CHPN Study Guide 2 — Questions and Answers
Question 1: A hospice nurse is performing a pain assessment on a patient with end-stage dementia who cannot self-report. Which validated tool is MOST appropriate?
- Numeric Rating Scale (NRS)
- PAINAD (Pain Assessment in Advanced Dementia) (Correct answer)
- Visual Analog Scale (VAS)
- Brief Pain Inventory (BPI)
Correct answer: PAINAD (Pain Assessment in Advanced Dementia)
PAINAD is specifically validated for assessing pain in patients with advanced dementia who cannot self-report.
Question 2: Under the Medicare Hospice Benefit, which level of care is provided in a hospice facility or hospital for short-term pain and symptom management?
- Routine home care
- Continuous home care
- General inpatient care (GIP) (Correct answer)
- Respite care
Correct answer: General inpatient care (GIP)
General inpatient care (GIP) is provided in a facility when symptoms cannot be managed in the home setting.
Question 3: Which opioid rotation principle should the CHPN apply when switching a patient from oral morphine to transdermal fentanyl?
- Use an equianalgesic conversion table and reduce the calculated dose by 25-50% (Correct answer)
- Use an equianalgesic table and increase by 25% for cross-tolerance
- Convert directly 1:1 without dose adjustment
- Always start at the lowest available patch strength regardless of prior dose
Correct answer: Use an equianalgesic conversion table and reduce the calculated dose by 25-50%
When rotating opioids, equianalgesic tables guide conversion and a 25-50% reduction accounts for incomplete cross-tolerance.
Question 4: A palliative care patient asks about the difference between palliative sedation and euthanasia. The nurse's BEST response is:
- Both intend to hasten death, differing only in method
- Palliative sedation aims to relieve refractory suffering, not to hasten death, while euthanasia intentionally ends life (Correct answer)
- Palliative sedation is illegal everywhere in the US
- They are ethically identical under the principle of double effect
Correct answer: Palliative sedation aims to relieve refractory suffering, not to hasten death, while euthanasia intentionally ends life
Palliative sedation targets refractory symptom relief and death is not the intended outcome, distinguishing it ethically and legally from euthanasia.
Question 5: Which finding indicates that a patient with heart failure is entering the active dying phase?
- BNP level rising above 100 pg/mL
- Mottling of the knees and lower extremities (Correct answer)
- Shortness of breath requiring two pillows
- Pedal edema rating 2+
Correct answer: Mottling of the knees and lower extremities
Mottling (livedo reticularis) of the knees and lower extremities is a classic sign of imminent death due to circulatory failure.
Question 6: A family member insists that the patient be given IV fluids because 'they are starving.' The hospice nurse's MOST therapeutic response is:
- Initiate IV fluids immediately to address the family's concerns
- Explain that dehydration in dying patients often reduces secretions and edema, and the patient may not experience thirst or hunger (Correct answer)
- Tell the family that feeding is prohibited under hospice philosophy
- Document the family's refusal to accept hospice philosophy and notify the team
Correct answer: Explain that dehydration in dying patients often reduces secretions and edema, and the patient may not experience thirst or hunger
Educating the family that natural dehydration near end of life is typically not distressing and may reduce discomfort addresses their concern therapeutically.
Question 7: Which ethical principle is PRIMARILY invoked when a competent patient refuses a recommended blood transfusion at end of life?
- Beneficence
- Nonmaleficence
- Autonomy (Correct answer)
- Justice
Correct answer: Autonomy
Autonomy is the principle that competent individuals have the right to make decisions about their own medical care, including refusal of treatment.
CHPN Study Guide 2
A hospice nurse is performing a pain assessment on a patient with end-stage dementia who cannot self-report.
Which validated tool is MOST appropriate?