CHPN General Knowledge 5 — Questions and Answers
Question 1: A patient receiving hospice care at home begins experiencing refractory nausea unresponsive to oral antiemetics. The most appropriate route for medication delivery is:
- Rectal administration of suppositories
- Subcutaneous infusion via a continuous subcutaneous pump (Correct answer)
- Intramuscular injections every 4 hours
- Resuming the oral route with higher doses
Correct answer: Subcutaneous infusion via a continuous subcutaneous pump
Subcutaneous infusion via a pump provides continuous medication delivery and is the preferred route when the oral route is unavailable or ineffective in home hospice settings.
Question 2: The Edmonton Symptom Assessment System (ESAS) primarily measures:
- Caregiver burden and family quality of life
- Nine common symptoms rated by the patient on a 0–10 numeric scale (Correct answer)
- Objective clinical signs of pain and distress in non-verbal patients
- Functional decline using activity and mobility subscales
Correct answer: Nine common symptoms rated by the patient on a 0–10 numeric scale
ESAS is a patient-reported outcome tool that asks patients to rate nine symptoms — including pain, fatigue, nausea, and anxiety — on a 0–10 scale.
Question 3: A hospice patient states, 'I've done everything wrong in my life and I'm afraid God won't forgive me.' The nurse's best initial response is to:
- Reassure the patient that God is forgiving and they should not worry
- Listen attentively, acknowledge the patient's concerns, and offer to contact the chaplain (Correct answer)
- Change the subject to focus on physical comfort needs
- Provide literature about forgiveness from the patient's religion
Correct answer: Listen attentively, acknowledge the patient's concerns, and offer to contact the chaplain
The nurse's role is to listen, acknowledge the spiritual distress without offering personal theological opinions, and facilitate access to the appropriate spiritual care provider.
Question 4: Which of the following best describes the role of a hospice volunteer?
- Providing skilled nursing assessments in the home
- Offering companionship, respite for caregivers, and non-clinical support services (Correct answer)
- Dispensing and managing controlled substances for the patient
- Coordinating the patient's medical appointments and specialist referrals
Correct answer: Offering companionship, respite for caregivers, and non-clinical support services
Hospice volunteers provide non-clinical support such as companionship, caregiver respite, errands, and emotional support; they do not perform clinical tasks.
Question 5: A hospice nurse is caring for an African American patient who refuses hospice-prescribed opioids citing fear of addiction. The nurse's best approach is to:
- Discontinue opioid orders and document patient refusal without further discussion
- Acknowledge the concern, explore its cultural or past context, and educate about the difference between tolerance/dependence and addiction in serious illness (Correct answer)
- Contact the physician to prescribe non-opioid medications only
- Explain that addiction does not matter when someone is terminally ill
Correct answer: Acknowledge the concern, explore its cultural or past context, and educate about the difference between tolerance/dependence and addiction in serious illness
Culturally competent care requires exploring and validating patient concerns, then providing tailored education that distinguishes physical dependence from addiction in the context of serious illness.
Question 6: Under HIPAA, a hospice nurse may share a patient's protected health information with the patient's family member without written authorization when:
- The family member requests it verbally and identifies themselves as next of kin
- The patient is present, has capacity, and does not object to the disclosure (Correct answer)
- The nurse believes sharing will benefit the family's emotional wellbeing
- The family member has power of attorney for financial matters
Correct answer: The patient is present, has capacity, and does not object to the disclosure
HIPAA permits sharing PHI with involved family members when the patient is present, has decision-making capacity, and does not object to the disclosure.
Question 7: Which of the following medications is considered first-line pharmacological treatment for terminal restlessness/agitation in the actively dying patient?
- Haloperidol or benzodiazepines (e.g., lorazepam, midazolam) (Correct answer)
- High-dose intravenous corticosteroids
- Opioid rotation to methadone
- Acetaminophen scheduled around the clock
Correct answer: Haloperidol or benzodiazepines (e.g., lorazepam, midazolam)
Haloperidol (for delirium component) and benzodiazepines (for anxiety/myoclonus component) are first-line agents for managing terminal restlessness in the actively dying patient.
CHPN General Knowledge 5
A patient receiving hospice care at home begins experiencing refractory nausea unresponsive to oral antiemetics.
The most appropriate route for medication delivery is: