CHPN General Knowledge 4 — Questions and Answers
Question 1: Which validated tool is most commonly used to assess delirium in hospice and palliative care patients?
- Mini-Mental State Examination (MMSE)
- Confusion Assessment Method (CAM) (Correct answer)
- Montreal Cognitive Assessment (MoCA)
- Brief Psychiatric Rating Scale (BPRS)
Correct answer: Confusion Assessment Method (CAM)
The Confusion Assessment Method (CAM) is the most widely validated and used tool for diagnosing delirium in clinical and palliative care settings.
Question 2: A hospice patient with advanced cancer has an ECOG Performance Status of 4. This means the patient is:
- Fully active and able to carry on all pre-disease activities
- Ambulatory and capable of all self-care but unable to do work activities
- Capable of only limited self-care; confined to bed or chair more than 50% of waking hours
- Completely disabled, unable to carry on any self-care, totally confined to bed or chair (Correct answer)
Correct answer: Completely disabled, unable to carry on any self-care, totally confined to bed or chair
ECOG Performance Status 4 indicates the patient is completely disabled, confined to bed or chair, and unable to perform any self-care.
Question 3: Palliative sedation to unconsciousness is ethically distinguished from euthanasia primarily because:
- Palliative sedation uses lower drug doses than euthanasia
- The intent of palliative sedation is to relieve refractory suffering, not to hasten death (Correct answer)
- Palliative sedation requires family consent while euthanasia requires only physician consent
- Euthanasia is always faster in onset than palliative sedation
Correct answer: The intent of palliative sedation is to relieve refractory suffering, not to hasten death
The ethical distinction rests on intent: palliative sedation aims to relieve intractable suffering while death may be an unintended consequence, whereas euthanasia is the intentional ending of life.
Question 4: A patient taking long-acting opioids for cancer pain develops breakthrough pain. What is the typical breakthrough dose calculation?
- 10–15% of the total daily opioid dose every 1–2 hours as needed (Correct answer)
- 25–30% of the total daily opioid dose every 4–6 hours as needed
- 50% of the long-acting dose administered every 8 hours
- A fixed dose of 5 mg morphine regardless of baseline opioid dose
Correct answer: 10–15% of the total daily opioid dose every 1–2 hours as needed
Breakthrough pain doses are typically calculated as 10–15% of the total 24-hour opioid dose, administered every 1–2 hours as needed.
Question 5: Which finding on a Palliative Performance Scale (PPS) assessment of 20% most accurately predicts the patient's status?
- Patient requires occasional assistance and is up 50% of the time
- Patient is totally bedbound, unable to do any self-care, intake is minimal (Correct answer)
- Patient is ambulatory with some disease evidence and normal activity
- Patient is in bed for most of the day with mostly unable to do work
Correct answer: Patient is totally bedbound, unable to do any self-care, intake is minimal
A PPS of 20% indicates total bedbound status, complete inability to perform self-care, and minimal to mouth-care-only oral intake, signifying very advanced illness.
Question 6: A hospice nurse is providing anticipatory grief support to a family. Which action is most appropriate?
- Telling the family they should avoid thinking about the death until it happens
- Providing information about the signs of dying and what to expect so they can prepare (Correct answer)
- Referring all grief counseling exclusively to the social worker
- Discouraging family members from expressing fear or sadness in the patient's presence
Correct answer: Providing information about the signs of dying and what to expect so they can prepare
Anticipatory grief support includes educating the family about expected changes, signs of dying, and what to expect, helping them prepare emotionally and practically.
Question 7: Which of the following is an absolute contraindication to the use of meperidine (Demerol) for pain management in hospice patients?
- Concurrent use of low-dose aspirin
- Renal impairment due to accumulation of the toxic metabolite normeperidine (Correct answer)
- Patient allergy to codeine
- Concurrent use of a proton pump inhibitor
Correct answer: Renal impairment due to accumulation of the toxic metabolite normeperidine
Meperidine is contraindicated in patients with renal impairment because its metabolite normeperidine accumulates and causes CNS toxicity including seizures.
CHPN General Knowledge 4
Which validated tool is most commonly used to assess delirium in hospice and palliative care patients?