CHPN Psychosocial & Spiritual Support 2 — Questions and Answers
Question 1: A hospice patient states, 'I don't understand why God is letting me suffer like this.' Which response best demonstrates spiritual support?
- Explain that suffering has theological meaning in most religions.
- Refer the patient immediately to the chaplain without further discussion.
- Acknowledge the patient's distress and ask if they would like to explore these feelings further. (Correct answer)
- Reassure the patient that their suffering will soon end.
Correct answer: Acknowledge the patient's distress and ask if they would like to explore these feelings further.
Acknowledging distress and inviting further dialogue is the most therapeutic initial response to spiritual pain.
Question 2: Which grief theory describes mourning as having 'tasks' rather than fixed stages that must be completed?
- Kübler-Ross's Stage Model
- Worden's Task Model (Correct answer)
- Bowlby's Attachment Theory
- Engel's Grief Process
Correct answer: Worden's Task Model
William Worden's Task Model describes four tasks of mourning that bereaved individuals work through, not necessarily in order.
Question 3: A family caregiver is exhausted and tearful but insists on providing all personal care for the dying patient. The nurse's priority intervention is to:
- Arrange for CNA visits and inform the caregiver their patient care role is over.
- Acknowledge the caregiver's dedication and assess for caregiver burden and respite needs. (Correct answer)
- Contact the social worker to evaluate for neglect.
- Document the caregiver's behavior and notify the attending physician.
Correct answer: Acknowledge the caregiver's dedication and assess for caregiver burden and respite needs.
Recognizing caregiver dedication while assessing for burnout and introducing respite options is the priority psychosocial intervention.
Question 4: When conducting a spiritual assessment, which mnemonic tool is commonly used in palliative and hospice care?
- CAGE
- FICA (Correct answer)
- OPQRST
- SLUMS
Correct answer: FICA
FICA (Faith, Importance, Community, Address in care) is a validated spiritual assessment tool widely used in hospice and palliative settings.
Question 5: A patient from a culture that prohibits discussing death directly with the patient asks that all prognosis information be given only to the family. The CHPN should:
- Refuse to withhold information as it violates patient autonomy.
- Respect the cultural preference and explore the patient's own wishes through culturally sensitive questions. (Correct answer)
- Document only that information was given to the family.
- Consult legal counsel before proceeding.
Correct answer: Respect the cultural preference and explore the patient's own wishes through culturally sensitive questions.
Culturally competent care requires exploring the patient's own wishes sensitively before assuming Western autonomy norms apply.
Question 6: Which intervention is MOST appropriate for a patient experiencing anticipatory grief over losing independence?
- Distract the patient with activities to redirect focus from losses.
- Encourage the patient to identify what they can still control and focus on legacy activities. (Correct answer)
- Tell the patient that accepting dependency is a normal part of dying.
- Increase sedation to reduce emotional distress.
Correct answer: Encourage the patient to identify what they can still control and focus on legacy activities.
Identifying areas of retained control and legacy work addresses anticipatory grief by reinforcing meaning and autonomy.
Question 7: A patient's adult child becomes angry at the nursing staff, accusing them of 'not doing enough.' This behavior is BEST understood as:
- A legitimate complaint requiring an incident report.
- A manifestation of anticipatory grief and helplessness displaced onto staff. (Correct answer)
- Evidence of a dysfunctional family dynamic requiring social work referral.
- A sign the family needs more education about hospice goals.
Correct answer: A manifestation of anticipatory grief and helplessness displaced onto staff.
Anger directed at staff often reflects displaced grief and feelings of helplessness, a normal part of anticipatory grieving.
CHPN Psychosocial & Spiritual Support 2
A hospice patient states, 'I don't understand why God is letting me suffer like this.' Which response best demonstrates spiritual support?