ACHPN Palliative Care Assessment and Diagnosis 1 — Questions and Answers
Question 1: Which validated tool is most appropriate for conducting a comprehensive palliative care needs assessment in a hospice patient?
- Palliative Performance Scale (PPS) (Correct answer)
- CAGE questionnaire
- PHQ-9
- Mini-Mental State Examination
Correct answer: Palliative Performance Scale (PPS)
The Palliative Performance Scale (PPS) is a validated instrument widely used in hospice and palliative settings to assess functional status and guide care planning.
Question 2: When assessing dyspnea in a palliative care patient, which approach best reflects advanced practice nursing competency?
- Rely solely on oxygen saturation readings
- Use a patient self-report scale combined with clinical observation (Correct answer)
- Administer oxygen until SpO2 normalizes
- Order a chest X-ray as the first step
Correct answer: Use a patient self-report scale combined with clinical observation
Dyspnea is a subjective experience and is best assessed using patient self-report tools combined with clinical observation, as SpO2 does not correlate with perceived breathlessness.
Question 3: A patient with advanced COPD reports fatigue rated 8/10. Which assessment domain should the ACHPN prioritize next?
- Fluid and electrolyte balance only
- Psychological, spiritual, and social contributors to fatigue (Correct answer)
- Pulmonary function testing
- Dietary calorie intake
Correct answer: Psychological, spiritual, and social contributors to fatigue
Fatigue in palliative care is multidimensional, requiring assessment of psychological, spiritual, and social factors in addition to physical causes.
Question 4: Which finding on a palliative care assessment most strongly indicates a need for immediate goals-of-care conversation?
- Patient requests additional pain medication
- Functional decline to PPS 30% or below (Correct answer)
- Family reports patient is sleeping more
- Patient declines a meal
Correct answer: Functional decline to PPS 30% or below
A PPS score of 30% or below signals significant functional decline and typically indicates days-to-weeks prognosis, warranting urgent goals-of-care discussion.
Question 5: When performing a spiritual assessment using the FICA tool in a palliative patient, what does the 'A' stand for?
- Anxiety
- Address in care (Correct answer)
- Autonomy
- Advance directive
Correct answer: Address in care
In the FICA spiritual assessment tool, 'A' stands for 'Address in care,' exploring how spiritual needs should be incorporated into the patient's care plan.
Question 6: Which assessment finding would prompt the ACHPN to initiate a delirium workup in a hospice patient?
- Gradual weight loss over weeks
- Acute onset confusion with fluctuating consciousness (Correct answer)
- Mild memory complaints for months
- Preference to sleep during daytime
Correct answer: Acute onset confusion with fluctuating consciousness
Acute onset confusion with fluctuating consciousness is the hallmark presentation of delirium, which is common near end of life and requires prompt assessment for reversible causes.
