CHPLN® Question Bank

Answer: (a)

Electing the Medicare Hospice Benefit requires a physician's order certifying that the patient is terminally ill with a prognosis of six months or less if the disease runs its normal course. A DNR in the home, a 24-hour caregiver, and discontinuing all non-comfort medications are not Medicare requirements for electing hospice.

Answer: (c)

Patients with dementia are especially prone to acute confusion and agitation when moved to an unfamiliar setting. Although cerebral metastases and hypoxia can also cause confusion, combativeness appearing immediately after admission is best explained by the disorienting effect of a new environment.

Answer: (d)

Swelling at the site together with blood backing up into the tubing suggests the vein is obstructed by a thrombus. Phlebitis usually causes redness and warmth along the vein, while vasculitis and a histamine reaction present differently.

Answer: (b)

Repositioning a bedbound patient every 2-3 hours relieves pressure over bony prominences and is the cornerstone of pressure-injury prevention. Pre-medicating with morphine or lorazepam may ease turning but does not protect the skin, and hourly turning is not the standard.

Answer: (b)

Hospice eligibility for end-stage cardiac disease typically includes optimally treated NYHA Class IV symptoms and an ejection fraction of 20% or less. Edema that still responds to diuretics indicates treatable disease rather than end-stage failure.

Answer: (a)

Frequent or persistent pain in end-stage disease is best controlled with scheduled, around-the-clock dosing rather than waiting for pain to recur. Route changes, combination analgesics, and opioid rotation are used selectively, not as the core principle.

Answer: (d)

Anorexia (loss of appetite) is an expected finding as patients approach death. Respirations usually become irregular, the desire for conversation typically decreases, and infection is not a universal feature of the dying process.

Answer: (c)

When dyspnea is driven by end-stage weakness, reducing physical exertion through increased assistance with activities of daily living lessens the breathlessness. Inhalation therapy and high-flow oxygen are of limited benefit when the patient is not hypoxic.

Answer: (a)

Primary liver cancer commonly produces ascites through portal hypertension and impaired lymphatic drainage. Glioblastoma, myeloma, and prostate cancer are not typically associated with ascites.

Answer: (c)

Opioids slow gastrointestinal motility, making constipation their most common and predictable side effect; a prophylactic bowel regimen is standard. Pruritus and vertigo can occur but are less common, and tachypnea is not an opioid effect.