FLORIDA BOARD OF NURSING CERTIFIED
HOSPICE AND PALLIATIVE NURSE EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A patient with metastatic pancreatic cancer is receiving hospice
care at home. During a nursing visit, the patient reports severe
abdominal pain rated 8/10 despite taking prescribed immediate-
release morphine every 4 hours. The patient says, “The morphine
helps for about two hours, and then the pain becomes unbearable.”
Which nursing action is most appropriate?
A. Tell the patient to wait until the next scheduled dose because
increasing opioids may cause respiratory depression.
B. Assess the patient's pain characteristics, timing, current opioid use,
adherence, adverse effects, and breakthrough pain pattern and
communicate the findings for possible regimen adjustment.
C. Discontinue morphine and recommend acetaminophen because
opioid tolerance indicates addiction.
D. Encourage the patient to use relaxation techniques instead of
requesting additional opioid medication.
Answer: B. Assess the patient's pain characteristics, timing, current
opioid use, adherence, adverse effects, and breakthrough pain
pattern and communicate the findings for possible regimen
adjustment.
1
,Rationale: Persistent severe pain occurring before the next scheduled
dose suggests inadequate baseline analgesia, poorly controlled
breakthrough pain, or a changing disease process. Hospice nursing
focuses on proportional symptom relief and individualized opioid
titration rather than withholding medication because of fear of
respiratory depression. A comprehensive assessment is necessary
before modifying therapy.
2. A hospice patient receiving escalating doses of morphine develops
increasing somnolence, hallucinations, myoclonus, and agitation.
The patient has advanced renal failure. Which complication should
the nurse suspect?
A. Opioid-induced neurotoxicity
B. Serotonin syndrome
C. Acute alcohol withdrawal
D. Anticholinergic toxicity
Answer: A. Opioid-induced neurotoxicity
Rationale: Opioid-induced neurotoxicity may manifest as cognitive
impairment, hallucinations, delirium, agitation, myoclonus, and
seizures. Accumulation of opioid metabolites is particularly
concerning in renal impairment. Management may include
reassessing hydration, reviewing medications, rotating opioids when
appropriate, and adjusting the regimen rather than simply
discontinuing analgesia.
3. A dying patient becomes increasingly restless and repeatedly
attempts to climb out of bed despite severe weakness. The patient
has no urinary retention, uncontrolled pain, or obvious respiratory
distress. Which intervention should the nurse perform first?
2
,A. Apply physical restraints.
B. Immediately administer a large dose of an antipsychotic medication.
C. Assess for potentially reversible causes of terminal agitation and
provide a calm, low-stimulation environment.
D. Tell the family that the behavior indicates psychiatric illness.
Answer: C. Assess for potentially reversible causes of terminal
agitation and provide a calm, low-stimulation environment.
Rationale: Terminal agitation may be caused by pain, urinary
retention, constipation, medication effects, hypoxia, metabolic
abnormalities, fear, or delirium. The nurse should first assess for
reversible contributors while minimizing environmental stimulation.
Physical restraints may worsen agitation and should generally be
avoided when possible.
4. A hospice patient with advanced heart failure develops severe
dyspnea while resting. Oxygen saturation is 88% on room air. The
patient states, “I feel like I cannot breathe.” Which nursing
intervention is most appropriate initially?
A. Focus exclusively on correcting the oxygen saturation.
B. Position the patient upright, provide a fan or airflow if tolerated,
administer prescribed symptom-relief medication, and assess the cause
and severity of dyspnea.
C. Encourage the patient to ambulate to improve ventilation.
D. Withhold opioids because they suppress respiration.
Answer: B. Position the patient upright, provide a fan or airflow if
tolerated, administer prescribed symptom-relief medication, and
assess the cause and severity of dyspnea.
Rationale: Dyspnea is a subjective symptom and should be treated
according to the patient's distress, not oxygen saturation alone.
3
, Upright positioning, airflow, reassurance, treatment of reversible
causes when consistent with goals of care, and appropriately
prescribed opioids are commonly used. Low-dose opioids can reduce
the sensation of breathlessness without necessarily causing clinically
significant respiratory compromise when appropriately titrated.
5. A patient with terminal cancer develops noisy respiratory
secretions during the final hours of life. Family members are
distressed and repeatedly say, “He is choking.” The patient appears
unconscious and does not show signs of distress. What should the
nurse do?
A. Explain that the sound is commonly caused by pooled secretions and
does not necessarily indicate suffering, then reposition and provide
appropriate comfort measures.
B. Perform deep suctioning every 15 minutes.
C. Begin aggressive intravenous hydration.
D. Tell the family that death is imminent and leave the room.
Answer: A. Explain that the sound is commonly caused by pooled
secretions and does not necessarily indicate suffering, then
reposition and provide appropriate comfort measures.
Rationale: Noisy respiratory secretions are common near death
because the patient loses the ability to effectively swallow or clear
secretions. Repositioning and gentle oral care may help. Deep
suctioning can be uncomfortable and may not improve the underlying
process. Education and emotional support are essential because the
sound is often more distressing to family members than to the
unconscious patient.
