Certified Hospice and Palliative Nurse (CHPN)
Practice Examination Questions & 100%
Verified Answers # Ace Your 2026 RN ATI Med-
Surg Proctored Exam with Confidence!
1. A hospice patient with endstage COPD reports severe dyspnea at rest. What is
the firstline pharmacological intervention for symptom management?
Answer: Oral or parenteral opioids (Morphine).
Rationale: Opioids reduce the perception of air hunger and decrease preload and
afterload without causing respiratory depression at therapeutic doses in tolerant
patients. Morphine is the gold standard for palliation of terminal dyspnea.
2. What is the primary difference between hospice care and palliative care in the
United States?
Answer: Hospice requires a prognosis of 6 months or less and forgoes curative
treatment; palliative care is appropriate at any stage of serious illness alongside
curative therapy.
Rationale: Hospice is a philosophy and Medicare benefit with specific eligibility
criteria. Palliative care focuses on symptom management and quality of life
regardless of prognosis or treatment plan.
3. A patient with advanced cancer develops hypercalcemia. Which symptoms
would the nurse expect to find?
Answer: Fatigue, nausea, constipation, polyuria, confusion, and bone pain.
Rationale: Hypercalcemia of malignancy causes a "stones, bones, groans, and
psychic overtones" presentation. Dehydration worsens it; treatment includes
aggressive hydration and IV bisphosphonates.
,4. What is the most appropriate tool to assess pain in a nonverbal patient with
advanced dementia?
Answer: PAINAD (Pain Assessment in Advanced Dementia) scale.
Rationale: PAINAD evaluates breathing, vocalization, facial expression, body
language, and consolability. Selfreport tools are not valid if the patient cannot
reliably communicate.
5. A hospice patient is actively dying with audible respiratory secretions ("death
rattle"). What is the firstline anticholinergic medication?
Answer: Glycopyrrolate or Atropine drops (sublingual).
Rationale: These agents reduce salivary and bronchial secretions without crossing
the bloodbrain barrier extensively, minimizing sedation. Scopolamine crosses the
barrier and can provide sedation as an added benefit.
6. A family member of a dying patient asks, "Why aren't you giving IV fluids? They
will starve to death!" What is the best evidencebased response?
Answer: "At the end of life, the body naturally shuts down and cannot process
fluids effectively. Artificial hydration can cause fluid overload, pulmonary edema,
and increased secretions, potentially increasing suffering."
Rationale: Dehydration in the dying process promotes ketosis, which produces
endogenous analgesia and reduces urine output and GI secretions. It is a natural
anesthetic.
7. What is "Total Pain" as defined by Dame Cicely Saunders?
Answer: Suffering that encompasses physical, emotional, social, and spiritual
domains.
, Rationale: Effective palliative care requires addressing all four dimensions.
Physical pain may be exacerbated by anxiety (emotional), financial worries
(social), and existential guilt (spiritual).
8. A patient on oral Morphine 30 mg every 4 hours is being transitioned to a
continuous subcutaneous infusion (CSCI). What is the equianalgesic conversion to
IV/Subcutaneous Morphine over 24 hours?
Answer: Calculate total 24hour oral dose (180 mg), divide by 3 to convert to
parenteral (approx. 60 mg), and administer as 2.5 mg/hr continuous infusion.
Rationale: The oraltoparenteral morphine ratio is approximately 3:1. Dividing the
24hour parenteral dose by 24 gives the hourly rate. A rescue dose (1/6 to 1/10 of
24hr dose) must also be available.
9. What is the hallmark of "impending death" in the final hours to days?
Answer: CheyneStokes respirations, mottling of extremities, terminal pooling of
secretions, and decreased urine output (<100 mL/24 hours).
Rationale: These signs reflect multisystem organ failure and circulatory collapse.
The nurse educates the family that these are expected and not uncomfortable for
the patient.
10. A patient with metastatic bone cancer has neuropathic pain described as
"burning and shooting." Which adjuvant analgesic is firstline?
Answer: Gabapentin or Pregabalin (anticonvulsants) or Tricyclic Antidepressants
(Amitriptyline/Nortriptyline).
Rationale: Opioids alone are often insufficient for neuropathic pain.
Gabapentinoids stabilize nerve membranes, reducing aberrant signaling.
11. What is the most appropriate intervention for malignant bowel obstruction in
a hospice patient who is not a surgical candidate?
