, Support, and Advocacy 5 — Questions and Answers
Question 1: A hospice patient's POLST form indicates 'DNR/DNI.' During a home visit, the patient's family begins CPR. The nurse should:
- Assist with CPR to support the family
- Calmly stop CPR, explain the patient's wishes, and provide comfort-focused care (Correct answer)
- Call 911 immediately
- Leave the home and call the physician
Correct answer: Calmly stop CPR, explain the patient's wishes, and provide comfort-focused care
The nurse must uphold the patient's legal POLST directive by stopping CPR, educating the family calmly, and redirecting to comfort care.
Question 2: Which statement indicates a family member has understood teaching about the active dying phase?
- 'I should offer small sips of water every hour to keep them hydrated.'
- 'Changes in breathing and mottled skin mean the end is very near.' (Correct answer)
- 'Increased sleeping means their condition is improving.'
- 'I should call 911 if their breathing becomes irregular.'
Correct answer: 'Changes in breathing and mottled skin mean the end is very near.'
Understanding that mottling and breathing changes are signs of imminent death, not reversible decline, is a key educational goal for families.
Question 3: A grieving widower tells the hospice bereavement counselor he is 'fine' but has lost 15 pounds and isolates himself. The team should:
- Accept his statement and close the bereavement case
- Assess for complicated grief and depression and increase support contact (Correct answer)
- Refer him immediately to inpatient psychiatric care
- Advise him to join a dating site to reduce isolation
Correct answer: Assess for complicated grief and depression and increase support contact
Significant weight loss and social isolation despite verbal denial of distress are red flags for complicated grief requiring closer assessment and support.
Question 4: When teaching a family about administering sublingual morphine to a non-swallowing patient, the nurse should emphasize:
- Injecting the medication into the buccal mucosa
- Placing drops under the tongue and waiting for absorption without forcing swallowing (Correct answer)
- Crushing the tablet and mixing with water for oral administration
- Holding the dose until the patient regains the ability to swallow
Correct answer: Placing drops under the tongue and waiting for absorption without forcing swallowing
Sublingual administration relies on mucosal absorption; the family must understand drops are placed under the tongue and swallowing is not required or forced.
Question 5: Which action by the hospice nurse BEST demonstrates advocacy at the systems level?
- Administering medications correctly per policy
- Participating in policy review to improve access to palliative sedation for refractory symptoms (Correct answer)
- Documenting all patient interactions thoroughly
- Reporting medication errors through proper channels
Correct answer: Participating in policy review to improve access to palliative sedation for refractory symptoms
Systems-level advocacy involves influencing policies and practices that affect patient populations, not just individual patient care actions.
Question 6: A hospice nurse is explaining the difference between palliative sedation and euthanasia to a family. Which statement is ACCURATE?
- Both are intended to hasten death
- Palliative sedation relieves refractory suffering while allowing natural death; euthanasia intentionally causes death (Correct answer)
- Palliative sedation is only legal in certain US states
- There is no ethical difference between the two practices
Correct answer: Palliative sedation relieves refractory suffering while allowing natural death; euthanasia intentionally causes death
Palliative sedation reduces consciousness to relieve suffering with natural death as the outcome, while euthanasia intentionally causes death — a fundamental ethical distinction.
Question 7: Which educational intervention is MOST appropriate for a family who fears the patient will suffer at the end of life?
- Assure them that all patients die peacefully without any intervention
- Explain the interdisciplinary team's symptom management plan and reassure them that comfort is the primary goal (Correct answer)
- Discourage them from being present at the time of death
- Recommend they watch educational videos and call with questions
Correct answer: Explain the interdisciplinary team's symptom management plan and reassure them that comfort is the primary goal
Explaining the concrete comfort-focused care plan, including symptom management strategies, directly addresses fear and builds trust in the hospice team.
CHPN Education, Support, and Advocacy 5
A hospice patient's POLST form indicates 'DNR/DNI.' During a home visit, the patient's family begins CPR.
The nurse should: