1
CHPN® CERTIFICATION
EXAMINATION – CERTIFIED
HOSPICE AND PALLIATIVE NURSE
|ACADEMIC CYCLE EXAM
QUESTIONS AND ANSWERS WITH
RATIONALES
Question:
A patient with advanced heart failure states, “I am tired of fighting. I just want
comfort.” What is the best nursing response?
A. “You should continue treatment as long as possible.”
B. “Tell me more about what comfort means to you.”
C. “Your family would want you to keep trying.”
D. “Are you feeling depressed?”
Correct Answer:
B. “Tell me more about what comfort means to you.”
Rationale:
Open-ended communication promotes exploration of patient goals and values. This
response supports shared decision-making and respects autonomy. The other
responses either impose judgment or redirect the conversation away from the
patient’s expressed wishes.
,Question:
Which medication class is most appropriate for managing neuropathic pain in
palliative care?
A. Nonsteroidal anti-inflammatory drugs
B. Acetaminophen
C. Anticonvulsants
D. Antacids
Correct Answer:
C. Anticonvulsants
Rationale:
Neuropathic pain responds best to adjuvant medications such as anticonvulsants or
certain antidepressants. Traditional analgesics alone are often insufficient because
neuropathic pain arises from nerve injury rather than tissue inflammation alone.
Question:
A family member asks the nurse, “How will we know when death is near?” What is
the most appropriate response?
A. “There is no way to tell.”
B. “You will notice changes such as decreased appetite, increased sleep, and
changes in breathing.”
C. “The physician will let you know.”
D. “It usually happens suddenly.”
Correct Answer:
B. “You will notice changes such as decreased appetite, increased sleep, and
changes in breathing.”
Rationale:
Providing anticipatory guidance prepares families for expected signs of active dying
and reduces anxiety. Education about physical changes promotes understanding and
supports coping. Avoiding the question or minimizing it does not support
therapeutic communication.
2
, 3
Question:
A patient with advanced cancer reports increasing shortness of breath at rest.
Oxygen saturation is within acceptable range, but the patient appears anxious. What
is the most appropriate initial nursing intervention?
A. Increase oxygen flow rate
B. Administer a prescribed opioid
C. Encourage deep breathing exercises
D. Request immediate intubation
Correct Answer:
B. Administer a prescribed opioid
Rationale:
Opioids are first-line therapy for dyspnea in palliative care, even when oxygen
saturation is adequate. They reduce the sensation of air hunger by altering central
perception. Increasing oxygen is not helpful if hypoxia is not present. Intubation is
inconsistent with hospice goals unless specifically aligned with patient wishes.
Nonpharmacologic measures may help but opioids are the most effective initial
intervention.
Question:
A hospice patient becomes increasingly restless, pulling at linens and attempting to
get out of bed. The family reports this is new behavior. What is the priority nursing
assessment?
A. Evaluate for spiritual distress
B. Assess for pain and urinary retention
C. Provide family education about dying process
D. Reduce environmental stimulation
Correct Answer:
, B. Assess for pain and urinary retention
Rationale:
Terminal restlessness or delirium is often caused by reversible factors such as pain,
urinary retention, constipation, or medication effects. A focused physical
assessment is essential before implementing supportive interventions. Addressing
underlying causes may reduce agitation and improve comfort.
Question:
A hospice nurse is caring for a patient whose cultural beliefs require large family
gatherings at the bedside. The facility has general visitation guidelines. What is the
best action?
A. Enforce standard visitation rules
B. Ask security to limit visitors
C. Collaborate with leadership to accommodate cultural needs when possible
D. Transfer the patient to another facility
Correct Answer:
C. Collaborate with leadership to accommodate cultural needs when possible
Rationale:
Culturally competent care is essential in hospice practice. Whenever safe and
feasible, accommodations should be made to honor patient and family traditions.
Advocacy is a key component of hospice nursing.
Question:
A patient receiving high-dose opioids develops myoclonus and increasing
confusion. What is the most appropriate nursing action?
