CHPN Study Guide 5 — Questions and Answers
Question 1: Which factor is the STRONGEST predictor of complicated grief in a bereaved family member after a hospice patient dies?
- Age of the bereaved individual being over 65
- A prior history of depression, a traumatic or sudden death, or lack of social support (Correct answer)
- The duration of the hospice stay being less than 7 days
- The bereaved being a spouse rather than an adult child
Correct answer: A prior history of depression, a traumatic or sudden death, or lack of social support
Risk factors for complicated grief include prior mental health history, traumatic circumstances of the death, and inadequate social support systems.
Question 2: A patient with end-stage renal disease on hospice develops uremic pruritus. Which intervention is MOST appropriate as a first-line comfort measure?
- Systemic opioids at high doses
- Topical emollients and antihistamines (e.g., hydroxyzine), with gabapentin for refractory cases (Correct answer)
- Initiating dialysis to reduce BUN levels
- Topical corticosteroid cream to all affected areas
Correct answer: Topical emollients and antihistamines (e.g., hydroxyzine), with gabapentin for refractory cases
Uremic pruritus is first managed with skin moisturization and antihistamines, with gabapentin added for refractory itch.
Question 3: The interdisciplinary team in hospice MUST include which core members per Medicare Conditions of Participation?
- Physician, registered nurse, social worker, and pastoral or counseling services (Correct answer)
- Physician, RN, pharmacist, and physical therapist
- Nurse practitioner, social worker, chaplain, and dietitian
- Attending physician and RN only
Correct answer: Physician, registered nurse, social worker, and pastoral or counseling services
Medicare requires the hospice IDT to include a physician, RN, social worker, and pastoral/counseling services at minimum.
Question 4: A terminally ill patient scores 8/10 on the Edmonton Symptom Assessment System (ESAS) for anxiety. Which pharmacologic intervention would the nurse anticipate?
- Starting a selective serotonin reuptake inhibitor (SSRI) as immediate therapy
- Administering a short-acting benzodiazepine such as lorazepam for rapid relief (Correct answer)
- Prescribing a tricyclic antidepressant as first-line
- Increasing the current opioid dose to reduce overall distress
Correct answer: Administering a short-acting benzodiazepine such as lorazepam for rapid relief
Short-acting benzodiazepines provide rapid relief for acute anxiety in terminal illness while longer-term therapies are considered.
Question 5: Which statement about the Palliative Performance Scale (PPS) is CORRECT?
- A PPS of 100% indicates the patient is actively dying
- A PPS of 10-20% correlates with total dependence and minimal oral intake, suggesting death within days to weeks (Correct answer)
- PPS measures cognitive function primarily
- PPS scores below 50% are ineligible for the Medicare Hospice Benefit
Correct answer: A PPS of 10-20% correlates with total dependence and minimal oral intake, suggesting death within days to weeks
PPS 10-20% indicates total dependence, mouth care only or no intake, and typically correlates with death within days to weeks.
Question 6: A patient on hospice is found to have been purchasing street drugs in addition to prescribed opioids. The MOST appropriate response from the CHPN is:
- Immediately discharge the patient from hospice for violating the agreement
- Maintain a non-judgmental stance, assess for undertreated pain or substance use disorder, and work with the IDT (Correct answer)
- Reduce the patient's opioid prescription as a punitive measure
- Report the patient to law enforcement
Correct answer: Maintain a non-judgmental stance, assess for undertreated pain or substance use disorder, and work with the IDT
A non-judgmental, IDT-based approach addresses potential undertreated pain or comorbid addiction while maintaining the therapeutic relationship in hospice.
Question 7: Which of the following BEST describes the concept of 'total pain' as defined by Dame Cicely Saunders?
- Pain that cannot be controlled by any pharmacologic means
- The multidimensional suffering encompassing physical, psychological, social, and spiritual components (Correct answer)
- Pain that affects the entire body rather than a localized site
- Pain that occurs continuously without any periods of relief
Correct answer: The multidimensional suffering encompassing physical, psychological, social, and spiritual components
Saunders coined 'total pain' to describe the holistic suffering of dying patients, requiring a multidisciplinary approach addressing all dimensions.
CHPN Study Guide 5
Which factor is the STRONGEST predictor of complicated grief in a bereaved family member after a hospice patient dies?