ADVANCED CERTIFIED HOSPICE AND PALLIATIVE NURSE – PRACTICE
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
- Clinical Assessment and Management
- Symptom Management and Palliative Care
- Patient and Family Education and Support
- Ethical and Legal Issues in End-of-Life Care
- Professional Responsibility and Leadership
- Interdisciplinary Collaboration and Consultation
- Grief, Loss, and Bereavement Support
- Psychosocial and Spiritual Care
Introduction
The Advanced Certified Hospice and Palliative Nurse (ACHPN) assessment is
designed to validate the specialized knowledge and expert clinical judgment required
for advanced practice nurses in the field of hospice and palliative care. This exam
assesses a wide range of skills, including complex symptom management, leadership
,in interdisciplinary teams, and the navigation of intricate ethical dilemmas. The
structure consists of multiple-choice and scenario-based questions that mirror real-
world clinical challenges. By emphasizing critical thinking and evidence-based
decision-making, this assessment ensures that practitioners are equipped to provide
high-quality, compassionate care to patients and families facing life-limiting illnesses.
SECTION ONE: QUESTIONS 1–100
1. A 72-year-old patient with metastatic lung cancer reports new-onset back pain
that is worse when lying flat. The nurse practitioner should first:
A. Order a physical therapy evaluation for core strengthening.
B. Increase the dose of the patient's long-acting opioid.
C. Perform a neurological assessment and order a stat MRI.
D. Apply heat packs to the affected area for comfort.
🟢 C. Perform a neurological assessment and order a stat MRI.
🔴 RATIONALE: New-onset back pain in a patient with metastatic cancer is highly
suspicious for malignant spinal cord compression, an oncologic emergency requiring
immediate diagnostic imaging and intervention to prevent permanent paralysis.
, 2. Which of the following is the most appropriate initial treatment for a hospice
patient experiencing "death rattle" or terminal secretions?
A. Immediate oropharyngeal suctioning every 30 minutes.
B. Repositioning the patient and administering an anticholinergic like glycopyrrolate.
C. Initiating aggressive IV fluid resuscitation to thin the secretions.
D. Administering a high-dose loop diuretic to reduce fluid overload.
🟢 B. Repositioning the patient and administering an anticholinergic like
glycopyrrolate.
🔴 RATIONALE: Management of terminal secretions focuses on non-invasive
measures like repositioning and the use of anticholinergic medications to reduce
production; suctioning is often distressing and ineffective for deep secretions.
3. In the context of the Principle of Double Effect, an action that has both a good
and a bad effect is ethically permissible if:
A. The bad effect is intended as a means to achieve the good effect.
B. The good effect outweighs the bad effect in a ratio of 10:1.
C. The intention is to achieve the good effect, and the bad effect is an unintended
, side effect.
D. The patient’s family provides written consent for the bad effect.
🟢 C. The intention is to achieve the good effect, and the bad effect is an unintended
side effect.
🔴 RATIONALE: The Principle of Double Effect requires that the clinician's primary
intent is the relief of suffering (good effect), even if a secondary, unintended effect
(such as respiratory depression) is foreseen.
4. A patient with end-stage renal disease refuses further dialysis. According to the
Patient Self-Determination Act, the facility's primary responsibility is to:
A. Persuade the patient to continue treatment for at least 30 more days.
B. Ensure the patient has information regarding their right to accept or refuse
treatment.
C. Contact the ethics committee to override the patient’s decision.
D. Require the patient to undergo a psychiatric evaluation for depression.
🟢 B. Ensure the patient has information regarding their right to accept or refuse
treatment.
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS
RATIONALES 2026 Q&A | INSTANT DOWNLOAD PDF.
Core Domains
- Clinical Assessment and Management
- Symptom Management and Palliative Care
- Patient and Family Education and Support
- Ethical and Legal Issues in End-of-Life Care
- Professional Responsibility and Leadership
- Interdisciplinary Collaboration and Consultation
- Grief, Loss, and Bereavement Support
- Psychosocial and Spiritual Care
Introduction
The Advanced Certified Hospice and Palliative Nurse (ACHPN) assessment is
designed to validate the specialized knowledge and expert clinical judgment required
for advanced practice nurses in the field of hospice and palliative care. This exam
assesses a wide range of skills, including complex symptom management, leadership
,in interdisciplinary teams, and the navigation of intricate ethical dilemmas. The
structure consists of multiple-choice and scenario-based questions that mirror real-
world clinical challenges. By emphasizing critical thinking and evidence-based
decision-making, this assessment ensures that practitioners are equipped to provide
high-quality, compassionate care to patients and families facing life-limiting illnesses.
SECTION ONE: QUESTIONS 1–100
1. A 72-year-old patient with metastatic lung cancer reports new-onset back pain
that is worse when lying flat. The nurse practitioner should first:
A. Order a physical therapy evaluation for core strengthening.
B. Increase the dose of the patient's long-acting opioid.
C. Perform a neurological assessment and order a stat MRI.
D. Apply heat packs to the affected area for comfort.
🟢 C. Perform a neurological assessment and order a stat MRI.
🔴 RATIONALE: New-onset back pain in a patient with metastatic cancer is highly
suspicious for malignant spinal cord compression, an oncologic emergency requiring
immediate diagnostic imaging and intervention to prevent permanent paralysis.
, 2. Which of the following is the most appropriate initial treatment for a hospice
patient experiencing "death rattle" or terminal secretions?
A. Immediate oropharyngeal suctioning every 30 minutes.
B. Repositioning the patient and administering an anticholinergic like glycopyrrolate.
C. Initiating aggressive IV fluid resuscitation to thin the secretions.
D. Administering a high-dose loop diuretic to reduce fluid overload.
🟢 B. Repositioning the patient and administering an anticholinergic like
glycopyrrolate.
🔴 RATIONALE: Management of terminal secretions focuses on non-invasive
measures like repositioning and the use of anticholinergic medications to reduce
production; suctioning is often distressing and ineffective for deep secretions.
3. In the context of the Principle of Double Effect, an action that has both a good
and a bad effect is ethically permissible if:
A. The bad effect is intended as a means to achieve the good effect.
B. The good effect outweighs the bad effect in a ratio of 10:1.
C. The intention is to achieve the good effect, and the bad effect is an unintended
, side effect.
D. The patient’s family provides written consent for the bad effect.
🟢 C. The intention is to achieve the good effect, and the bad effect is an unintended
side effect.
🔴 RATIONALE: The Principle of Double Effect requires that the clinician's primary
intent is the relief of suffering (good effect), even if a secondary, unintended effect
(such as respiratory depression) is foreseen.
4. A patient with end-stage renal disease refuses further dialysis. According to the
Patient Self-Determination Act, the facility's primary responsibility is to:
A. Persuade the patient to continue treatment for at least 30 more days.
B. Ensure the patient has information regarding their right to accept or refuse
treatment.
C. Contact the ethics committee to override the patient’s decision.
D. Require the patient to undergo a psychiatric evaluation for depression.
🟢 B. Ensure the patient has information regarding their right to accept or refuse
treatment.
