CHPN Basics Flashcards: 190 Practice Questions & Answers

LCDs provide clinical guidelines to help determine if a patient has a terminal prognosis of 6 months or less, meeting Medicare Part A eligibility. While not absolute, they offer a framework for disease-specific (e.g., CHF, COPD) and non-disease specific (e.g., decline in PPS) criteria. **Exam Tip:** HPCC emphasizes that LCDs are guidelines, not laws. Documentation must support the clinical trajectory of decline even if the patient doesn't meet every specific LCD metric.

In most jurisdictions, a valid photocopy or electronic version of a POLST is legally binding and must be honored just like the original. While bright paper is encouraged for visibility, it is not a legal requirement for validity. Exam Tip: HPCC may test your knowledge of barriers to care. Do NOT delay following a DNR order just because it is a photocopy. If the order is legible and signed, it is actionable. If there is genuine doubt about validity during an arrest, the default is always to provide life-sustaining treatment.

The priority is to perform a comprehensive physical assessment and implement pharmacological/non-pharmacological interventions per existing orders or by contacting the physician for new orders. Transitioning to Continuous Home Care (CHC) or General Inpatient (GIP) is only appropriate if the crisis remains uncontrolled despite active nursing intervention and meets specific hourly/clinical criteria for a higher level of care.

The NP must document: 1. The date of the encounter. 2. A signature and date of signing. 3. A clear statement that clinical findings were provided to the certifying physician for use in the recertification. Critical Note: The NP's F2F note provides the clinical basis for the physician's narrative. The physician remains solely responsible for the actual Certification of Terminal Illness (CTI) and the accompanying narrative, which must incorporate the NP's F2F findings.

The patient must be an adult (18+), have a terminal illness with a prognosis of 6 months or less (confirmed by two physicians), and possess the mental capacity to make informed healthcare decisions. Note: As of 2026, residency requirements have been removed in several jurisdictions (e.g., OR, VT) following legal challenges. HPCC tests the two-physician rule and the capacity requirement.