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Hospice, HPNA Exam
Hospice and Palliative Nurses Association RN Certification Exam Study
| Question | Answer |
|---|---|
| Where was the first palliative care program? | First palliative care program founded by Dr. Balfour Mount in 1975 in Montreal, Canada. |
| An example of advocacy in hospice and palliative care is | Promoting patient and family values, wishes, and preference of care, legal and ethical decision-making, and improved access to care and community resources by influencing or formulating health and social policy. Eg. negotiating continuous care reimb |
| When did hospice become a Medicare benefit? | 1983 |
| National certification is available to all roles of the hospice and palliative team EXCEPT | Social workers |
| Aside from unspecified debility, which is the most common non-cancer hospice admitting diagnosis nationally? | Dementia |
| How does hospice care differ from palliative care? | Palliative care is not the same as end of life care; hospice care is palliative care as the end of life nears, usually within 6 months of death |
| To seek scholarship assistance for certification as a specialist in hospice and palliative nursing, the best source would be to apply to: | Hospice and Palliative Nurses Association |
| What is the National Consensus Project for Quality Palliative Care? | An organization that promotes quality palliative care, fosters consistent and high standards in palliative care, and encourage continuity of care across settings. |
| Which of the following has its roots in the early hospice movement? | Care of the whole person (as early as the middle ages, early hospices promoted care for mind, body, soul, spirit |
| The growth in palliative care can be accounted for by | 1. ack by healthcare system that care of those with serious illness is in need of improvement 2. NOT lessening of Medicare and Medicaid regulations 3. National emphasis on advance care planning 4. Increased interest in physician aid in dying |
| CORE members of interdisciplinary team under Medicare Hospice Benefit: | Physician Nurse Medical Social Worker Counseling Services |
| Types of typical healthcare teams may include | Multidisciplinary Interdisciplinary Transdisciplinary |
| A multidisciplinary team | can be organized in a hierarchical manner |
| According to the Medicare Hospice Benefit, how often must the interdisciplinary group review, revise, and document the individualized plan? | At least every 15 days |
| Which of the following best reflects the definition of a peer review? | A process by which clinicians are held accountable for their practice- a collegial, systematic, and periodic process by which clinicians are held accountable for practice and that fosters the refinement of one's knowledge, skills, and decision-mak |
| Volunteers | are required by the Hospice Medicare Benefit (5%) |
| Compassion fatigue differs from post traumatic stress disorder in that compassion fatigue | it applies to the emotionally affected by the trauma of another |
| When team members do not agree on the plan of care, which of the following would be a first step for the leader to take in resolving the disagreement? | Listening to all team members' concerns |
| woman with stage IV breast cancer, what symptoms would be most worrisome? | bone pain, visual disturbances, shortness of breath mets to bone, brain, and lungs (liver) are most common 4 sites |
| Chemo given to pt with colon cancer prior to surgical resection is known as what type of therapy? | Neoadjuvent = treatment given prior to the primary treatment |
| Which factor is most significant in prognostication in patients with a cancer diagnosis? | Functional status= most significant predictor in treatment tolerance and overall survival |
| Pt with non-small cell lung cancer, nurse concerned about possible spinal cord compression due to most commonly reported first symptom: | back pain |
| Symptoms of R sided heart failure | Dependent edema, nausea, ascites weight gain, dependent peripheral edema, ascites, weakness, anorexia, nausea |
| Pt serious subarachnoid aneurysm, pt in emergency room. Most immediate response to hemorrhagic stroke (i.e. aneurysm) is | Preserve as much brain function as possible |
| Hospice eligibility guidelines for persons with neurodegenerative diseases include | weight loss, decreased albumin, rapid functional decline when neurodegenerative disease becomes terminal, hospice indicators: rapid progression of symptoms, breathing difficulties, infections, diminished nutrition/wt loss dec albumin, sepsis |
| Use of scales such as _ can be helpful in determining neurodegenerative disease progression | Karnofsky and Palliative Performance Scale and FAST |
| Major medication groups used to manage dyspnea in chronic lung conditions at the end of life include | opioids and anxiolytics- morphine and lorazepam |
