CHPN Patient Assessment and Planning 4 — Questions and Answers
Question 1: Which component of the nursing assessment MOST directly informs the appropriateness of hospice eligibility for a non-cancer diagnosis?
- Patient's subjective pain rating
- Disease-specific decline criteria and functional status (Correct answer)
- Family caregiver availability
- Insurance coverage and financial resources
Correct answer: Disease-specific decline criteria and functional status
For non-cancer diagnoses, hospice eligibility is determined by disease-specific LCD (Local Coverage Determination) criteria combined with evidence of functional decline.
Question 2: A palliative nurse uses the Memorial Symptom Assessment Scale (MSAS). What distinguishes MSAS from simpler symptom tools?
- It measures only physical symptoms
- It captures frequency, severity, and distress for 32 symptoms (Correct answer)
- It is exclusively used for cancer patients
- It provides a single composite pain score
Correct answer: It captures frequency, severity, and distress for 32 symptoms
MSAS is a multidimensional tool that assesses 32 symptoms across three dimensions—frequency, severity, and distress—giving a comprehensive symptom burden profile.
Question 3: A hospice nurse is assessing a patient's caregiver for burnout. Which finding is MOST indicative of caregiver strain?
- Caregiver reports satisfaction with the patient's current symptom control
- Caregiver reports sleep deprivation, resentment, and social isolation (Correct answer)
- Caregiver asks questions about the patient's medication schedule
- Caregiver participates actively in interdisciplinary team meetings
Correct answer: Caregiver reports sleep deprivation, resentment, and social isolation
Sleep deprivation, resentment, and social isolation are hallmark signs of caregiver strain and burnout, requiring targeted support interventions.
Question 4: When performing a spiritual assessment using the FICA framework, the 'I' stands for:
- Identity
- Importance and Influence (Correct answer)
- Interventions requested
- Illness meaning
Correct answer: Importance and Influence
In the FICA Spiritual Assessment Tool, 'I' represents Importance and Influence—asking how important spirituality is to the patient and how it influences their health decisions.
Question 5: A dying patient's wife asks the hospice nurse why her husband's hands and feet are mottled and cold. The nurse's BEST response explains that this occurs because:
- The patient is in pain and needs more medication
- Circulation is withdrawing to vital organs as the body shuts down (Correct answer)
- The patient has developed peripheral vascular disease
- Room temperature is too low and extra blankets are needed
Correct answer: Circulation is withdrawing to vital organs as the body shuts down
Mottling and cool extremities occur as circulation centralizes to perfuse vital organs in the final stages of dying, not from cold environment or pain.
Question 6: Which assessment finding in a hospice patient with heart failure MOST strongly predicts short-term mortality and warrants urgent care plan revision?
- Bilateral pitting edema that is unchanged from last week
- Resting dyspnea unrelieved by diuretics with SpO2 below 85% (Correct answer)
- Mild orthopnea relieved by two pillows
- Weight gain of 1 pound over three days
Correct answer: Resting dyspnea unrelieved by diuretics with SpO2 below 85%
Resting dyspnea refractory to diuretics combined with SpO2 below 85% indicates severely decompensated heart failure with high short-term mortality risk, requiring immediate care plan adjustment.
Question 7: A nurse documents the patient's appetite using a validated tool. The Simplified Nutritional Appetite Questionnaire (SNAQ) predicts which outcome in palliative patients?
- Risk of aspiration pneumonia
- Significant weight loss and nutritional decline (Correct answer)
- Likelihood of requiring parenteral nutrition
- Dehydration severity
Correct answer: Significant weight loss and nutritional decline
SNAQ is validated to predict significant weight loss (≥5% in 6 months) in community-dwelling and palliative patients, guiding nutritional intervention decisions.
