CHPN Professional Practice Issues 2 — Questions and Answers
Question 1: A hospice nurse disagrees with a physician's order for a higher opioid dose than the nurse believes is appropriate. What is the most appropriate first action?
- Refuse to administer the medication
- Contact the physician to discuss the clinical rationale (Correct answer)
- Administer the dose without question
- Report the physician to the state board immediately
Correct answer: Contact the physician to discuss the clinical rationale
The nurse should first communicate directly with the prescriber to clarify the rationale, which supports safe collaborative practice.
Question 2: Which ethical principle is most directly applied when a patient with decision-making capacity refuses a recommended comfort intervention?
- Beneficence
- Justice
- Autonomy (Correct answer)
- Nonmaleficence
Correct answer: Autonomy
Autonomy grants competent patients the right to accept or refuse any treatment or intervention.
Question 3: A hospice nurse is caring for a patient whose family insists on continuing aggressive treatments. The patient previously expressed a wish for comfort-focused care. What should guide the nurse's advocacy?
- The family's wishes, as they know the patient best
- The patient's documented advance directives and prior expressed wishes (Correct answer)
- The physician's clinical judgment
- The hospice agency's financial considerations
Correct answer: The patient's documented advance directives and prior expressed wishes
The patient's own advance directives and prior wishes are the primary guide for advocacy when the patient cannot speak for themselves.
Question 4: What is the primary purpose of a palliative care interdisciplinary team meeting?
- To assign accountability for errors
- To coordinate holistic care and update the plan of care (Correct answer)
- To reduce nursing documentation burden
- To determine whether to discontinue hospice services
Correct answer: To coordinate holistic care and update the plan of care
IDT meetings facilitate coordinated, patient-centered care planning across all disciplines.
Question 5: A CHPN nurse is asked by a hospice administrator to falsify documentation to support continued Medicare eligibility. The correct response is to:
- Comply if the patient truly needs care
- Refuse and report the request through appropriate channels (Correct answer)
- Discuss with colleagues before deciding
- Document that the administrator gave the order
Correct answer: Refuse and report the request through appropriate channels
Falsifying Medicare documentation is fraud; the nurse must refuse and report it through compliance or legal channels.
Question 6: Which document is most important for a nurse to review when determining a patient's resuscitation preferences in the home hospice setting?
- The hospice admission paperwork
- The out-of-hospital DNR or POLST/MOLST form (Correct answer)
- The attending physician's verbal instructions
- The family's written letter of preferences
Correct answer: The out-of-hospital DNR or POLST/MOLST form
An out-of-hospital DNR or POLST/MOLST is the legally recognized document that guides EMS and home care providers.
Question 7: A hospice nurse experiences moral distress after being unable to provide adequate pain control due to institutional barriers. The most constructive response is to:
- Resign from the position immediately
- Bring the issue to the IDT and quality improvement process (Correct answer)
- Accept the situation as unavoidable
- Increase personal opioid prescriptions without orders
Correct answer: Bring the issue to the IDT and quality improvement process
Raising systemic barriers through IDT and QI channels allows for sustainable change while supporting professional integrity.
CHPN Professional Practice Issues 2
A hospice nurse disagrees with a physician's order for a higher opioid dose than the nurse believes is appropriate.
What is the most appropriate first action?