CHPN Exam Prep 2026 Comprehensive Hospice
and Palliative Nursing Review Practice Questions
with Detailed Rationales
DOMAIN 1: ASSESSMENT AND PLANNING (Questions 1-25)
Question 1
A hospice nurse is conducting an initial assessment of a 72-year-old patient with
end-stage heart failure. Which finding is most indicative of a poor prognosis and
should be prioritized in the care plan?
A) Patient reports occasional shortness of breath with minimal exertion
B) Patient has a history of three hospitalizations for heart failure in the past six
months
C) Patient's ejection fraction is 35%
D) Patient reports difficulty sleeping due to nocturia
Answer: B
Rationale: Frequent hospitalizations for heart failure (two or more in the past six
months) are a key indicator of poor prognosis and disease progression in end-stage
heart failure. While shortness of breath, reduced ejection fraction, and nocturia are
all relevant findings, recurrent hospitalizations signal clinical instability and are
critical for hospice eligibility determination. The nurse should prioritize this
finding when developing the plan of care and discussing prognosis with the patient
and family.
Question 2
Which assessment tool is specifically designed to evaluate pain in nonverbal
patients with advanced dementia?
A) Numeric Rating Scale (NRS)
B) Visual Analog Scale (VAS)
C) Pain Assessment in Advanced Dementia (PAINAD) Scale
D) Brief Pain Inventory (BPI)
,Answer: C
Rationale: The PAINAD Scale is a validated observational tool specifically
designed to assess pain in patients with advanced dementia who cannot self-report.
It evaluates five items: breathing, negative vocalization, facial expression, body
language, and consolability. The NRS and VAS require patient self-report and are
inappropriate for nonverbal patients. The BPI is a comprehensive pain assessment
tool that also requires patient participation.
Question 3
A hospice patient with terminal cancer reports pain rated 8/10. The nurse notes the
patient is grimacing and restless. What is the nurse's priority action?
A) Administer the prescribed PRN opioid and reassess in 30 minutes
B) Notify the provider for a dose increase
C) Document the pain score and continue monitoring
D) Apply a heating pad to the painful area
Answer: A
Rationale: The priority action is to administer the prescribed PRN analgesic and
reassess within an appropriate timeframe (typically 30-60 minutes for intravenous
medications and 60 minutes for oral medications). Pain management is a
cornerstone of hospice and palliative care. The nurse should treat the patient's pain
promptly while continuing to assess effectiveness. Notifying the provider may be
necessary if the PRN medication is ineffective, but it is not the immediate priority.
Documentation is important but should follow intervention.
Question 4
When conducting a spiritual assessment for a hospice patient, which question best
reflects the FICA spiritual assessment tool?
A) "What is your religious affiliation?"
B) "Do you attend church regularly?"
C) "What gives your life meaning and purpose?"
D) "Would you like to see a chaplain?"
Answer: C
,Rationale: The FICA tool (Faith, Importance, Community, and Address) includes
exploration of what gives the patient's life meaning and purpose. This open-ended
question allows the patient to express their spiritual beliefs and values in their own
words. While religious affiliation and chaplain requests are relevant, they do not
fully capture the depth of spiritual assessment. The FICA tool emphasizes
understanding the patient's belief system and how it influences their coping.
Question 5
A patient with advanced COPD has an FEV1 of 25% of predicted and is dependent
on oxygen. The patient's family asks if the patient is eligible for hospice. What is
the nurse's best response?
A) "Hospice is only for patients with cancer diagnoses."
B) "The patient's oxygen dependence makes them eligible."
C) "Hospice eligibility is based on prognosis of six months or less, and the patient's
FEV1 and oxygen dependence are concerning indicators."
D) "We need to wait until the patient can no longer ambulate."
Answer: C
Rationale: Hospice eligibility is determined by a prognosis of six months or less if
the disease follows its normal course. For COPD, indicators include FEV1 of less
than 30% of predicted, dependence on oxygen, and significant functional decline.
The nurse should provide honest, compassionate information about the patient's
condition and prognosis while acknowledging the family's concern. Hospice is not
limited to cancer diagnoses.
Question 6
A hospice nurse is completing a comprehensive assessment of a new patient.
Which of the following should be included in the psychosocial assessment?
A) Complete blood count results
B) Patient's advance directives and healthcare proxy
C) Oxygen saturation levels
D) Medication reconciliation
Answer: B
, Rationale: The psychosocial assessment includes evaluation of the patient's
support system, coping mechanisms, advance care planning, and understanding of
their illness. Advance directives and healthcare proxy designation are critical
components of psychosocial assessment in hospice and palliative care. Complete
blood count, oxygen saturation, and medication reconciliation are part of the
physical/clinical assessment.
Question 7
Which of the following is the most appropriate method for assessing a patient's
functional status in hospice care?
A) Glasgow Coma Scale
B) Palliative Performance Scale (PPS)
C) APACHE II Score
D) Braden Scale
Answer: B
Rationale: The Palliative Performance Scale (PPS) is a validated tool specifically
designed to assess functional status in palliative care populations. It evaluates
ambulation, activity/evidence of disease, self-care, oral intake, and level of
consciousness. The Glasgow Coma Scale assesses neurological status, the
APACHE II is for critical care prognostication, and the Braden Scale assesses
pressure ulcer risk.
Question 8
A patient with end-stage renal disease (ESRD) has decided to discontinue dialysis.
The patient's family is distressed and asks the nurse, "How can you just let him
die?" What is the nurse's best response?
A) "The patient has the right to make this decision."
B) "I understand this is difficult. Let's talk about what this decision means and how
we can support him."
C) "You need to accept his decision."
D) "Maybe you should talk to the doctor about this."
Answer: B
and Palliative Nursing Review Practice Questions
with Detailed Rationales
DOMAIN 1: ASSESSMENT AND PLANNING (Questions 1-25)
Question 1
A hospice nurse is conducting an initial assessment of a 72-year-old patient with
end-stage heart failure. Which finding is most indicative of a poor prognosis and
should be prioritized in the care plan?
A) Patient reports occasional shortness of breath with minimal exertion
B) Patient has a history of three hospitalizations for heart failure in the past six
months
C) Patient's ejection fraction is 35%
D) Patient reports difficulty sleeping due to nocturia
Answer: B
Rationale: Frequent hospitalizations for heart failure (two or more in the past six
months) are a key indicator of poor prognosis and disease progression in end-stage
heart failure. While shortness of breath, reduced ejection fraction, and nocturia are
all relevant findings, recurrent hospitalizations signal clinical instability and are
critical for hospice eligibility determination. The nurse should prioritize this
finding when developing the plan of care and discussing prognosis with the patient
and family.
Question 2
Which assessment tool is specifically designed to evaluate pain in nonverbal
patients with advanced dementia?
A) Numeric Rating Scale (NRS)
B) Visual Analog Scale (VAS)
C) Pain Assessment in Advanced Dementia (PAINAD) Scale
D) Brief Pain Inventory (BPI)
,Answer: C
Rationale: The PAINAD Scale is a validated observational tool specifically
designed to assess pain in patients with advanced dementia who cannot self-report.
It evaluates five items: breathing, negative vocalization, facial expression, body
language, and consolability. The NRS and VAS require patient self-report and are
inappropriate for nonverbal patients. The BPI is a comprehensive pain assessment
tool that also requires patient participation.
Question 3
A hospice patient with terminal cancer reports pain rated 8/10. The nurse notes the
patient is grimacing and restless. What is the nurse's priority action?
A) Administer the prescribed PRN opioid and reassess in 30 minutes
B) Notify the provider for a dose increase
C) Document the pain score and continue monitoring
D) Apply a heating pad to the painful area
Answer: A
Rationale: The priority action is to administer the prescribed PRN analgesic and
reassess within an appropriate timeframe (typically 30-60 minutes for intravenous
medications and 60 minutes for oral medications). Pain management is a
cornerstone of hospice and palliative care. The nurse should treat the patient's pain
promptly while continuing to assess effectiveness. Notifying the provider may be
necessary if the PRN medication is ineffective, but it is not the immediate priority.
Documentation is important but should follow intervention.
Question 4
When conducting a spiritual assessment for a hospice patient, which question best
reflects the FICA spiritual assessment tool?
A) "What is your religious affiliation?"
B) "Do you attend church regularly?"
C) "What gives your life meaning and purpose?"
D) "Would you like to see a chaplain?"
Answer: C
,Rationale: The FICA tool (Faith, Importance, Community, and Address) includes
exploration of what gives the patient's life meaning and purpose. This open-ended
question allows the patient to express their spiritual beliefs and values in their own
words. While religious affiliation and chaplain requests are relevant, they do not
fully capture the depth of spiritual assessment. The FICA tool emphasizes
understanding the patient's belief system and how it influences their coping.
Question 5
A patient with advanced COPD has an FEV1 of 25% of predicted and is dependent
on oxygen. The patient's family asks if the patient is eligible for hospice. What is
the nurse's best response?
A) "Hospice is only for patients with cancer diagnoses."
B) "The patient's oxygen dependence makes them eligible."
C) "Hospice eligibility is based on prognosis of six months or less, and the patient's
FEV1 and oxygen dependence are concerning indicators."
D) "We need to wait until the patient can no longer ambulate."
Answer: C
Rationale: Hospice eligibility is determined by a prognosis of six months or less if
the disease follows its normal course. For COPD, indicators include FEV1 of less
than 30% of predicted, dependence on oxygen, and significant functional decline.
The nurse should provide honest, compassionate information about the patient's
condition and prognosis while acknowledging the family's concern. Hospice is not
limited to cancer diagnoses.
Question 6
A hospice nurse is completing a comprehensive assessment of a new patient.
Which of the following should be included in the psychosocial assessment?
A) Complete blood count results
B) Patient's advance directives and healthcare proxy
C) Oxygen saturation levels
D) Medication reconciliation
Answer: B
, Rationale: The psychosocial assessment includes evaluation of the patient's
support system, coping mechanisms, advance care planning, and understanding of
their illness. Advance directives and healthcare proxy designation are critical
components of psychosocial assessment in hospice and palliative care. Complete
blood count, oxygen saturation, and medication reconciliation are part of the
physical/clinical assessment.
Question 7
Which of the following is the most appropriate method for assessing a patient's
functional status in hospice care?
A) Glasgow Coma Scale
B) Palliative Performance Scale (PPS)
C) APACHE II Score
D) Braden Scale
Answer: B
Rationale: The Palliative Performance Scale (PPS) is a validated tool specifically
designed to assess functional status in palliative care populations. It evaluates
ambulation, activity/evidence of disease, self-care, oral intake, and level of
consciousness. The Glasgow Coma Scale assesses neurological status, the
APACHE II is for critical care prognostication, and the Braden Scale assesses
pressure ulcer risk.
Question 8
A patient with end-stage renal disease (ESRD) has decided to discontinue dialysis.
The patient's family is distressed and asks the nurse, "How can you just let him
die?" What is the nurse's best response?
A) "The patient has the right to make this decision."
B) "I understand this is difficult. Let's talk about what this decision means and how
we can support him."
C) "You need to accept his decision."
D) "Maybe you should talk to the doctor about this."
Answer: B