4
HOSPICE AND PALLIATIVE NURSE EXAM
WITH ACTUAL QUESTIONS AND VERIFIED
ANSWERS, PLUS EXPLAINED
RATIONALES/EXPERT VERIFIED FOR
GUARANTEED 100% PASS 2026/LATEST
UPDATE/INSTANT DOWNLOAD PDF
1. A patient with metastatic pancreatic cancer is receiving hospice
care at home. During a nursing visit, the patient reports severe
abdominal pain rated 8/10 despite taking prescribed immediate-
release morphine every 4 hours. The patient says, “The morphine
helps for about two hours, and then the pain becomes unbearable.”
Which nursing action is most appropriate?
A. Tell the patient to wait until the next scheduled dose because
increasing opioids may cause respiratory depression.
B. Assess the patient's pain characteristics, timing, current opioid use,
adherence, adverse effects, and breakthrough pain pattern and
communicate the findings for possible regimen adjustment.
C. Discontinue morphine and recommend acetaminophen because
opioid tolerance indicates addiction.
D. Encourage the patient to use relaxation techniques instead of
requesting additional opioid medication.
Answer: B. Assess the patient's pain characteristics, timing, current
opioid use, adherence, adverse effects, and breakthrough pain
pattern and communicate the findings for possible regimen
adjustment.
1
,Rationale: Persistent severe pain occurring before the next scheduled
dose suggests inadequate baseline analgesia, poorly controlled
breakthrough pain, or a changing disease process. Hospice nursing
focuses on proportional symptom relief and individualized opioid
titration rather than withholding medication because of fear of
respiratory depression. A comprehensive assessment is necessary
before modifying therapy.
2. A hospice patient receiving escalating doses of morphine develops
increasing somnolence, hallucinations, myoclonus, and agitation.
The patient has advanced renal failure. Which complication should
the nurse suspect?
A. Opioid-induced neurotoxicity
B. Serotonin syndrome
C. Acute alcohol withdrawal
D. Anticholinergic toxicity
Answer: A. Opioid-induced neurotoxicity
Rationale: Opioid-induced neurotoxicity may manifest as cognitive
impairment, hallucinations, delirium, agitation, myoclonus, and
seizures. Accumulation of opioid metabolites is particularly
concerning in renal impairment. Management may include
reassessing hydration, reviewing medications, rotating opioids when
appropriate, and adjusting the regimen rather than simply
discontinuing analgesia.
3. A dying patient becomes increasingly restless and repeatedly
attempts to climb out of bed despite severe weakness. The patient
has no urinary retention, uncontrolled pain, or obvious respiratory
distress. Which intervention should the nurse perform first?
2
,A. Apply physical restraints.
B. Immediately administer a large dose of an antipsychotic medication.
C. Assess for potentially reversible causes of terminal agitation and
provide a calm, low-stimulation environment.
D. Tell the family that the behavior indicates psychiatric illness.
Answer: C. Assess for potentially reversible causes of terminal
agitation and provide a calm, low-stimulation environment.
Rationale: Terminal agitation may be caused by pain, urinary
retention, constipation, medication effects, hypoxia, metabolic
abnormalities, fear, or delirium. The nurse should first assess for
reversible contributors while minimizing environmental stimulation.
Physical restraints may worsen agitation and should generally be
avoided when possible.
4. A hospice patient with advanced heart failure develops severe
dyspnea while resting. Oxygen saturation is 88% on room air. The
patient states, “I feel like I cannot breathe.” Which nursing
intervention is most appropriate initially?
A. Focus exclusively on correcting the oxygen saturation.
B. Position the patient upright, provide a fan or airflow if tolerated,
administer prescribed symptom-relief medication, and assess the cause
and severity of dyspnea.
C. Encourage the patient to ambulate to improve ventilation.
D. Withhold opioids because they suppress respiration.
Answer: B. Position the patient upright, provide a fan or airflow if
tolerated, administer prescribed symptom-relief medication, and
assess the cause and severity of dyspnea.
Rationale: Dyspnea is a subjective symptom and should be treated
according to the patient's distress, not oxygen saturation alone.
3
, Upright positioning, airflow, reassurance, treatment of reversible
causes when consistent with goals of care, and appropriately
prescribed opioids are commonly used. Low-dose opioids can reduce
the sensation of breathlessness without necessarily causing clinically
significant respiratory compromise when appropriately titrated.
5. A patient with terminal cancer develops noisy respiratory
secretions during the final hours of life. Family members are
distressed and repeatedly say, “He is choking.” The patient appears
unconscious and does not show signs of distress. What should the
nurse do?
A. Explain that the sound is commonly caused by pooled secretions and
does not necessarily indicate suffering, then reposition and provide
appropriate comfort measures.
B. Perform deep suctioning every 15 minutes.
C. Begin aggressive intravenous hydration.
D. Tell the family that death is imminent and leave the room.
Answer: A. Explain that the sound is commonly caused by pooled
secretions and does not necessarily indicate suffering, then
reposition and provide appropriate comfort measures.
Rationale: Noisy respiratory secretions are common near death
because the patient loses the ability to effectively swallow or clear
secretions. Repositioning and gentle oral care may help. Deep
suctioning can be uncomfortable and may not improve the underlying
process. Education and emotional support are essential because the
sound is often more distressing to family members than to the
unconscious patient.
4
