CHPN Psychosocial & Spiritual Support 3 — Questions and Answers
Question 1: A dying patient tells the nurse, 'I need to make things right with my estranged son before I die.' This represents which dimension of suffering?
- Physical
- Existential/relational (Correct answer)
- Financial
- Cognitive
Correct answer: Existential/relational
Unresolved relational conflict reflects existential and relational suffering, a key dimension of total pain in hospice care.
Question 2: Which statement about complicated grief (prolonged grief disorder) is CORRECT?
- It is defined by grief lasting more than two weeks after a loss.
- It involves persistent, disabling grief that significantly impairs functioning for at least 12 months. (Correct answer)
- It only occurs in bereaved spouses, not children or parents.
- It is treated exclusively with antidepressant medication.
Correct answer: It involves persistent, disabling grief that significantly impairs functioning for at least 12 months.
Prolonged grief disorder is characterized by intense, impairing grief symptoms persisting beyond 12 months that disrupt daily functioning.
Question 3: A hospice nurse notices a patient has placed meaningful photos and objects at the bedside. This behavior BEST reflects:
- Denial of the terminal prognosis.
- Life review and legacy-building as a coping strategy. (Correct answer)
- Confusion related to medication side effects.
- Social isolation requiring intervention.
Correct answer: Life review and legacy-building as a coping strategy.
Arranging meaningful objects is a common life review behavior that supports meaning-making and psychological well-being near end of life.
Question 4: When a patient's religious beliefs conflict with the recommended medical plan, the CHPN's primary role is to:
- Advocate for the medical team's plan as it is evidence-based.
- Facilitate communication between the patient, family, and team while respecting the patient's beliefs. (Correct answer)
- Defer all religious questions to the chaplain and avoid further discussion.
- Document the conflict and wait for the physician to resolve it.
Correct answer: Facilitate communication between the patient, family, and team while respecting the patient's beliefs.
The CHPN facilitates open communication and ensures the patient's spiritual values are integrated into care planning.
Question 5: Which of the following is a recognized risk factor for complicated bereavement in surviving family members?
- A long illness that allowed time to prepare
- A history of depression or prior losses in the caregiver (Correct answer)
- Having a large social support network
- Patient death occurring in a hospice facility
Correct answer: A history of depression or prior losses in the caregiver
A personal history of depression or previous significant losses substantially increases risk for complicated grief after bereavement.
Question 6: A patient asks the nurse to pray with them. The nurse does not share the patient's religious beliefs. The BEST response is to:
- Decline and refer the patient to the chaplain immediately.
- Offer to sit quietly with the patient in support while they pray, or offer to call the chaplain. (Correct answer)
- Pray along using generic language to avoid conflict.
- Explain the nurse's own beliefs to the patient.
Correct answer: Offer to sit quietly with the patient in support while they pray, or offer to call the chaplain.
Offering presence and support or arranging chaplain support respects both the patient's needs and the nurse's personal boundaries.
Question 7: The concept of 'dignity-conserving care' in hospice practice PRIMARILY focuses on:
- Ensuring physical comfort through aggressive symptom management alone.
- Preserving the patient's sense of self, meaning, and personhood throughout the dying process. (Correct answer)
- Maintaining patient privacy by limiting family presence.
- Avoiding discussions of death to protect the patient's psychological state.
Correct answer: Preserving the patient's sense of self, meaning, and personhood throughout the dying process.
Dignity-conserving care, developed by Harvey Chochinov, focuses on supporting the patient's identity, meaning, and sense of worth at end of life.
CHPN Psychosocial & Spiritual Support 3
A dying patient tells the nurse, 'I need to make things right with my estranged son before I die.' This represents which dimension of suffering?