CHPN Patient Assessment and Planning 2 — Questions and Answers
Question 1: A hospice nurse uses the Edmonton Symptom Assessment System (ESAS). Which symptom domain does ESAS NOT directly measure?
- Pain
- Anxiety
- Spiritual distress (Correct answer)
- Shortness of breath
Correct answer: Spiritual distress
ESAS measures physical and psychological symptoms (pain, dyspnea, nausea, depression, anxiety, drowsiness, appetite, wellbeing, tiredness) but does not directly measure spiritual distress.
Question 2: When assessing a patient with dementia for pain, which behavioral indicator is MOST reliable?
- Self-reported pain score
- Facial grimacing and guarding (Correct answer)
- Verbal complaints of discomfort
- Family report of pain
Correct answer: Facial grimacing and guarding
In patients with dementia who cannot self-report, behavioral indicators such as facial grimacing and guarding are the most direct observable signs of pain.
Question 3: Which functional assessment tool stratifies patients into seven levels based on progressive loss of cognitive and functional abilities in dementia?
- Karnofsky Performance Scale
- FAST (Functional Assessment Staging Tool) (Correct answer)
- Barthel Index
- ECOG Performance Status
Correct answer: FAST (Functional Assessment Staging Tool)
The FAST scale stages dementia from normal aging (Stage 1) through severe dementia with loss of all functional abilities (Stage 7), and Stage 7C indicates hospice eligibility.
Question 4: A palliative nurse assesses a patient's goals of care. The patient states, 'I just want to be able to attend my granddaughter's wedding in three months.' This is best classified as:
- A clinical prognosis
- A patient-centered goal (Correct answer)
- An unrealistic expectation requiring correction
- A surrogate decision-maker's preference
Correct answer: A patient-centered goal
The patient's expressed wish to attend a meaningful event is a patient-centered goal that should guide care planning and discussions about achievability.
Question 5: Which scale is MOST appropriate for assessing dyspnea intensity in a palliative care patient who can communicate verbally?
- Borg Scale (Correct answer)
- PAINAD Scale
- Ramsay Sedation Scale
- Glasgow Coma Scale
Correct answer: Borg Scale
The Borg Scale is a validated tool for rating perceived breathlessness on a 0–10 scale and is appropriate for communicative patients reporting dyspnea.
Question 6: A hospice nurse documents that a patient has a Palliative Performance Scale (PPS) score of 40%. What does this indicate?
- Patient is ambulatory with normal activity
- Patient is mainly in bed with limited self-care ability (Correct answer)
- Patient requires total care and is unable to do any activity
- Patient is ambulatory with some evidence of disease
Correct answer: Patient is mainly in bed with limited self-care ability
A PPS score of 40% indicates the patient is mainly in bed (>50% of the day), unable to do most activities, with disease evident, and requires assistance with all self-care.
Question 7: When completing a comprehensive hospice admission assessment, which component specifically evaluates the patient's understanding of their illness trajectory?
- Medication reconciliation
- Illness understanding and prognostic awareness (Correct answer)
- Activities of daily living assessment
- Nutritional screening
Correct answer: Illness understanding and prognostic awareness
Assessing illness understanding and prognostic awareness determines whether the patient grasps the nature of their terminal diagnosis, which is foundational to informed consent and advance care planning.
CHPN Patient Assessment and Planning 2
A hospice nurse uses the Edmonton Symptom Assessment System (ESAS).
Which symptom domain does ESAS NOT directly measure?