| Which of the following symptoms must be closely monitored and managed in palliative care for all neurodegenerative diseases? | constipation, cognitive impairment, drooling in Parkinson's, weakened muscle tone |
| Which of the following is a terminal event at end stage liver disease? | bleeding from gi or esophageal varices |
| Late stage HIV is dx when CD4 count is less than | 200 cells/mm3 |
| hospice criteria for HIV CD4 count less than | 25 cells/mm3 |
| hospice eligibility criteria for HIV, | viral load > 100,000 copies/mL |
| S/s opioid withdrawal | anxiety, nausea, lacrimation |
| acetaminophen | hepatotoxic in high doses and can compromise renal function (?) |
| pain poorly localized, cramping, and referred to distant sites usually | visceral |
| NSAIDs can | increase risk of MI or cardiovascular events in those at risk |
| Opioid-induced respiratory depression | occurs more often in those with obstructive sleep apnea |
| Opioids can be given by a variety of routes of administration. Which statement true? | with morphine a subcut bolus peaks at approx 30 minutes whereas IV bolus peaks at aprox 15 min |
| Anti epileptic drugs are effective for neuropathic pain. Which statement is true? | Pregabalin can be administered 2-3 times a day (better bioavailability) while gabapentin should be given 3 times per day |
| Antidepressants are useful in relieving neuropathic pain. Which statement is true? | amitriptyline has sig anticholinergic effects and not considered first line therapy |
| Corticosteroids such as dexamethasone | can relieve bone pain and R upper quad pain associated with liver mets |
| principles of opioid use | 25% reduction after performing equianalgesic conversion accounts for incomplete cross tolerance |
| hallmark sign of delirium? | alteration in consciousness aka acute change in level of arousal |
| Pt reports myoclonus causing him distress. What nonpharm intervention should be added to plan? | gentle massage to affected area |
| Education regarding healthy sleep practices | listen to calming music or meditate prior to bedtime |
| Most important piece of info when assessing dyspnea? | Patient's level of distress (dyspnea is a subjective symptom reported by the patient) |
| Family members concerned that giving morphine to relieve dyspnea will accelerate the dying process. What response most appropriate? | Given in appropriate doses, morphine will slow respirations and relieve the feeling of air hunger- morphine's response is does dependent and families should be reassured that starting with low doses and taking as prescribed would not hasten death |
| What stage is a pressure ulcer with skin that is red and blistered? | blister = Stage 2 |
| Which of the following is an irreversible cause of anorexia-cachexia? | metastatic pancreatic cancer |
| Which of the following is a no pharmacological tx for nausea and vomiting? | food at room temperature |
| Which of the following treatments is required for opioid-induced constipation? | stool softener and stimulant laxative daily |
| What is the cause of hiccoughs in a patient who has ascites? | Phrenic and vagus nerve irritation |
| Which statement best describes what to teach a patient on how to treat dry itchy skin? | apply moisturizer over damp skin after bathing |
| Pt treated for known psychosis exhibits uncontrollable muscle movements and spasms around the mouth. The patient is most likely experiencing | Tardive dyskinesia = uncontrollable muscle movements and spasms around the mouth are classic signs of tardive dyskinesia. It is also associated with antipsychotic medications. |
| 3 hallmark signs of PTSD include | anxiety, intrusive memories, and distressing dreams are hallmark signs of PTSD |
| A delusion in which the individual is preoccupied with their state of health is a | Somatic delusion |
| What is delusion of control? | belief that outside force is controlling the individual |
| What is erotomanic delusion? | False belief that another person is in love with the individual |
| What is nihilistic delusion? | Conviction that major catastrophe will occur |
| Patient tells the nurse, "I need the voices in my head to stop yelling so loud." Based on this statement, the first thing the nurse should do is... | Ask the patient what the voices are saying to assess risk for violence or self harm from command hallucinations |
| The nurse arrives at the home of a new hospice patient but has difficulty walking through the house because of the amount of clutter stacked in the family room and kitchen. The most likely reason for this is that the patient is... | Exhibiting a type of OCD; hoarding disorder is characterized by a persistent difficulty in parting with possessions to the point of excess often resulting in extreme clutter throughout the home |
| A patient living in a group home with a known history of borderline personality disorder and end stage lung cancer | Patients with psych history often have undertreated pain |
