CHPN Patient & Family-Centered Care 4 — Questions and Answers
Question 1: A patient with a POLST form specifying DNR/DNI is found unresponsive by the family. The family calls 911. The hospice nurse's priority is:
- Support the family in honoring the POLST by clearly communicating the patient's wishes to emergency responders (Correct answer)
- Begin CPR until EMS arrives to avoid legal liability
- Ask the family to hide the POLST until the nurse arrives
- Defer entirely to the EMS team's protocols
Correct answer: Support the family in honoring the POLST by clearly communicating the patient's wishes to emergency responders
The nurse's priority is ensuring the patient's documented wishes on the POLST are communicated clearly to EMS to prevent unwanted interventions.
Question 2: Which statement BEST explains the difference between an advance directive and a POLST form?
- Advance directives are medical orders; POLST forms are legal documents
- POLST forms are actionable medical orders; advance directives express preferences that guide surrogates (Correct answer)
- Both documents serve the same purpose and are interchangeable
- Advance directives apply only to inpatients; POLST forms apply only at home
Correct answer: POLST forms are actionable medical orders; advance directives express preferences that guide surrogates
POLST forms are physician-signed medical orders immediately actionable by providers, while advance directives are legal documents expressing wishes for surrogates.
Question 3: A hospice nurse is conducting a goals-of-care conversation with a patient who has weeks to live. The BEST opening question is:
- 'Have you decided whether you want CPR?'
- 'What matters most to you in the time you have left?' (Correct answer)
- 'Are you ready to discuss stopping all treatments?'
- 'What does your family want for your care?'
Correct answer: 'What matters most to you in the time you have left?'
Opening with 'What matters most to you?' invites the patient to define their own values and goals, forming the foundation of patient-centered care planning.
Question 4: A patient wants to be kept comfortable but her son insists on hospitalization for IV nutrition. The nurse should:
- Support the son's wishes to avoid family conflict
- Clarify and advocate for the patient's expressed comfort-focused goals (Correct answer)
- Document the disagreement and take no further action
- Order the IV nutrition to satisfy both parties
Correct answer: Clarify and advocate for the patient's expressed comfort-focused goals
The nurse's ethical duty is to advocate for the patient's own expressed wishes, which take precedence over family preferences.
Question 5: Which factor is MOST important to assess when a patient requests hospice care at home?
- Distance from the nearest hospital
- Availability of a capable and willing primary caregiver (Correct answer)
- Patient's insurance coverage limits
- Number of family members living in the household
Correct answer: Availability of a capable and willing primary caregiver
A capable, willing primary caregiver is the most critical factor for safe and effective home hospice care delivery.
Question 6: A patient asks the hospice nurse, 'Am I dying soon?' The most therapeutically appropriate response is:
- 'I can't answer that; only your doctor knows.'
- 'Tell me more about what's prompting your question right now.' (Correct answer)
- 'You have at least a few more weeks.'
- 'Don't worry about that; let's focus on your comfort.'
Correct answer: 'Tell me more about what's prompting your question right now.'
Exploring the patient's question opens a therapeutic dialogue about their fears and information needs rather than deflecting or making specific predictions.
Question 7: When is it appropriate for a hospice nurse to contact the patient's primary care provider outside of the hospice team?
- Never; the hospice team assumes full care responsibility
- When the patient has a condition unrelated to the terminal diagnosis that requires management (Correct answer)
- Only when the hospice medical director is unavailable
- When the family specifically requests it
Correct answer: When the patient has a condition unrelated to the terminal diagnosis that requires management
Hospice assumes care for conditions related to the terminal diagnosis, but the PCP may still manage unrelated conditions under certain hospice benefit structures.
CHPN Patient & Family-Centered Care 4
A patient with a POLST form specifying DNR/DNI is found unresponsive by the family.
The family calls 911.
The hospice nurse's priority is: