ACHPN (Advanced Certified Hospice and Palliative
Nurse) examination, based on the HPCC (Hospice
and Palliative Credentialing Center) exam WITH
CORRECT ACTUAL QUESTIONS AND CORRECTLY
WELL DEFINED ANSWERS LATEST ALREADY
GRADED A+ (2025/2026)
Question 1
A hospice patient with end-stage heart failure reports progressive
dyspnea at rest. The patient is not on any cardiac medications. What is
the most appropriate initial intervention?
A. Start oral morphine 2.5–5 mg every 4 hours as needed
B. Administer high-flow oxygen at 6 L/min
C. Start IV furosemide 40 mg
D. Transfer to the emergency department
Correct ,,,,answer,,,: A
Rationale: In palliative care, low-dose oral or sublingual morphine
reduces dyspnea by decreasing central respiratory drive and anxiety.
Oxygen is not routinely indicated unless hypoxemic. Furosemide may help
fluid overload but is not first-line for dyspnea without signs of florid
pulmonary edema. Transfer is not indicated if symptom management can
be provided in place.
Question 2
A patient with advanced cancer has been receiving morphine 30 mg every
,4 hours for pain. The patient now develops myoclonus and confusion.
What is the most likely cause?
A. Disease progression to the brain
B. Morphine toxicity from metabolite (morphine-3-glucuronide)
accumulation
C. Opioid withdrawal
D. Hypercalcemia of malignancy
Correct ,,,,answer,,,: B
Rationale: Morphine metabolites (M3G and M6G) accumulate in renal
impairment, causing neurotoxicity: myoclonus, confusion, hyperalgesia,
and seizures. Renal function declines in advanced illness. Management
includes opioid rotation (e.g., to hydromorphone or fentanyl) and
hydration if appropriate.
Question 3
A patient with terminal cancer is delirious, agitated, and pulling at IV lines.
The family is distressed. What is the most appropriate pharmacological
intervention?
A. Haloperidol 2–5 mg IV/IM/sublingual
B. Lorazepam 2 mg IV push
C. Diphenhydramine 50 mg IM
D. Morphine 10 mg IV push
Correct ,,,,answer,,,: A
Rationale: Haloperidol (or other antipsychotics such as olanzapine,
risperidone) is first-line for delirium with agitation in palliative care. It
targets agitation, hallucinations, and confusion. Lorazepam may be
,added if severe agitation (but can worsen delirium as monotherapy).
Morphine treats pain but not delirium.
Question 4
According to the Medicare Hospice Benefit, which statement about the
election of hospice is correct?
A. The patient must have a life expectancy of 6 months or less if the
disease runs its usual course
B. The patient must be cancer-free
C. The patient must be homebound
D. The patient must have a do-not-resuscitate (DNR) order on file
Correct ,,,,answer,,,: A
Rationale: The Medicare Hospice Benefit requires certification by two
physicians (or physician + hospice medical director) that the patient has a
prognosis of 6 months or less if the disease follows its usual course.
Homebound is not required; DNR is encouraged but not mandatory.
Question 5
A palliative care patient with severe COPD has refractory dyspnea despite
optimal medical therapy. What is the most appropriate next step?
A. Continuous subcutaneous infusion of midazolam
B. High-dose systemic corticosteroids
C. Nebulized fentanyl
D. Scheduled low-dose morphine and non-pharmacologic dyspnea
interventions
, Correct ,,,,answer,,,: D
Rationale: Scheduled low-dose systemic opioids (morphine,
hydromorphone) are evidence-based for refractory dyspnea in COPD.
Nebulized fentanyl has mixed evidence. Non-pharmacologic measures
(fan, positioning, anxiety management) are essential. Midazolam is
reserved for terminal agitation/severe anxiety.
Question 6
A patient with end-stage renal disease (ESRD) on hospice discontinues
dialysis. What is the expected survival time most likely?
A. 1–2 weeks
B. 2–4 weeks
C. 2–3 months
D. 6–12 months
Correct ,,,,answer,,,: B
Rationale: After discontinuation of dialysis in ESRD, the median survival is
7–14 days, with a range of 2–4 weeks in most studies. Uremic symptoms
(nausea, confusion, pruritus) should be managed palliatively. Some
patients may survive longer with residual renal function.
Question 7
A patient with advanced dementia develops dysphagia and weight loss.
The family requests a percutaneous endoscopic gastrostomy (PEG) tube.
What is the most appropriate response?
A. "PEG tube placement is mandatory to prevent starvation."
Nurse) examination, based on the HPCC (Hospice
and Palliative Credentialing Center) exam WITH
CORRECT ACTUAL QUESTIONS AND CORRECTLY
WELL DEFINED ANSWERS LATEST ALREADY
GRADED A+ (2025/2026)
Question 1
A hospice patient with end-stage heart failure reports progressive
dyspnea at rest. The patient is not on any cardiac medications. What is
the most appropriate initial intervention?
A. Start oral morphine 2.5–5 mg every 4 hours as needed
B. Administer high-flow oxygen at 6 L/min
C. Start IV furosemide 40 mg
D. Transfer to the emergency department
Correct ,,,,answer,,,: A
Rationale: In palliative care, low-dose oral or sublingual morphine
reduces dyspnea by decreasing central respiratory drive and anxiety.
Oxygen is not routinely indicated unless hypoxemic. Furosemide may help
fluid overload but is not first-line for dyspnea without signs of florid
pulmonary edema. Transfer is not indicated if symptom management can
be provided in place.
Question 2
A patient with advanced cancer has been receiving morphine 30 mg every
,4 hours for pain. The patient now develops myoclonus and confusion.
What is the most likely cause?
A. Disease progression to the brain
B. Morphine toxicity from metabolite (morphine-3-glucuronide)
accumulation
C. Opioid withdrawal
D. Hypercalcemia of malignancy
Correct ,,,,answer,,,: B
Rationale: Morphine metabolites (M3G and M6G) accumulate in renal
impairment, causing neurotoxicity: myoclonus, confusion, hyperalgesia,
and seizures. Renal function declines in advanced illness. Management
includes opioid rotation (e.g., to hydromorphone or fentanyl) and
hydration if appropriate.
Question 3
A patient with terminal cancer is delirious, agitated, and pulling at IV lines.
The family is distressed. What is the most appropriate pharmacological
intervention?
A. Haloperidol 2–5 mg IV/IM/sublingual
B. Lorazepam 2 mg IV push
C. Diphenhydramine 50 mg IM
D. Morphine 10 mg IV push
Correct ,,,,answer,,,: A
Rationale: Haloperidol (or other antipsychotics such as olanzapine,
risperidone) is first-line for delirium with agitation in palliative care. It
targets agitation, hallucinations, and confusion. Lorazepam may be
,added if severe agitation (but can worsen delirium as monotherapy).
Morphine treats pain but not delirium.
Question 4
According to the Medicare Hospice Benefit, which statement about the
election of hospice is correct?
A. The patient must have a life expectancy of 6 months or less if the
disease runs its usual course
B. The patient must be cancer-free
C. The patient must be homebound
D. The patient must have a do-not-resuscitate (DNR) order on file
Correct ,,,,answer,,,: A
Rationale: The Medicare Hospice Benefit requires certification by two
physicians (or physician + hospice medical director) that the patient has a
prognosis of 6 months or less if the disease follows its usual course.
Homebound is not required; DNR is encouraged but not mandatory.
Question 5
A palliative care patient with severe COPD has refractory dyspnea despite
optimal medical therapy. What is the most appropriate next step?
A. Continuous subcutaneous infusion of midazolam
B. High-dose systemic corticosteroids
C. Nebulized fentanyl
D. Scheduled low-dose morphine and non-pharmacologic dyspnea
interventions
, Correct ,,,,answer,,,: D
Rationale: Scheduled low-dose systemic opioids (morphine,
hydromorphone) are evidence-based for refractory dyspnea in COPD.
Nebulized fentanyl has mixed evidence. Non-pharmacologic measures
(fan, positioning, anxiety management) are essential. Midazolam is
reserved for terminal agitation/severe anxiety.
Question 6
A patient with end-stage renal disease (ESRD) on hospice discontinues
dialysis. What is the expected survival time most likely?
A. 1–2 weeks
B. 2–4 weeks
C. 2–3 months
D. 6–12 months
Correct ,,,,answer,,,: B
Rationale: After discontinuation of dialysis in ESRD, the median survival is
7–14 days, with a range of 2–4 weeks in most studies. Uremic symptoms
(nausea, confusion, pruritus) should be managed palliatively. Some
patients may survive longer with residual renal function.
Question 7
A patient with advanced dementia develops dysphagia and weight loss.
The family requests a percutaneous endoscopic gastrostomy (PEG) tube.
What is the most appropriate response?
A. "PEG tube placement is mandatory to prevent starvation."