| A male patient was admitted to hospice with stage IV liver cancer. His sister reports he did not sleep the night before as he was shaky, sweaty, agitated, and swatting at imaginary bugs in his bed. The nurse should ask | Assess pt's history of alcohol use |
| Nurse visits 72 year old woman with adv breast cancer, and son/caregiver in home. Nurse knows pt well and notices on this visit patient has not maintained eye contact with nurse or her son. Nurse should ask | To speak to patient alone - give patient privacy to talk about nurse's observation |
| Patient tells the nurse that he knows he will go to hell because Jesus is jealous of his powers and will not let him into heaven. Best explanation of this behavior: | Delusional activity |
| During hospice admit interview 67 year old woman with adv cardiac disease admits to being treated for depression in her 30s. The nurse understands that the patient | Pt should be monitored closely due to greater risk for depression with this illness |
| Pt has been experiencing poorly controlled neuropathic pain for several weeks, but is otherwise stable. As the nurse prepares to leave the home, patient says, "I don't think I'll be here when you come back." The most appropriate question from the nurse: | Can you tell me why you won't be here? (try to find out if patient contemplating self harm) |
| The nurse providing wound care to a male patient with schizophrenia should | tell the patient when she will touch him (avoid physical contact if possible and warn patients when they must touch them). |
| Grief expressed by family members at the time of pt death | Is a normal response to loss |
| The hospice bereavement counselor observes that after 12 months of bereavement support, a widow is expressing strong yearning for her husband, disturbing nightmares of his death, and guilt that his death was "her fault." Pt is experiencing: | complicated grief |
| Carefully assessing the strengths of a family caregiver includes learning: | Caregiver history in coping with uncertainty |
| Puchalski's FICA is a tool for conducting a spiritual assessment. the FICA acronym stands for: | Faith, Influence, Community, and Address |
| The search for ultimate meaning and purpose in life, which may involve a connection to a higher power is | Spirituality |
| In palliative care, "unit of care" consists of | Patient and family |
| Comprehensive resource assessment | Includes a collaboration with the interdisciplinary team- promotes clear understanding of resources available to each patient-family unit |
| Cultural humility is | Ongoing practice of self-awareness and self-critique that addresses power imbalances inherent in medical system |
| Culturally sensitive communication by the interdisciplinary team is demonstrated by | Using professionally trained interpreters |
| Before a scheduled visit to Mrs. Alexander today, the hospice nurse has been informed that she was seen in the emergency room last night due to side effects from giving herself too much pain medication. How can nurse check understanding? | using the "teachback" method |
| Hospital-based palliative care programs have been shown to be advantageous because | They help patients and families clarify goals of care, resulting in improved pain control and symptom management, and decrease intensive care unit length of stays |
| When providing hospice and palliative care to individuals with intellectual and developmental disabilities, it is important to recognize | Deficits in cognition and communication may make it difficult for patients to understand their illness and verbalize their symptoms |
| Pt 69 year old man dx 2 years ago with metastatic lung cancer now in end stage. Patient lives in boarding house, does not drive, no cell phone, no family, relies on friends, pain 7/10, pt says he can't afford copay for meds | Admit patient, contact physician to review initial plan of care, and request order for pain medication |
| Which of the following demonstrates understanding of Medicare Conditions of Participation criteria for general inpatient hospice care? | Despite recent changes we made with his dosing, he is still very uncomfortable. I think our best option right now is to transfer him to an inpatient bed for a few days to get his pain under control. |
| Communication and collaboration among healthcare providers is essential to the delivery of quality hospice and palliative care because | Good communication fosters seamless continuity of care and improved patient outcomes |
| A nursing assistant working on an inpatient palliative care unit asks the nurse how she can help with Mr. Francis' pain management. Which of the following statements is appropriate to say to a nursing assistant? | Ask if he would like to hear about the great catch your son made yesterday. |
