2024 Edition

CHPN Practice Exam

Take this free CHPN practice test to get a sample of the types of questions on the actual Hospice and Palliative Nurse certification exam. 

The CHPN exam is a 3 hour exam covering 150 multiple choice questions. The CHPN exam focuses on five domain practice areas: Life-limiting Conditions in Adult Patients, Pain Management, Symptom Management, Patient and Family Care and Practical Issues.  

You can also try the Complete 750 Question CHPN Practice Exam Kit with fully explained answers, testing tips and more.


Patient Care: Assessment and Planning

1. The hospice nurse is assessing a patient while on a routine visit. The patient reports pain while swallowing. The nurse assesses the patient's mouth and throat, noting moist mucous membranes and white curd-like plaques near the back of the tongue. The nurse will call the provider with which suggestion?
2. The nurse is reviewing the plan of care for a patient receiving general inpatient care. Though the patient's level of consciousness has decreased, symptoms of discomfort have been managed. The patient's family expresses satisfaction with the care at this level and would like to continue with general inpatient care. What is the appropriate level of care for this patient?
3. The nurse is talking about goals of care with a patient who has terminal cancer of unknown origin. Which of the following patient priorities most indicates a hospice referral will be appropriate?
4. The nurse is assessing a dying patient who has been unresponsive for the last 18 hours. The nurse informs the family death is imminent. Which assessment finding would most support this determination?
5. A hospice patient with advanced COPD expresses the desire to attend a rodeo two counties away. The nurse understands that the rodeo will have animals, dust in the air, and many people in attendance. How should the nurse address this desire in the plan of care?
6. The nurse is caring for a patient with metastatic lung cancer. Which sign most indicates the patient is experiencing an oncologic emergency?
7. Alzheimer disease is associated with what characteristics?
8. You are the nurse on-call and receive a call from a continuous care nurse who states that her patient has started to have "rattling" secretions and the patient's wife is very concerned. You know from report that this patient is actively dying. What would be the most appropriate response?
9. Which characteristics are most closely associated with end-stage renal disease?
10. Mary is a 73-year-old patient with a 50-year history of smoking and a diagnosis of emphysema. She is very thin with a barrel chest, has intermittent dyspnea both at rest and with exertion, and supraclavicular retractions on exertion. What non-pharmacologic intervention would likely improve dyspnea in this patient?
11. John is a new hospice patient with heart failure. John reports a six-pound weight gain since his discharge from the hospital 3 days ago. The nurse notes that John has dependent peripheral edema 2 +, and he reports feeling nauseated and with poor appetite. Based on these findings, what is the pathophysiology of John's heart disease?
12. A nurse is meeting a patient for the first time. When introducing himself, the nurse notes a series of symptoms that are concerning for acute stroke. Which symptoms are associated with acute stroke?

Patient Care: Pain Management

13. A hospice patient has been receiving hydrocodone by mouth but will be changing to parenteral morphine. After calculating the equianalgesic dose, what knowledge will guide the new dose?
14. The nurse is caring for a patient who is actively dying and is in persistent pain. The patient's spouse says, "I think we should stop giving the morphine. It doesn't seem to be working anymore." Which of the following is an appropriate response?
15. A nurse is reporting to the provider about a patient with advanced breast cancer. New findings include shooting pain down the left leg, increased respiratory rate, bilateral crackles in lungs, and drowsiness. Amitriptyline is among the new medications ordered. How will the nurse determine if this medication is effective?
16. A patient on hospice has been receiving increasingly high doses of morphine over the last 2 months to manage pain. During a weekly visit, the hospice nurse recognizes pronounced muscle twitching. How will the nurse proceed?
17. Which of the following most accurately describes "breakthrough" pain?
18. Madge is an 88 year-old with end stage colon cancer, who is transitioning. She has been minimally responsive for the past six hours, but opens her eyes in response to her name.  She is restless at times with furrowing of her brow. She is still swallowing her secretions, and sucks on the oral sponge when mouth care is provided. Prior to her change in status, she was receiving Oxycontin 40 mg po tablets q12 hr ATC with liquid oxycodone 8-12 mg po q2hrs prn for breakthrough pain. In light of Madge's change in level of consciousness, what changes should be made to her pain management regimen?
19. Which patient is at most risk for under-treatment of pain symptoms?
20. Margaret is an 87-year old with breast cancer that has metastasized to bone and brain. She lives alone, and is checked in on by a neighbor every other day. During a home visit, Margaret complains of dull, constant pain in her back and breastbone. The nurse notes that the oxycodone tablets that he had counted out for her for the last two days are still in the pill box; Margaret cannot explain why she did not take them as prescribed. This is the second occasion when the nurse has found tablets not taken. What is an appropriate pain management strategy for Margaret?
21. What should be prescribed concurrently with any opioid regimen?
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22. Jordan is taking continuous-release morphine every 12 hours for pain control, and has a short-acting prn opioid for break through pain. He is experiencing end-of-dose failure at 9-10 hours. What would be the most appropriate intervention to manage Jordan's pain?

