CHPN General Knowledge 2 — Questions and Answers
Question 1: Which Medicare hospice benefit condition requires that two physicians certify a terminal prognosis?
- Life expectancy of 12 months or less if disease runs its normal course
- Life expectancy of 6 months or less if disease runs its normal course (Correct answer)
- Life expectancy of 3 months or less based on functional decline
- Life expectancy of 1 month or less based on weight loss
Correct answer: Life expectancy of 6 months or less if disease runs its normal course
Medicare hospice eligibility requires certification by the attending physician and hospice medical director that life expectancy is 6 months or less if the illness runs its normal course.
Question 2: A patient on hospice develops new-onset dyspnea. Which non-pharmacological intervention should the nurse try first?
- Position the patient supine to promote lung expansion
- Direct a fan toward the patient's face to stimulate cool airflow (Correct answer)
- Administer supplemental oxygen immediately
- Encourage pursed-lip breathing exercises
Correct answer: Direct a fan toward the patient's face to stimulate cool airflow
A fan directed at the face stimulates trigeminal nerve receptors, reducing the sensation of dyspnea and is a first-line non-pharmacological intervention.
Question 3: When assessing a cognitively intact hospice patient's pain, which tool is most appropriate?
- PAINAD scale
- Numeric Rating Scale (NRS) (Correct answer)
- FLACC scale
- Abbey Pain Scale
Correct answer: Numeric Rating Scale (NRS)
The Numeric Rating Scale is the preferred self-report tool for cognitively intact adults who can verbally rate pain from 0 to 10.
Question 4: Which of the following best describes the principle of double effect in palliative care?
- Administering two medications simultaneously to improve symptom control
- An action intended to relieve suffering may be justified even if it has a foreseen but unintended harmful effect (Correct answer)
- Withholding treatment to hasten death is ethically acceptable
- Providing equal doses of opioid and benzodiazepine for comfort
Correct answer: An action intended to relieve suffering may be justified even if it has a foreseen but unintended harmful effect
The principle of double effect holds that an action intended to produce a good effect is ethically permissible even if a harmful side effect is foreseen but unintended.
Question 5: A hospice nurse notes a patient has Cheyne-Stokes respirations. This finding most likely indicates:
- Acute pulmonary edema requiring immediate intervention
- Approaching death, typically within hours to days (Correct answer)
- Uncontrolled pain causing respiratory distress
- Need for supplemental oxygen titration
Correct answer: Approaching death, typically within hours to days
Cheyne-Stokes respirations — cycles of apnea and hyperpnea — are a common sign of imminent death, typically occurring hours to days before death.
Question 6: Which interdisciplinary team member is primarily responsible for addressing a patient's spiritual distress in hospice care?
- Social worker
- Hospice nurse
- Chaplain or spiritual care counselor (Correct answer)
- Bereavement coordinator
Correct answer: Chaplain or spiritual care counselor
The chaplain or spiritual care counselor is the primary IDT member responsible for assessing and addressing spiritual distress, though all team members support spiritual needs.
Question 7: Under the Medicare Hospice Benefit, which of the following services must be provided as needed, 24 hours a day, 7 days a week?
- Continuous nursing care at the bedside
- On-call telephone access to a nurse or physician (Correct answer)
- Daily aide visits for personal care
- Weekly chaplain visits for spiritual support
Correct answer: On-call telephone access to a nurse or physician
Medicare requires hospice programs to provide around-the-clock telephone access to a nurse or other qualified professional to address patient and family needs.
CHPN General Knowledge 2
Which Medicare hospice benefit condition requires that two physicians certify a terminal prognosis?