CHPN practice test: 30 free questions

A patient with end-stage renal disease who has decided to stop dialysis is admitted to hospice. Which baseline assessment is most important for planning comfort care?

Mark a letter. The key, plus a line on every option, opens at once.

1. BUN, creatinine, and potassium on the latest labs

   BUN, creatinine, and potassium are expected to climb after dialysis stops and are seldom redrawn in hospice; they do not guide comfort care.
2. Fluid status, including edema, lung sounds, and dyspnea

   Once dialysis stops, fluid builds up and becomes a main source of breathlessness and discomfort, so a baseline of edema, lung sounds, and dyspnea lets the team catch and ease overload early.
3. Dialysis sessions missed over the past month

   How many sessions were missed belongs to the history of the decision, not to planning comfort from here on.
4. The patient's knowledge of renal diet and fluid limits

   Diet teaching mattered while dialysis was the plan; once it stops, restrictions are usually relaxed for comfort.

The hospice nurse is beginning a goals-of-care conversation with a patient. Which question best identifies what matters most to the patient?

1. "Would you want to go to the hospital if you got worse?"

   Jumping to a specific treatment choice comes before the values that should guide it, and it can feel abrupt as an opener.
2. "Have you already completed an advance directive form?"

   Asking about a form is a closed, document-focused question that can be answered yes or no without revealing what matters to the patient.
3. "Which of your symptoms worries you the most today?"

   This finds the most bothersome symptom, useful for symptom planning, but it keeps the talk on problems rather than on what the patient values.
4. "What brings meaning and joy to your life right now?"

   An open question about meaning and joy uncovers values and priorities, the foundation of any goals-of-care discussion.

A hospice patient with end-stage pulmonary fibrosis has increasing dyspnea despite maximum oxygen therapy. Which finding most strongly indicates the need to revise the plan of care?

1. Oxygen saturation that drops 4% with minimal exertion

   Desaturation on exertion is expected in end-stage fibrosis already on maximum oxygen; the number alone does not show unrelieved suffering.
2. Respiratory rate that rises to 24 per minute each evening

   A rate of 24 is only mildly raised and, on its own and without distress, does not show that the plan is failing.
3. Fear of suffocation that keeps the patient from resting

   Distress that prevents rest shows the current plan is not controlling the patient's experience of breathlessness, which is what calls for revising the plan with the team.
4. Use of a shower chair, unchanged since admission

   A shower chair the patient has needed since admission is already in the plan and signals no new need.

A hospice nurse is evaluating disease progression in a patient with advanced Parkinson's disease. Which finding is most important to document?

1. More frequent 'off' periods despite medication changes

   Off periods that keep increasing even after the regimen is adjusted show the disease outrunning levodopa, a key marker of advancing Parkinson's disease to record.
2. Slowness that improves after each dose

   Slowness that still responds to each dose shows the medication is working, the opposite of progression beyond drug control.
3. Soft speech that sometimes needs to be repeated

   Soft speech is common and can be present for years; repeating a phrase now and then is not a sign of new progression.
4. Tremor in one hand that appears only when anxious

   A one-sided tremor that shows up with anxiety is an early, typical feature and says little about late-stage decline.

A hospice patient with advanced dementia can no longer communicate verbally. Which approach is most appropriate when the nurse develops the plan of care?

1. Combine observed discomfort cues with family input on past preferences

   When the patient cannot speak, discomfort seen at the bedside plus the family's knowledge of past preferences gives the plan both current and personal information.
2. Apply the facility's standard dementia comfort protocol to the plan

   A standard protocol is a starting point, but it cannot reflect this person's history, habits, and preferences, which the family can supply.
3. Plan comfort measures from changes in the patient's vital signs

   Vital signs change little with ongoing pain and are an unreliable sign of discomfort in advanced dementia, so they cannot steer comfort care.
4. Leave comfort decisions to the attending physician's next visit

   Comfort care in hospice is planned by the team as needs arise; waiting for the physician's next visit delays relief and leaves the family out.

