CHPN Trivia 4 — Questions and Answers
Question 1: A hospice patient is placed on continuous home care (CHC). What is the minimum number of hours of care required per day for this level of care?
- 4 hours
- 6 hours
- 8 hours (Correct answer)
- 12 hours
Correct answer: 8 hours
CMS requires at least 8 hours of skilled nursing or aide care per day to qualify for continuous home care.
Question 2: Which finding is most characteristic of the 'death rattle' (noisy breathing) in a dying patient?
- Laryngospasm from hypocalcemia
- Accumulated secretions the patient cannot clear due to reduced consciousness (Correct answer)
- Bronchospasm from opioid-induced histamine release
- Pulmonary edema from fluid overload
Correct answer: Accumulated secretions the patient cannot clear due to reduced consciousness
The death rattle results from pooled oral and pharyngeal secretions that a semiconscious patient cannot swallow or cough up.
Question 3: Which medication class is FIRST-LINE for treating nausea caused by opioid-induced constipation and gastric dysmotility in hospice patients?
- Antihistamines
- Prokinetics (e.g., metoclopramide) (Correct answer)
- Corticosteroids
- Benzodiazepines
Correct answer: Prokinetics (e.g., metoclopramide)
Prokinetic agents like metoclopramide improve gastric emptying and are first-line for opioid-related nausea and dysmotility.
Question 4: The FAST scale (Functional Assessment Staging Tool) is used to stage which condition in hospice eligibility determinations?
- Heart failure
- Dementia (Alzheimer's disease) (Correct answer)
- COPD
- Cancer
Correct answer: Dementia (Alzheimer's disease)
The FAST scale stages functional decline in Alzheimer's dementia and guides Medicare hospice eligibility for non-cancer diagnoses.
Question 5: Palliative sedation is ethically distinguished from euthanasia primarily by which principle?
- The medication used
- The intent (comfort vs. hastening death) and the doctrine of double effect (Correct answer)
- The patient's age
- The duration of treatment
Correct answer: The intent (comfort vs. hastening death) and the doctrine of double effect
Palliative sedation aims to relieve refractory suffering with doses titrated to symptom relief, not to intentionally hasten death.
Question 6: Which nonpharmacologic intervention has evidence supporting reduction of dyspnea in hospice patients?
- Prone positioning
- Directed facial airflow with a fan or open window (Correct answer)
- Humidified oxygen via face tent
- Pursed-lip breathing exercises
Correct answer: Directed facial airflow with a fan or open window
Cool airflow directed at the face stimulates V2 trigeminal receptors and reduces the perception of breathlessness.
Question 7: In bereavement care, what is the recommended minimum duration of follow-up that hospice programs must offer to bereaved family members under the Medicare Conditions of Participation?
- 30 days
- 6 months
- 13 months (Correct answer)
- 24 months
Correct answer: 13 months
Medicare CoPs require hospices to offer bereavement services to the family for at least 13 months following the patient's death.
CHPN Trivia 4
A hospice patient is placed on continuous home care (CHC).
What is the minimum number of hours of care required per day for this level of care?