A. Discontinue all opioids immediately
B. Assess for opioid toxicity and notify the provider
C. Increase the opioid dose
4
CHPN® CERTIFICATION
EXAMINATION – CERTIFIED
HOSPICE AND PALLIATIVE NURSE
|ACADEMIC CYCLE EXAM
QUESTIONS AND ANSWERS WITH
RATIONALES
Question:
A patient with advanced heart failure states, “I am tired of fighting. I just want
comfort.” What is the best nursing response?
A. “You should continue treatment as long as possible.”
B. “Tell me more about what comfort means to you.”
C. “Your family would want you to keep trying.”
D. “Are you feeling depressed?”
Correct Answer:
B. “Tell me more about what comfort means to you.”
Rationale:
Open-ended communication promotes exploration of patient goals and values. This
response supports shared decision-making and respects autonomy. The other
responses either impose judgment or redirect the conversation away from the
patient’s expressed wishes.
,Question:
Which medication class is most appropriate for managing neuropathic pain in
palliative care?
A. Nonsteroidal anti-inflammatory drugs
B. Acetaminophen
C. Anticonvulsants
D. Antacids
Correct Answer:
C. Anticonvulsants
Rationale:
Neuropathic pain responds best to adjuvant medications such as anticonvulsants or
certain antidepressants. Traditional analgesics alone are often insufficient because
neuropathic pain arises from nerve injury rather than tissue inflammation alone.
Question:
A family member asks the nurse, “How will we know when death is near?” What is
the most appropriate response?
A. “There is no way to tell.”
B. “You will notice changes such as decreased appetite, increased sleep, and
changes in breathing.”
C. “The physician will let you know.”
D. “It usually happens suddenly.”
Correct Answer:
B. “You will notice changes such as decreased appetite, increased sleep, and
changes in breathing.”
Rationale:
Providing anticipatory guidance prepares families for expected signs of active dying
and reduces anxiety. Education about physical changes promotes understanding and
supports coping. Avoiding the question or minimizing it does not support
therapeutic communication.
2
, 3
Question:
A patient with advanced cancer reports increasing shortness of breath at rest.
Oxygen saturation is within acceptable range, but the patient appears anxious. What
is the most appropriate initial nursing intervention?
A. Increase oxygen flow rate
B. Administer a prescribed opioid
C. Encourage deep breathing exercises
D. Request immediate intubation
Correct Answer:
B. Administer a prescribed opioid
Rationale:
Opioids are first-line therapy for dyspnea in palliative care, even when oxygen
saturation is adequate. They reduce the sensation of air hunger by altering central
perception. Increasing oxygen is not helpful if hypoxia is not present. Intubation is
inconsistent with hospice goals unless specifically aligned with patient wishes.
Nonpharmacologic measures may help but opioids are the most effective initial
intervention.
Question:
A hospice patient becomes increasingly restless, pulling at linens and attempting to
get out of bed. The family reports this is new behavior. What is the priority nursing
assessment?
A. Evaluate for spiritual distress
B. Assess for pain and urinary retention
C. Provide family education about dying process
D. Reduce environmental stimulation
Correct Answer:
, B. Assess for pain and urinary retention
Rationale:
Terminal restlessness or delirium is often caused by reversible factors such as pain,
urinary retention, constipation, or medication effects. A focused physical
assessment is essential before implementing supportive interventions. Addressing
underlying causes may reduce agitation and improve comfort.
Question:
A hospice nurse is caring for a patient whose cultural beliefs require large family
gatherings at the bedside. The facility has general visitation guidelines. What is the
best action?
A. Enforce standard visitation rules
B. Ask security to limit visitors
C. Collaborate with leadership to accommodate cultural needs when possible
D. Transfer the patient to another facility
Correct Answer:
C. Collaborate with leadership to accommodate cultural needs when possible
Rationale:
Culturally competent care is essential in hospice practice. Whenever safe and
feasible, accommodations should be made to honor patient and family traditions.
Advocacy is a key component of hospice nursing.
Question:
A patient receiving high-dose opioids develops myoclonus and increasing
confusion. What is the most appropriate nursing action?
A. Discontinue all opioids immediately
B. Assess for opioid toxicity and notify the provider
C. Increase the opioid dose
4