A hospice patient with end-stage cardiac disease has been declining over the past month. Which combination of findings most strongly indicates the patient has entered the active dying phase?

1. Fatigue, a 5-pound weight loss this month, and occasional chest pain

   Fatigue, weight loss over a month, and chest pain are features of advancing heart disease, not signs that death is hours to days away.
2. Periods of apnea, a weak rapid pulse, and minimal intake for 48 hours

   Breathing pauses, a weak and rapid pulse, and almost no intake over two days reflect failing circulation and respiration, the pattern of the last hours to days.
3. Increasing edema, occasional shortness of breath, and decreased appetite

   Increasing edema, breathlessness now and then, and a smaller appetite are signs of worsening heart failure that can go on for weeks or months; none shows the dying process has begun.
4. Intermittent confusion, increased sleeping, and decreased interest in activities

   More sleep, withdrawal, and on-and-off confusion are common weeks before death; they mark decline but not the active dying phase.

A cognitively intact hospice patient is starting IV patient-controlled analgesia (PCA) for unpredictable pain. Which safety feature is essential in the PCA order?

1. A continuous basal infusion for all

   A continuous basal infusion is used selectively, for example in opioid-tolerant patients; ordering it for all patients raises the risk of sedation.
2. A lockout interval between demand doses

   The lockout sets a minimum time between demand doses so each one can take effect before another is allowed, the main guard against dose stacking.
3. Family permission to press the dose button

   Only the patient should press the button; activation by family, called PCA by proxy, bypasses the safety of a drowsy patient simply stopping.
4. A demand dose equal to the full hourly need

   Demand doses are small increments; sizing one dose to the whole hourly need defeats the design and invites oversedation.

A patient with metastatic cancer has pain that intensifies whenever the patient talks about unpaid debts, estrangement from an adult child, and fear of what happens after death. Which concept best explains this presentation?

1. Total pain

   Total pain describes suffering in which physical, emotional, social, and spiritual distress feed one another, just as debts, estrangement, and fear amplify this patient's pain.
2. Incident pain

   Incident pain is a predictable flare tied to an activity such as moving or a dressing change, not to emotional topics.
3. Opioid-induced hyperalgesia

   Opioid-induced hyperalgesia is heightened pain sensitivity caused by opioid exposure, usually spreading as doses rise; nothing here links the pain to the drug.
4. Somatic symptom disorder

   Somatic symptom disorder is diagnosed from excessive, lasting thoughts, feelings, or behaviors around symptoms, which can occur alongside cancer; nothing here shows that, while pain rising with specific life worries is the picture total pain describes.

A hospice patient on an extended-release opioid reports that pain returns predictably near the end of each dosing interval. Which intervention is most appropriate?

1. Rely on rescue doses at the end of each interval

   Relying on rescue doses for predictable pain treats a scheduling problem as breakthrough pain and leaves the patient hurting until each rescue dose acts.
2. Crush the extended-release tablets for faster onset

   Crushing extended-release tablets for faster onset releases each whole dose at once and can cause an overdose; it must not be done.
3. Schedule the extended-release doses closer together

   Pain that returns before each next dose means the effect wears off early, so scheduling the doses closer together, such as every 8 instead of every 12 hours, closes the gap.
4. Replace the opioid with a non-drug intervention alone

   Nondrug measures can add comfort but cannot replace an opioid that is controlling pain for most of the interval.

A patient whose morphine dose has been escalated repeatedly now reports more widespread pain and pain from light touch. What is the primary mechanism underlying opioid-induced hyperalgesia?

1. Central sensitization of pain pathways

   Ongoing opioid exposure can make spinal and brain pain pathways more excitable, so pain spreads and light touch hurts; that central sensitization is the mechanism of hyperalgesia.
2. Reduced endogenous endorphin production

   Lower natural endorphin output is a popular idea, but it does not explain spreading pain and pain from touch as doses rise.
3. Heightened peripheral inflammatory response

   Inflammation would produce local signs at a tissue site, while this hyperalgesia is diffuse and arises in the central nervous system.
4. Demyelination of peripheral nerves

   Demyelination of peripheral nerves causes neuropathy with numbness or weakness, and opioids do not strip myelin from nerves.

