CHPN Patient Assessment and Planning 5 — Questions and Answers
Question 1: During an interdisciplinary team (IDT) meeting, which document MOST directly guides the hospice plan of care revision?
- The patient's insurance policy
- The comprehensive assessment with updated symptom data and patient goals (Correct answer)
- The physician's original admission orders
- The social worker's bereavement plan
Correct answer: The comprehensive assessment with updated symptom data and patient goals
The comprehensive assessment, including updated symptom burden and current patient goals, is the primary evidence base for revising the interdisciplinary plan of care.
Question 2: A hospice nurse assesses a patient who is non-verbal using the PAINAD scale. A score of 8 out of 10 indicates:
- Mild discomfort requiring monitoring only
- Moderate pain with some behavioral indicators
- Severe pain requiring immediate intervention (Correct answer)
- No pain — the patient appears relaxed
Correct answer: Severe pain requiring immediate intervention
On the PAINAD scale (0–10), scores of 7–10 indicate severe pain requiring immediate pharmacologic and non-pharmacologic intervention.
Question 3: Which change in a hospice patient's urinary output is MOST consistent with the active dying process?
- Increased urine output with clear, yellow urine
- Oliguria with dark, concentrated urine or anuria (Correct answer)
- Urinary incontinence with normal volume output
- Polyuria with dilute urine and no color change
Correct answer: Oliguria with dark, concentrated urine or anuria
As renal perfusion decreases during active dying, urine output drops to oliguria or anuria and urine becomes dark and concentrated.
Question 4: A palliative nurse assesses a patient's opioid regimen. The patient uses 240 mg of oral morphine daily with four breakthrough doses of 40 mg each used consistently. What does this pattern indicate?
- The patient's pain is well-controlled and no change is needed
- The current basal dose is insufficient and requires titration upward (Correct answer)
- The patient is exhibiting drug-seeking behavior
- Breakthrough dosing is excessive and should be reduced
Correct answer: The current basal dose is insufficient and requires titration upward
Consistent use of more than two to three breakthrough doses per day indicates the around-the-clock (basal) dose is inadequate and should be increased accordingly.
Question 5: A hospice nurse documents a patient's prognosis using the Palliative Prognostic Score (PaP). Which variable is included in PaP calculation?
- Serum albumin level
- Karnofsky Performance Status and clinical prediction of survival (Correct answer)
- Patient's advance directive status
- Number of hospitalizations in the past year
Correct answer: Karnofsky Performance Status and clinical prediction of survival
The PaP Score incorporates clinical prediction of survival, Karnofsky Performance Status, and laboratory values (WBC, lymphocyte percentage) to estimate 30-day survival probability.
Question 6: A hospice nurse is assessing a patient's medication burden. Which term describes the process of reducing or stopping medications that are no longer aligned with comfort-focused goals?
- Polypharmacy reduction
- Deprescribing (Correct answer)
- Medication reconciliation
- Formulary substitution
Correct answer: Deprescribing
Deprescribing is the intentional, supervised tapering or stopping of medications that no longer provide benefit or are inconsistent with the patient's comfort-oriented goals of care.
Question 7: When assessing a patient's psychosocial status, the hospice nurse identifies anticipatory grief. Which statement BEST describes anticipatory grief?
- Grief that occurs exclusively after the patient's death
- Grief experienced before an expected loss in response to the anticipated death (Correct answer)
- A pathological grief reaction requiring psychiatric referral
- Grief limited to the patient rather than the family
Correct answer: Grief experienced before an expected loss in response to the anticipated death
Anticipatory grief is the normal mourning process that begins before the actual death, experienced by both patients and families as they grieve losses already occurring and those expected.
CHPN Patient Assessment and Planning 5
During an interdisciplinary team (IDT) meeting, which document MOST directly guides the hospice plan of care revision?