Practice Examination Questions & 100%
Verified Answers # Ace Your 2026 RN ATI Med-
Surg Proctored Exam with Confidence!
1. A hospice patient with endstage COPD reports severe dyspnea at rest. What is
the firstline pharmacological intervention for symptom management?
Answer: Oral or parenteral opioids (Morphine).
Rationale: Opioids reduce the perception of air hunger and decrease preload and
afterload without causing respiratory depression at therapeutic doses in tolerant
patients. Morphine is the gold standard for palliation of terminal dyspnea.
2. What is the primary difference between hospice care and palliative care in the
United States?
Answer: Hospice requires a prognosis of 6 months or less and forgoes curative
treatment; palliative care is appropriate at any stage of serious illness alongside
curative therapy.
Rationale: Hospice is a philosophy and Medicare benefit with specific eligibility
criteria. Palliative care focuses on symptom management and quality of life
regardless of prognosis or treatment plan.
3. A patient with advanced cancer develops hypercalcemia. Which symptoms
would the nurse expect to find?
Answer: Fatigue, nausea, constipation, polyuria, confusion, and bone pain.
Rationale: Hypercalcemia of malignancy causes a "stones, bones, groans, and
psychic overtones" presentation. Dehydration worsens it; treatment includes
aggressive hydration and IV bisphosphonates.
,4. What is the most appropriate tool to assess pain in a nonverbal patient with
advanced dementia?
Answer: PAINAD (Pain Assessment in Advanced Dementia) scale.
Rationale: PAINAD evaluates breathing, vocalization, facial expression, body
language, and consolability. Selfreport tools are not valid if the patient cannot
reliably communicate.
5. A hospice patient is actively dying with audible respiratory secretions ("death
rattle"). What is the firstline anticholinergic medication?
Answer: Glycopyrrolate or Atropine drops (sublingual).
Rationale: These agents reduce salivary and bronchial secretions without crossing
the bloodbrain barrier extensively, minimizing sedation. Scopolamine crosses the
barrier and can provide sedation as an added benefit.
6. A family member of a dying patient asks, "Why aren't you giving IV fluids? They
will starve to death!" What is the best evidencebased response?
Answer: "At the end of life, the body naturally shuts down and cannot process
fluids effectively. Artificial hydration can cause fluid overload, pulmonary edema,
and increased secretions, potentially increasing suffering."
Rationale: Dehydration in the dying process promotes ketosis, which produces
endogenous analgesia and reduces urine output and GI secretions. It is a natural
anesthetic.
7. What is "Total Pain" as defined by Dame Cicely Saunders?
Answer: Suffering that encompasses physical, emotional, social, and spiritual
domains.
, Rationale: Effective palliative care requires addressing all four dimensions.
Physical pain may be exacerbated by anxiety (emotional), financial worries
(social), and existential guilt (spiritual).
8. A patient on oral Morphine 30 mg every 4 hours is being transitioned to a
continuous subcutaneous infusion (CSCI). What is the equianalgesic conversion to
IV/Subcutaneous Morphine over 24 hours?
Answer: Calculate total 24hour oral dose (180 mg), divide by 3 to convert to
parenteral (approx. 60 mg), and administer as 2.5 mg/hr continuous infusion.
Rationale: The oraltoparenteral morphine ratio is approximately 3:1. Dividing the
24hour parenteral dose by 24 gives the hourly rate. A rescue dose (1/6 to 1/10 of
24hr dose) must also be available.
9. What is the hallmark of "impending death" in the final hours to days?
Answer: CheyneStokes respirations, mottling of extremities, terminal pooling of
secretions, and decreased urine output (<100 mL/24 hours).
Rationale: These signs reflect multisystem organ failure and circulatory collapse.
The nurse educates the family that these are expected and not uncomfortable for
the patient.
10. A patient with metastatic bone cancer has neuropathic pain described as
"burning and shooting." Which adjuvant analgesic is firstline?
Answer: Gabapentin or Pregabalin (anticonvulsants) or Tricyclic Antidepressants
(Amitriptyline/Nortriptyline).
Rationale: Opioids alone are often insufficient for neuropathic pain.
Gabapentinoids stabilize nerve membranes, reducing aberrant signaling.
11. What is the most appropriate intervention for malignant bowel obstruction in
a hospice patient who is not a surgical candidate?