A patient who has taken morphine for 3 months now needs a higher dose for the same relief and asks, "Does this mean I'm addicted?" Which response by the nurse is most accurate?

1. "Possibly, but at this stage that is acceptable."

   Allowing that it may be addiction mislabels the change, and calling it acceptable leaves the patient's fear unanswered.
2. "This most often reflects tolerance or disease."

   Needing more drug for the same effect most often reflects tolerance or advancing disease; addiction is defined by compulsive use despite harm, not by the dose.
3. "Needing more means you are dependent, so yes."

   Needing more drug is tolerance, not dependence, and neither tolerance nor physical dependence equals addiction; this reply stacks two mix-ups.
4. "It usually means morphine has stopped working."

   A rising dose need does not mean the drug has stopped working; morphine still controls pain at a higher dose, and stopping it would leave the pain uncontrolled.

A hospice patient on a stable schedule of oral opioids becomes increasingly confused and drowsy over 24 hours. The respiratory rate is 16 breaths/min. What is the most appropriate first nursing action?

1. Give the as-needed haloperidol for confusion

   Sedating the patient with an antipsychotic treats the symptom while the cause of this quiet, drowsy confusion goes unexamined.
2. Increase the opioid dose to settle the patient

   A higher dose would deepen the drowsiness and confusion without addressing whatever caused them.
3. Assess for infection, dehydration, or new drugs

   New confusion and drowsiness on a stable opioid schedule call for a search for other causes, such as infection, dehydration, or a newly added drug, before the opioid is blamed or changed.
4. Give naloxone, then recheck the level of alertness

   With normal breathing there is no respiratory depression to reverse, and giving naloxone would bring back severe pain and withdrawal.

A patient with advanced COPD reports severe dyspnea and appears anxious. Pulse oximetry shows 94% on room air. Which additional assessment finding most strongly suggests true respiratory distress rather than anxiety alone?

1. The patient states they feel short of breath and cannot get enough air

   The patient's statement of feeling short of breath defines dyspnea and guides comfort care, but it does not tell respiratory distress apart from anxiety, which is what the question asks.
2. Elevated heart rate, diaphoresis, and a sense of impending doom

   Fast heart rate, sweating, and dread are sympathetic responses common in panic and anxiety; they do not prove respiratory compromise.
3. Use of accessory muscles and inability to speak in full sentences

   Accessory muscle use and speaking in broken phrases are objective signs of increased work of breathing that anxiety alone does not produce.
4. A respiratory rate of 22 breaths per minute with clear breath sounds

   A mildly raised rate with clear lungs fits anxiety as easily as a respiratory cause, so it does not separate the two.

A hospice patient with advanced cancer and refractory cachexia starts a plan that combines symptom control, small favorite foods, and gentle movement. Which outcome best shows the plan is working?

1. Serum albumin back within the normal range

   Albumin falls with inflammation and illness, not only with intake, so it stays low in cachexia and does not reflect comfort or function.
2. More energy for activities the patient values

   In refractory cachexia, weight and lab values rarely recover, so success is judged by what matters to the patient, such as having more energy for the activities the patient values.
3. Eating at least three-quarters of each meal

   A target for how much of each meal is eaten puts pressure on the patient and family and says nothing about whether daily life feels better.
4. A 4-pound weight gain over the next two weeks

   Regaining weight is unlikely once cachexia is refractory, and chasing a number on the scale can turn meals into a source of conflict and distress.

A hospice patient expected to die within days has a temperature of 101.8 °F, is sweating, and seems restless under heavy blankets. The goals of care are comfort only. Which nursing measure is most appropriate?

