CHPPN Paediatric Hospice & Palliative Nursing Certification Exam
2026: Comprehensive Professional Practice Test — paediatric
Symptom Management, Pain Control, End-of-Life Care, Family
Support, Ethics & Clinical Decision-Making — 195 Multiple-Choice
Questions with Answers & Detailed Rationales
Domain 1: Assessment and Planning (Questions 1–35)
Question 1
A 4-year-old child with a life-limiting neuromuscular condition is admitted to hospice. The
nurse conducts an initial assessment. Which component is the priority for establishing a
comprehensive plan of care?
A. The child's current pain score
B. The family's understanding of prognosis and goals
C. The child's nutritional intake over the past 24 hours
D. The number of hospitalizations in the past year
Correct Answer: B
Explanation: Establishing goals of care based on family understanding of prognosis is
foundational to developing an appropriate hospice plan. Comprehensive assessment begins
with the family's perspective, values, and priorities before focusing on specific clinical
indicators. Pain, nutrition, and hospitalization history are important but secondary to
understanding the family's goals and understanding of the child's condition.
Question 2
A 7-year-old child receiving hospice care for a brain tumor reports increasing headache
severity. The nurse should first:
,A. Administer the prescribed breakthrough analgesic
B. Assess for signs of increased intracranial pressure
C. Document the pain score and notify the physician
D. Apply a cold compress to the forehead
Correct Answer: B
Explanation: Headache in a child with a brain tumor may indicate increased intracranial
pressure, which requires urgent assessment before intervention. While pain management is
important, identifying the underlying etiology—particularly a potentially life-threatening
change in ICP—takes clinical priority. The nurse should assess for accompanying signs such
as vomiting, altered consciousness, or pupillary changes.
Question 3
The parents of a 2-year-old with a progressive metabolic disorder ask the nurse, "How will
we know when our child is nearing the end of life?" The nurse's best response is based on
which understanding?
A. The child will typically experience a sudden decline over hours
B. Indicators include decreased oral intake, increased sleep, and changes in breathing
patterns
C. The physician will provide a specific timeline at the next appointment
D. The child's pain will become unmanageable despite medication
Correct Answer: B
Explanation: Signs of imminent death in pediatric patients include decreased oral intake,
increased somnolence, mottling, and irregular breathing patterns. Families need anticipatory
,guidance about these indicators to prepare emotionally and practically. Providing specific
timelines is rarely accurate and may create false expectations.
Question 4
A 10-year-old child with cystic fibrosis tells the nurse, "I don't want to do my breathing
treatments anymore." The nurse should first:
A. Explain why the treatments are essential for lung health
B. Explore the child's reasons for refusing and assess for distress
C. Notify the parents that the child is noncompliant
D. Document the refusal and reassess in one hour
Correct Answer: B
Explanation: Exploring the child's perspective respects autonomy and identifies potentially
treatable distress such as fatigue, pain, or depression. Pediatric palliative care emphasizes
the child's voice in decision-making appropriate to developmental level. Understanding the
reason for refusal guides appropriate intervention—whether symptom management,
education, or goals-of-care discussion.
Question 5
Which assessment finding most strongly indicates that a pediatric hospice patient is entering
the terminal phase?
A. Decreased interest in favorite activities
B. Increased sleep and decreased responsiveness
C. Occasional episodes of nausea
D. Mild increase in pain requiring breakthrough medication
, Correct Answer: B
Explanation: Increasing somnolence with decreased responsiveness is a hallmark of the
dying phase. While decreased interest and symptom fluctuations occur throughout the
illness trajectory, a sustained pattern of increasing sleep and reduced interaction signals
physiologic decline. Nausea and pain are treatable symptoms that do not independently
indicate imminent death.
Question 6
A 5-year-old with a congenital heart condition has been receiving palliative care for six
months. The interdisciplinary team is reassessing the plan of care. Which factor should drive
the reassessment?
A. The child's weight has remained stable
B. The family requests a change in medication administration route
C. The child's functional status has declined significantly
D. The hospice benefit period is nearing expiration
Correct Answer: C
Explanation: Significant changes in functional status require reassessment and modification
of the care plan. While family requests and regulatory timelines are relevant considerations,
clinical changes in the child's condition are the primary trigger for updating goals and
interventions. Weight stability alone does not indicate a need for comprehensive
reassessment.