| Offender aides working in hospice prisons | Report being able to atone for their own offenses |
| At admission Mr. Paul said he retired from the US Navy after serving in WWII and Korean War. Which is an accurate statement about Mr. Paul? | Mr. Paul has been affected by his time in the military |
| Homeless patient. Which of the following is a challenge that the hospice nurses will face when providing care to this pt? | Finding a healthcare power of attorney |
| Which of the following is a characteristic that many rural dwellers share? | Equate being healthy with being able to work |
| The Patient Self-Determination Act requires that hospitals accepting Medicare patients must | Ask if a patient has an advance directive |
| Goals of advance care planning include | Determining values and priorities for end of life care |
| Patients with an out-of-hospital do not resuscitate order | May revoke it at any time |
| A POLST differs from a living will in that POLST | Is a signed medical order by a provider |
| The Patient Self-Determination Act (PSDA) was passed as a result of | Nancy Cruzan case "Right to Die" |
| Which of the following is true about the nurse's role in advance care planning? | Complete his/her own advance directive (establish relationship with patient before discussing) |
| The nurse's primary role in advance care planning is to | advocate for the patient |
| Barriers to completion of an advance directive include | Fear of substandard care |
| In discussing advance care planning with a patient with severe COPD, the nurse should | Include discussion of intubation |
| A family member who is designated as the healthcare power of attorney | only makes healthcare decisions when the patient lacks capacity |
| Which symptom is unlikely to occur during the final days if it has not occurred previously? | pain |
| Which of the following should be emphasized in teaching the family about symptoms as death nears? | Vocalizations are not always signs of distress |
| In the treatment of dyspnea, what is the rationale for directing a fan to the patient's face? | Stimulation of the baroreceptors |
| In a patient nearing death, which of the following changes in breathing requires intervention? | audible respiratory secretions- requires interventions such as repositioning and discontinuation fluids and select medications |
| What is the first guiding principle when providing care of the body after death? | All of the postmortem changes are temporary |
| Which of the following describes hypoactive delirium? | lethargy |
| Restlessness can also occur as death nears. Which of the following medications can worsen restlessness? | Benzodiazepines can have paradoxical effect (Haldol is first line treatment of restlessness) |
| What is the overall approach to care as the patient approaches the final days? | Discontinuation of routine assessments or tests that will not alter the course of care |
| Pt experiencing pain from rectal cancer is close to death, IV access not dependable. Which route would be best for admin of analgesics? | subcutaneous |
| Patient's husband tells nurse that he thinks his wife has died. Which of the following would confirm this? | lack of pulse, respiration, and blood pressure |
| What is the ethical principle that guides a patient's right to choose or refuse therapies? | autonomy |
| An ethics of care focuses on | How and why nurses care for patients and not just caregiving actions |
| What is the first step in resolving an ethical dilemma? | Identify the issue |
| The following professional resources may help inform possible courses of actions and potential outcomes from an ethical dilemma EXCEPT | patient's medical record |
| Which is an instance when the truth about a patent's condition may be withheld from the patient? | The patient states he/she does not want to be burdened with the information and requests that a family member make all decisions |
| What is the definition of a substituted judgement? | Surrogate relies on known preferences of a patient to make a decision about medical care |
| How might a time-limited trial of a life-prolonging therapy be beneficial? | Establishes specific criteria and timeline for achieving clinical goals of these therapies, potentially relieving emotional distress of patients and families |
| What is the Rule of Double Effect? | The ethical justification for actions that have positive intended effects and negative unintended but forseen effects. |
| What is the intended effect of palliative sedation? | Relieve one or more refractory symptoms of a terminally ill patient by reducing consiousness |
| Nurses should incorporate ethical practices into their roles by doing all of the following EXCEPT | rely on interdisciplinary colleagues to keep current with ethical and legal issues related to end of life care |
Created by:
cskrivanek
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