1. Extra blankets so that the patient can sweat the fever out

   Extra blankets trap heat and worsen the sweating and restlessness; sweating a fever out has no benefit.
2. Blood cultures drawn before any fever treatment is given

   Blood cultures add a needle stick and a wait for results that would change nothing in the last days, so they do not fit comfort-only goals and only delay relief.
3. An ice-water sponge bath to bring the temperature down fast

   An ice-water sponge bath causes shivering, which produces more heat and adds distress; cool, not cold, cloths are used.
4. Light covers with cool cloths and the ordered antipyretic

   Fever this close to death is treated for comfort: lighter covers, cool cloths on the skin, and the antipyretic already ordered ease the sweating and restlessness without burdensome tests.

After a hospice patient's seizure ends, which assessment finding requires urgent escalation?

1. Urinary incontinence during the seizure

   Loss of bladder control is part of many generalized seizures and needs skin care and reassurance, not urgent escalation.
2. Repeated seizures without regaining consciousness

   Seizures that follow one another without recovery in between are status epilepticus, an emergency that needs prompt escalation for rescue medication under the plan of care.
3. Mild headache and fatigue

   Headache and tiredness are common after a seizure and are managed with comfort measures, not emergency escalation.
4. Confusion and drowsiness that persist for 30 minutes after the seizure

   A postictal period of confusion and sleepiness often lasts 30 minutes or more and is expected; it calls for safety measures and observation.

A jaundiced hospice patient has intractable itching that disrupts sleep and is at high risk of falls. Which intervention is most appropriate for the nurse to start?

1. Long hot baths to soothe the itchy skin

   Heat dilates skin vessels and dries the skin, which makes itching worse once the bath ends.
2. An as-needed opioid dose for the itching

   Opioids do not relieve this itch and can themselves cause or worsen pruritus, while adding sedation.
3. A sedating antihistamine taken nightly at bedtime

   Itching from bile buildup is driven little by histamine, so an antihistamine adds drowsiness and fall risk with little relief.
4. Cool skin care with emollients and short nails

   Cool skin care with emollients and short, smooth nails eases itching and prevents scratch injury without adding sedation for a patient already at high risk of falling.

A patient with brain metastases has taken high-dose dexamethasone for two months and now has trouble climbing stairs and rising from a chair. There is no back pain, and bladder and bowel function are unchanged. These findings most likely indicate:

1. Steroid-induced proximal myopathy

   Weakness of the hip and shoulder girdle after weeks of high-dose corticosteroids is the typical pattern of steroid myopathy, a drug effect the nurse reports so the dose can be reviewed.
2. Spinal cord compression from metastases

   Cord compression usually begins with back pain and goes on to leg weakness, sensory change, or bladder and bowel problems, and this patient has none of these.
3. Generalized weakness from anemia

   Anemia causes generalized tiredness and breathlessness on effort, not weakness focused on the hip and shoulder muscles.
4. Steroid-induced adrenal insufficiency

   Adrenal insufficiency follows stopping or quickly tapering a steroid, not ongoing high-dose use, and shows as fatigue, low blood pressure, and nausea.

A hospice patient with advanced COPD is unsure whether to stop some long-term daily medications and asks the nurse what to do. What is the most supportive approach?

1. Recommend stopping the medications the nurse considers unnecessary.

   Recommending that the patient stop the drugs the nurse considers unnecessary puts the nurse's values in place of the patient's, and any change also needs the prescriber.
2. Advise stopping the long-term medicines to focus on comfort.

   Stopping a whole group of drugs at once, without weighing each one, can remove medicines such as inhalers that still ease symptoms.
3. Review the benefits and burdens of each medicine with the patient.

   Going through what each drug still offers and what it costs the patient supports an informed choice, grounded in the patient's goals, to bring to the prescriber.
4. Encourage the patient to keep taking the current medicines for now.

   Steering the patient to keep everything as is sidesteps the question the patient raised and may leave burdensome drugs in place without discussion.

A hospice patient with nausea controlled by a scheduled antiemetic asks about also using acupressure wristbands. What is the most appropriate response by the nurse?

1. Advise against the bands because they may interfere with the antiemetic.

   Wristbands work by pressure on the skin and have no known interaction with antiemetic drugs; discouraging them removes a harmless option.
2. Suggest stopping the antiemetic to test the bands alone.

