Certified Hospice and Palliative Nurse (CHPN)EXAM
WITH QUESTIONS AND CORRECT DETAILED
ANSWERS/EXPERT VERIFIED FOR GUARANTEED
PASS!/LATEST UPDATE
Domain 1: Patient Care: Life-Limiting Conditions in Adult Patients (Approx. 25 Questions)
1. A patient with end-stage COPD reports severe dyspnea. The patient is already on scheduled morphine and
2L O2 via nasal cannula. What is the best initial intervention?
,A) Increase oxygen to 4L
B) Administer a low dose of an anxiolytic
C) Assess for reversible causes and give a breakthrough morphine dose
D) Place the patient in a supine position to rest
Answer: C
Rationale: In hospice, opioids are first-line for dyspnea. Before escalating other treatments, giving a
breakthrough dose and assessing for reversible causes (e.g., secretions, anxiety, equipment malfunction) is
standard. Increasing oxygen is not always effective and may not be indicated if saturations are adequate.
2. A hallmark symptom of malignant hypercalcemia is:
A) Tremors and tetany
B) Somnolence, nausea, and polyuria
C) Severe hypertension and headache
D) Petechiae and fever
Answer: B
Rationale: Hypercalcemia causes "bones, stones, groans, and psychiatric overtones." Symptoms include
lethargy/somnolence, nausea/vomiting, constipation, and polyuria/polydipsia. Tremors suggest hypocalcemia.
,3. A dying patient develops loud, wet respiratory sounds (death rattle) but is unresponsive and appears
comfortable. The family is distressed. The best intervention is:
A) Suctioning the oropharynx immediately
B) Repositioning the patient and explaining that the sound does not indicate suffering
C) Increasing IV fluids to thin secretions
D) Administering a diuretic
Answer: B
Rationale: Death rattle is caused by air moving over pooled secretions in a patient too weak to swallow. It is not
typically distressing to the patient. Repositioning and anticholinergics (like glycopyrrolate) are first-line, but
education is key. Suctioning is usually ineffective and can cause agitation.
4. Which medication is an appropriate first-line choice for intractable hiccups in a palliative care patient?
A) Lorazepam
B) Haloperidol
C) Chlorpromazine
D) Omeprazole
Answer: C
, Rationale: Chlorpromazine is the only FDA-approved drug for intractable hiccups. Baclofen, metoclopramide,
and haloperidol are also used off-label, but chlorpromazine is the classic first-line agent when gastric distention
is not the clear cause.
5. A patient with advanced ALS has decided to discontinue non-invasive ventilation (BiPAP). The nurse’s priority
is to:
A) Ensure the ethics committee has reviewed the case
B) Prepare high-dose opioids in case of severe respiratory distress
C) Immediately remove the BiPAP to honor the patient's autonomy
D) Verify the patient understands they may die shortly after, and aggressively manage symptoms of dyspnea
and anxiety
Answer: D
Rationale: Discontinuing life-sustaining treatment is an ethical right of the patient. The priority is ensuring
informed consent/understanding, then providing meticulous symptom management (opioids/benzodiazepines)
for the expected dyspnea. The removal is a process that should be coordinated with comfort.
6. Which opioid is contraindicated in patients with severe renal failure (GFR <30)?
A) Hydromorphone
B) Fentanyl
C) Morphine
WITH QUESTIONS AND CORRECT DETAILED
ANSWERS/EXPERT VERIFIED FOR GUARANTEED
PASS!/LATEST UPDATE
Domain 1: Patient Care: Life-Limiting Conditions in Adult Patients (Approx. 25 Questions)
1. A patient with end-stage COPD reports severe dyspnea. The patient is already on scheduled morphine and
2L O2 via nasal cannula. What is the best initial intervention?
,A) Increase oxygen to 4L
B) Administer a low dose of an anxiolytic
C) Assess for reversible causes and give a breakthrough morphine dose
D) Place the patient in a supine position to rest
Answer: C
Rationale: In hospice, opioids are first-line for dyspnea. Before escalating other treatments, giving a
breakthrough dose and assessing for reversible causes (e.g., secretions, anxiety, equipment malfunction) is
standard. Increasing oxygen is not always effective and may not be indicated if saturations are adequate.
2. A hallmark symptom of malignant hypercalcemia is:
A) Tremors and tetany
B) Somnolence, nausea, and polyuria
C) Severe hypertension and headache
D) Petechiae and fever
Answer: B
Rationale: Hypercalcemia causes "bones, stones, groans, and psychiatric overtones." Symptoms include
lethargy/somnolence, nausea/vomiting, constipation, and polyuria/polydipsia. Tremors suggest hypocalcemia.
,3. A dying patient develops loud, wet respiratory sounds (death rattle) but is unresponsive and appears
comfortable. The family is distressed. The best intervention is:
A) Suctioning the oropharynx immediately
B) Repositioning the patient and explaining that the sound does not indicate suffering
C) Increasing IV fluids to thin secretions
D) Administering a diuretic
Answer: B
Rationale: Death rattle is caused by air moving over pooled secretions in a patient too weak to swallow. It is not
typically distressing to the patient. Repositioning and anticholinergics (like glycopyrrolate) are first-line, but
education is key. Suctioning is usually ineffective and can cause agitation.
4. Which medication is an appropriate first-line choice for intractable hiccups in a palliative care patient?
A) Lorazepam
B) Haloperidol
C) Chlorpromazine
D) Omeprazole
Answer: C
, Rationale: Chlorpromazine is the only FDA-approved drug for intractable hiccups. Baclofen, metoclopramide,
and haloperidol are also used off-label, but chlorpromazine is the classic first-line agent when gastric distention
is not the clear cause.
5. A patient with advanced ALS has decided to discontinue non-invasive ventilation (BiPAP). The nurse’s priority
is to:
A) Ensure the ethics committee has reviewed the case
B) Prepare high-dose opioids in case of severe respiratory distress
C) Immediately remove the BiPAP to honor the patient's autonomy
D) Verify the patient understands they may die shortly after, and aggressively manage symptoms of dyspnea
and anxiety
Answer: D
Rationale: Discontinuing life-sustaining treatment is an ethical right of the patient. The priority is ensuring
informed consent/understanding, then providing meticulous symptom management (opioids/benzodiazepines)
for the expected dyspnea. The removal is a process that should be coordinated with comfort.
6. Which opioid is contraindicated in patients with severe renal failure (GFR <30)?
A) Hydromorphone
B) Fentanyl
C) Morphine
