CHPN Psychosocial & Spiritual Support 4 — Questions and Answers
Question 1: A patient with no religious affiliation expresses existential distress about the meaninglessness of their life. Which approach is MOST appropriate?
- Encourage the patient to explore religious options for comfort.
- Use meaning-centered or dignity therapy techniques to help the patient identify sources of personal meaning. (Correct answer)
- Refer exclusively to the social worker, as the nurse cannot address existential issues.
- Provide education on the stages of dying to normalize their distress.
Correct answer: Use meaning-centered or dignity therapy techniques to help the patient identify sources of personal meaning.
Meaning-centered approaches such as dignity therapy are effective for existential distress regardless of religious affiliation.
Question 2: Which of the following BEST describes the purpose of a hospice bereavement program?
- To provide grief counseling only to spouses of deceased patients.
- To support bereaved family members for at least 13 months following the patient's death. (Correct answer)
- To assess families for liability risks related to care dissatisfaction.
- To provide counseling only to families who request it at the time of death.
Correct answer: To support bereaved family members for at least 13 months following the patient's death.
Medicare hospice regulations require bereavement services to be offered to families for at least 13 months after the patient's death.
Question 3: A patient who has been unconscious begins showing signs of terminal restlessness. The family is distressed. The nurse should:
- Remove the family from the room to reduce stimulation.
- Educate the family about terminal restlessness and reassure them that comfort measures are in place. (Correct answer)
- Increase IV fluids to treat possible dehydration causing agitation.
- Tell the family the patient is in pain and needs immediate escalation.
Correct answer: Educate the family about terminal restlessness and reassure them that comfort measures are in place.
Educating the family about terminal restlessness and demonstrating that comfort measures are active reduces family distress and supports coping.
Question 4: Which element of communication is MOST important when discussing prognosis with a patient who has health literacy challenges?
- Using precise medical terminology to ensure accuracy.
- Using plain language, teach-back methods, and visual aids to confirm understanding. (Correct answer)
- Providing written materials only, to avoid overwhelming the patient verbally.
- Summarizing information quickly to avoid prolonging distress.
Correct answer: Using plain language, teach-back methods, and visual aids to confirm understanding.
Plain language and teach-back methods are evidence-based strategies to confirm comprehension in patients with limited health literacy.
Question 5: A family refuses to allow the chaplain to visit a patient, saying 'We handle religion privately.' The nurse should:
- Override the family's decision since spiritual care is a Medicare-required service.
- Respect the family's wishes and document the refusal, while ensuring the patient's own preference is also assessed separately. (Correct answer)
- Involve the patient's physician to negotiate chaplain access.
- Discontinue spiritual care documentation since the family declined.
Correct answer: Respect the family's wishes and document the refusal, while ensuring the patient's own preference is also assessed separately.
Respecting the family's preference while separately assessing the patient's own wishes ensures patient autonomy and care compliance.
Question 6: A patient tearfully says, 'I'm scared of what dying will feel like.' The nurse's BEST initial response is to:
- Immediately describe the physical dying process to reduce uncertainty.
- Sit with the patient, acknowledge the fear, and ask what specific concerns they have. (Correct answer)
- Reassure the patient that hospice medications will prevent all discomfort.
- Ask the family to stay with the patient and then leave to give them privacy.
Correct answer: Sit with the patient, acknowledge the fear, and ask what specific concerns they have.
Acknowledging fear and exploring specific concerns opens therapeutic dialogue and identifies areas for targeted reassurance.
Question 7: Which of the following statements about children's grief is MOST accurate for CHPN care planning?
- Children under age 5 do not experience meaningful grief because they lack death concept maturity.
- Children grieve differently from adults and may appear to cycle in and out of grief with apparent periods of normal play. (Correct answer)
- Children should be shielded from attending the death of a parent or grandparent under all circumstances.
- Adolescents grieve identically to adults and require the same interventions.
Correct answer: Children grieve differently from adults and may appear to cycle in and out of grief with apparent periods of normal play.
Children's grief is intermittent and developmental; they may appear to play normally and then grieve, which is a healthy adaptive pattern.
CHPN Psychosocial & Spiritual Support 4
A patient with no religious affiliation expresses existential distress about the meaninglessness of their life.
Which approach is MOST appropriate?