CHPN Patient Assessment and Planning 3 — Questions and Answers
Question 1: A nurse uses the Confusion Assessment Method (CAM) to evaluate a hospice patient. Which feature is REQUIRED to confirm a diagnosis of delirium using CAM?
- Disorganized thinking alone
- Acute onset and fluctuating course plus inattention (Correct answer)
- Altered level of consciousness alone
- Memory impairment and disorientation
Correct answer: Acute onset and fluctuating course plus inattention
CAM requires both acute onset with fluctuating course AND inattention as mandatory features, with either disorganized thinking or altered consciousness as a third feature.
Question 2: In palliative care, the '4 Ms' framework for older adults includes Mind, Mobility, Medications, and:
- Mortality
- Meaning (Correct answer)
- Mood
- Malnutrition
Correct answer: Meaning
The Age-Friendly Health Systems '4 Ms' framework includes Mind, Mobility, Medications, and What Matters (meaning/goals), guiding patient-centered assessment.
Question 3: A hospice patient has new-onset bone pain and hypercalcemia. Which assessment finding would the nurse MOST expect?
- Hyperreflexia and muscle spasms
- Polyuria, polydipsia, and confusion (Correct answer)
- Bradycardia and hypertension
- Peripheral edema and weight gain
Correct answer: Polyuria, polydipsia, and confusion
Hypercalcemia of malignancy classically presents with polyuria, polydipsia, constipation, and confusion ('bones, groans, moans, and stones').
Question 4: Which of the following BEST describes the primary purpose of advance care planning in hospice?
- To establish a legal document preventing hospital transfer
- To align future medical decisions with the patient's values and wishes (Correct answer)
- To designate a healthcare proxy who overrides the patient's wishes
- To ensure maximum comfort medications are pre-authorized
Correct answer: To align future medical decisions with the patient's values and wishes
Advance care planning is a process of communication to ensure future medical care reflects the patient's values, goals, and preferences, not primarily a legal or administrative function.
Question 5: A palliative nurse assesses a patient for total pain. Which of the following represents the 'social' dimension of total pain?
- Uncontrolled neuropathic pain
- Fear of death and spiritual doubt
- Financial stress and family conflict (Correct answer)
- Depression and anticipatory grief
Correct answer: Financial stress and family conflict
Dame Cicely Saunders' concept of total pain includes physical, psychological, social (relationships, financial burden, role loss), and spiritual components.
Question 6: When assessing a terminally ill patient's respiratory status, which finding signals impending death within hours to days?
- Respiratory rate of 16 breaths/min
- Cheyne-Stokes respirations with apneic pauses (Correct answer)
- Mild dyspnea relieved by repositioning
- SpO2 of 92% on room air
Correct answer: Cheyne-Stokes respirations with apneic pauses
Cheyne-Stokes respirations—cycles of increasing and decreasing depth with apneic pauses—are a classic sign of impending death as brainstem control of breathing deteriorates.
Question 7: A hospice nurse completes a skin integrity assessment and finds a stage 2 pressure injury. According to hospice care planning standards, what is the PRIORITY intervention?
- Apply a compression bandage to reduce edema
- Document and update the care plan with a prevention and treatment protocol (Correct answer)
- Refer immediately to a wound care specialist for surgical debridement
- Discontinue all repositioning to minimize patient discomfort
Correct answer: Document and update the care plan with a prevention and treatment protocol
Documenting the wound and updating the interdisciplinary care plan with a tailored prevention and treatment protocol is the priority to guide ongoing wound management in hospice.
CHPN Patient Assessment and Planning 3
A nurse uses the Confusion Assessment Method (CAM) to evaluate a hospice patient.
Which feature is REQUIRED to confirm a diagnosis of delirium using CAM?