   Stopping a drug that controls nausea just to test the bands alone risks the symptom returning; the bands are an add-on, not a replacement.
3. Explain that complementary therapies are not permitted under hospice care.

   Hospice care commonly includes complementary approaches such as massage, music, and acupressure; no rule forbids them.
4. Support adding the bands to the antiemetic and note it in the plan.

   Acupressure bands are low risk and can add to drug therapy for nausea, so backing the patient's choice and recording it keeps the team informed.

The family of a hospice patient is upset that the patient now takes only sips of fluid and no food. The nurse should explain that reduced intake near death:

1. is a natural part of dying that rarely causes hunger

   Near death the need and desire for food and fluid fall, and most dying patients do not feel hunger; knowing this helps the family stop pressing food.
2. is often a sign of hunger that tube feeding would relieve

   Most dying patients do not feel hunger, and tube feeding adds no comfort or time at this point.
3. means the patient's pain is now poorly controlled

   Loss of appetite near death is part of dying itself; it is not a sign that pain control has failed.
4. usually means depression that needs a stimulant

   Loss of appetite near death is a normal physiological change rather than depression, and stimulants of any kind do not restore appetite at this stage.

A hospice patient wants to plan their funeral but worries that raising the topic will upset the family. What is the most helpful response by the hospice nurse?

1. Advise writing the wishes down privately for later.

   A private note may not be found in time and leaves the family guessing, while the patient has said they want to plan.
2. Recommend avoiding funeral planning so the family is not upset.

   Steering the patient away from planning protects the family's comfort at the cost of the patient's own wishes.
3. Suggest waiting for death to be closer before discussing funerals.

   Waiting risks losing the chance, because near death the patient may be too weak or unresponsive to share wishes.
4. Offer to help the patient raise funeral wishes with the family.

   Helping the patient start the conversation honors the patient's wishes and often brings relief to families who were unsure how to bring it up.

A home hospice patient has a crisis plan for pain, with oral and subcutaneous opioid doses kept in the home. During a pain crisis at night, the caregiver calls 911 instead of the hospice line. What should the nurse do at the next visit?

1. Ask the physician to discharge the patient from hospice care

   One emergency call is no reason to end hospice care; the patient's goals and eligibility have not changed.
2. Tell the caregiver that calling 911 first is the safest choice

   In hospice, the 911 route can lead to unwanted hospital treatment, while the hospice line connects the family to the comfort plan already in place.
3. Report the caregiver to the agency for not following the written plan

   Treating the call as a rule violation shames a frightened caregiver and will not make the crisis plan any easier to follow.
4. Review the crisis plan and the hospice phone line with the caregiver

   A 911 call in a crisis usually means the caregiver panicked or lost track of the plan, so going back over the crisis steps, the medicines kept at home, and how to reach hospice day and night makes the plan usable next time.

The adult child of a dying patient notices that the patient's knees and feet have become cool with a purple, blotchy pattern and asks what this means. Which response by the nurse is most appropriate?

1. "This is a sign of infection, and an antibiotic will likely be ordered today."

   Mottling near death is not a sign of infection, and starting antibiotics would not fit comfort-focused care.
2. "The circulation is slowing as the body shuts down; this is expected."

   Cool, mottled knees and feet reflect blood being shunted to the core as circulation fails, a common sign that death may be hours to days away.
3. "This could be a clot, so we should ask about a blood thinner."

   A clot usually affects one limb with swelling and pain, while mottling of both legs near death is circulatory shutdown that a blood thinner would not help.
4. "The room is too cold; warming the patient will bring the color back."

   Mottling comes from failing circulation, not room temperature; a light blanket adds comfort but will not restore the color.

A patient is electing the Medicare hospice benefit. Which acknowledgment must the signed election statement include?