Question 7
2026: Comprehensive Professional Practice Test — paediatric
Symptom Management, Pain Control, End-of-Life Care, Family
Support, Ethics & Clinical Decision-Making — 195 Multiple-Choice
Questions with Answers & Detailed Rationales
Domain 1: Assessment and Planning (Questions 1–35)
Question 1
A 4-year-old child with a life-limiting neuromuscular condition is admitted to hospice. The
nurse conducts an initial assessment. Which component is the priority for establishing a
comprehensive plan of care?
A. The child's current pain score
B. The family's understanding of prognosis and goals
C. The child's nutritional intake over the past 24 hours
D. The number of hospitalizations in the past year
Correct Answer: B
Explanation: Establishing goals of care based on family understanding of prognosis is
foundational to developing an appropriate hospice plan. Comprehensive assessment begins
with the family's perspective, values, and priorities before focusing on specific clinical
indicators. Pain, nutrition, and hospitalization history are important but secondary to
understanding the family's goals and understanding of the child's condition.
Question 2
A 7-year-old child receiving hospice care for a brain tumor reports increasing headache
severity. The nurse should first:
,A. Administer the prescribed breakthrough analgesic
B. Assess for signs of increased intracranial pressure
C. Document the pain score and notify the physician
D. Apply a cold compress to the forehead
Correct Answer: B
Explanation: Headache in a child with a brain tumor may indicate increased intracranial
pressure, which requires urgent assessment before intervention. While pain management is
important, identifying the underlying etiology—particularly a potentially life-threatening
change in ICP—takes clinical priority. The nurse should assess for accompanying signs such
as vomiting, altered consciousness, or pupillary changes.
Question 3
The parents of a 2-year-old with a progressive metabolic disorder ask the nurse, "How will
we know when our child is nearing the end of life?" The nurse's best response is based on
which understanding?
A. The child will typically experience a sudden decline over hours
B. Indicators include decreased oral intake, increased sleep, and changes in breathing
patterns
C. The physician will provide a specific timeline at the next appointment
D. The child's pain will become unmanageable despite medication
Correct Answer: B
Explanation: Signs of imminent death in pediatric patients include decreased oral intake,
increased somnolence, mottling, and irregular breathing patterns. Families need anticipatory
,guidance about these indicators to prepare emotionally and practically. Providing specific
timelines is rarely accurate and may create false expectations.
Question 4
A 10-year-old child with cystic fibrosis tells the nurse, "I don't want to do my breathing
treatments anymore." The nurse should first:
A. Explain why the treatments are essential for lung health
B. Explore the child's reasons for refusing and assess for distress
C. Notify the parents that the child is noncompliant
D. Document the refusal and reassess in one hour
Correct Answer: B
Explanation: Exploring the child's perspective respects autonomy and identifies potentially
treatable distress such as fatigue, pain, or depression. Pediatric palliative care emphasizes
the child's voice in decision-making appropriate to developmental level. Understanding the
reason for refusal guides appropriate intervention—whether symptom management,
education, or goals-of-care discussion.
Question 5
Which assessment finding most strongly indicates that a pediatric hospice patient is entering
the terminal phase?
A. Decreased interest in favorite activities
B. Increased sleep and decreased responsiveness
C. Occasional episodes of nausea
D. Mild increase in pain requiring breakthrough medication
, Correct Answer: B
Explanation: Increasing somnolence with decreased responsiveness is a hallmark of the
dying phase. While decreased interest and symptom fluctuations occur throughout the
illness trajectory, a sustained pattern of increasing sleep and reduced interaction signals
physiologic decline. Nausea and pain are treatable symptoms that do not independently
indicate imminent death.
Question 6
A 5-year-old with a congenital heart condition has been receiving palliative care for six
months. The interdisciplinary team is reassessing the plan of care. Which factor should drive
the reassessment?
A. The child's weight has remained stable
B. The family requests a change in medication administration route
C. The child's functional status has declined significantly
D. The hospice benefit period is nearing expiration
Correct Answer: C
Explanation: Significant changes in functional status require reassessment and modification
of the care plan. While family requests and regulatory timelines are relevant considerations,
clinical changes in the child's condition are the primary trigger for updating goals and
interventions. Weight stability alone does not indicate a need for comprehensive
reassessment.
Question 7
