CHPN certification for hospice and palliative RNs

At the interdisciplinary group's plan-of-care review, which data best determine whether the plan needs to change?

Mark a letter. The key, plus a line on every option, opens at once.

1. Patient report, function, and each discipline's findings

   Pulling together what the patient reports, how the patient is actually functioning, and what every discipline has seen shows the group which needs are still unmet, and that is what a plan revision must answer.
2. The family's account of how the past week has gone

   The family's view adds useful detail, but taken by itself it can miss what the patient reports and what each discipline has found.
3. Changes in the medication profile since the last review

   A medication review shows what has been ordered, not whether the patient's needs are being met, so it cannot settle whether the plan should change.
4. The trend in vital signs, weight, and intake since admission

   Trends in vital signs, weight, and intake describe the body, but in hospice they say little about comfort, function, or unmet family needs, which are what drive plan changes.

A patient with metastatic breast cancer describes new chest wall pain as "burning" and "shooting," and even the light touch of clothing hurts. This presentation is most consistent with which type of pain?

1. Psychogenic

   Calling this pain psychogenic ignores a clear nerve-injury pattern in a patient with metastatic disease and risks leaving real pain undertreated.
2. Nociceptive somatic

   Somatic pain from bone, muscle, or skin is aching or throbbing and well localized; the trap is assuming chest wall pain must be somatic because of where it sits.
3. Neuropathic

   Burning or shooting pain, plus pain from a touch that should not hurt (allodynia), points to injured nerves; recognizing it matters because neuropathic pain often needs an adjuvant beside the opioid.
4. Nociceptive visceral

   Visceral pain arises from organs and is felt as deep, cramping, or pressure-like and poorly localized, not as burning pain set off by light contact with the skin.

An adult child who agreed to hospice after the parent said they wanted comfort at home tells the nurse, "If I hadn't agreed to hospice, my parent might still be getting treatment. I feel so guilty." What is the most supportive response?

1. "You shouldn't feel guilty; treatment would not have worked."

   Telling someone not to feel guilty dismisses the emotion, and the claim that treatment would have failed is a prediction the nurse cannot make.
2. "Tell me more. That choice respected what mattered most to them."

   An open invitation lets the adult child put the guilt into words, and naming the decision as respect for the parent's stated wish for comfort reframes it without arguing or brushing the feeling aside.
3. "Try not to dwell on it; every family feels this guilt."

   Telling the child not to dwell on guilt that every family supposedly feels closes the conversation and minimizes a feeling that needs to be heard.
4. "If you feel this strongly, we can ask about restarting treatment."

   Offering to restart treatment answers the guilt by undoing a choice made for the parent's own wishes, instead of exploring the feeling behind it.

A hospice wants staff to be ready for terminal hemorrhage at home, which occurs rarely but is highly distressing. Which training method is most effective?

1. A self-paced online module that staff complete each year

   A solo online module can cover the facts but cannot rehearse teamwork or hands-on use of the kit under stress.
2. Reviewing the policy at each annual performance evaluation

   A yearly policy review gives knowledge without practice and is unlikely to hold for an event a nurse may meet once in years.
3. A skills lab on the clinical steps for nurses only

   A skills lab for nurses alone leaves out working as an interdisciplinary team and guiding the family through the event, which is much of what staff must do in the home.
4. Interdisciplinary simulation of the event with a crisis kit

   Rehearsing a rare, frightening event as a team with the actual crisis kit in hand builds the speed and calm that reading cannot; the event is too infrequent for experience alone to teach it.