1. That the patient will remain in hospice for 6 months

   The patient may revoke the benefit at any time, and the election statement promises no minimum stay.
2. That the patient will be discharged after 6 months

   Hospice election sets no discharge after 6 months; patients are recertified for further benefit periods as long as they remain terminally ill.
3. That the patient agrees to a do-not-resuscitate order

   A DNR order cannot be required as a condition of electing hospice; code status is a separate choice.
4. That curative care for the terminal illness is waived

   By electing hospice the patient waives Medicare coverage of curative treatment for the terminal illness and related conditions, and the statement must say so.

A hospice nurse documents visits on an agency laptop in patients' homes. Which practice best protects the electronic health information?

1. Saving notes to a personal USB drive as an extra backup

   A personal drive puts protected information outside the agency's secure systems and is easily lost.
2. Locking the screen whenever the laptop is left unattended

   Locking the screen each time the nurse steps away keeps protected health information from being seen or changed by anyone in the home.
3. Letting family members use the laptop to check their email

   Lending the work laptop gives others access to the records of many patients and is an unauthorized use.
4. Texting visit summaries to the IDG from a personal cell phone

   Ordinary texts from a personal cell phone are not a secure channel and leave patient data on an unmanaged device.

A hospice nurse notices emotional numbness during visits and keeps replaying patients' deaths at home in the evenings. Which strategy is most effective for managing this compassion fatigue?

1. Using a ritual to mark the end of each workday

   A deliberate ritual at the end of each workday, such as a few quiet minutes or a set routine before going home, helps the nurse leave the day's losses at work and interrupts the replaying at night.
2. Keeping contact with IDG colleagues to a minimum

   Pulling away from colleagues removes the peer support that buffers compassion fatigue and adds isolation.
3. Picking up extra shifts with complex patients

   More shifts with difficult deaths add exposure to the very stress behind the numbness and do not build resilience.
4. Avoiding all discussion of difficult cases with others

   Keeping difficult cases to oneself holds the distress inside; debriefing with peers is one of the main protections against compassion fatigue.

A hospice decides to align its nursing practice with the HPNA Palliative Nursing Scope and Standards of Practice. Which approach best integrates these standards into local practice?

1. Post a summary of the standards in each team office

   A posted summary informs staff, but it changes no protocol or routine of care.
2. Assign the standards as required reading for nurses

   Reading the standards spreads awareness but does not change the protocols nurses actually follow at the bedside.
3. Revise the protocols together with all disciplines

   Revising protocols jointly with every discipline lets each one adapt the standards to local practice and builds the buy-in a lasting change needs.
4. Have leadership issue the updated policies to staff

   Policies handed down by leadership tend to meet resistance and miss practical problems that the staff could have flagged.

A hospice patient's pain became uncontrolled 5 days after the last interdisciplinary group review of the plan of care. When should the plan of care be updated?

1. At the time of the change, as the condition requires

   The hospice Conditions of Participation require the plan of care to be updated as often as the patient's condition requires and at least every 15 days, so uncontrolled pain calls for an update now.
2. At the 30-day plan-of-care review the hospice holds

   Hospice rules set no 30-day review; the plan must be reviewed at least every 15 days and sooner when the condition changes.
3. At the next benefit-period recertification

   Recertification concerns continued eligibility for the benefit; waiting for it could leave pain uncontrolled for weeks.
4. At the next scheduled review, 15 days after the last

   Fifteen days is the minimum review frequency, not a reason to wait; a change in condition triggers an update sooner.

Surveyors cite a hospice because RN initial assessments are frequently completed later than 48 hours after election. Which response best addresses the deficiency?

1. Changing record dates to fall within 48 hours

   Altering dates falsifies the medical record and is fraud, not a correction.
2. Verbal reminders to the nurses at the next staff meetings

   Reminders that nobody tracks cannot show surveyors that the problem is fixed and seldom change practice.
3. A plan of correction with measurable targets and re-audits

   A survey citation calls for a plan of correction that fixes the process, sets measurable goals, and audits records to show the 48-hour standard is now met.
4. Replacing the admitting nurses with newly hired staff

   Replacing staff without looking at causes such as scheduling or referral timing may not fix the delays and harms morale.