Patient Care: Symptom Management

23. An unresponsive, bedbound patient has developed a pressure injury on the left heel. A large amount of purulent exudate is present. What is the nurse's first action?
24. A hospice nurse and the provider are discussing a patient who suffered a traumatic brain injury (TBI) and has increased intracranial pressure (ICP). They have exhibited somnolence, periodic seizures, and a high FLACC score. Which of the following orders will the nurse question?
25. A new hospice nurse is caring for a patient with constipation likely induced by opioid use. The nurse calls her preceptor to discuss the plan of care. Which recommendation addressing the constipation will cause the preceptor to intervene?
26. Of the following, which may indicate a poor prognosis for the hospice patient with a diagnosis of end-stage cardiac disease?
27. When a hospice patient is facing increasing weakness, with increased fatigue and decreased mobility, which of the following is an important aspect of supporting the patient's care needs?
28. Terri has an indwelling pleural catheter in place for intermittent drainage of her pleural effusion. The nurse is present to provide teaching on the use of the catheter at home. Which point is important for the nurse to stress to Terri to avoid vasovagal symptoms?
29. Daryl has an incomplete bowel obstruction secondary to metastatic ovarian cancer. She is experiencing significant abdominal pain and is vomiting fecal matter. She and her family want non-pharmacologic interventions only. Which intervention is likely to be the most effective?
30. Michelle has metastatic head/neck cancer and is in the last stages of life. She is cared for at home by her niece. In the last 24 hours she has become increasingly restless, and is repetitively attempting to get out of bed, while calling out in distress. Which group of interventions would be the most appropriate for Michelle at this time?

Care of Patient and Family

31. Which service for the hospice patient would be paid for by the Hospice Medicare/Medicaid benefit?
32. After a patient's death, how long are bereavement services available to families and other individuals associated with the patient?
33. Heidi is in her last days of life, being cared for by her husband and adult children. Over the last week she has increased her sleep from 16 to 20 hours per day and is taking only sips of water and juice. Her daughter calls the nurse, concerned that Heidi suddenly became alert and clearly demanded that she needs to get up and get into line with people outside who are waiting for her. These statements by Heidi have upset the family, but Heidi is comforted by them. What is an appropriate intervention for this family?
34. Ayaan has metastatic pancreatic cancer and is cared for at home by his wife and adult children. During a recent visit, the nurse notes that his symptoms have dramatically worsened and he is nearing the last days of life. The nurse knows that the family's spiritual beliefs hold that speaking about dying is considered "giving up", and is not acceptable. However, after the nurse's assessment, Ayaan's wife asks the nurse how he is doing, and happily reports that she thinks he is "improving". What would be the most appropriate response from the nurse?

Education and Advocacy

35. A hospice patient with metastatic hepatocellular carcinoma is no longer eligible for any life-prolonging treatments. Though she is alert and oriented, she is physically declining rapidly and may be days from death. During a routine visit, the patient tells the hospice nurse they would like to reverse the DNR and be full code. The patient's family strongly protests this decision. How will the nurse reply?
36. The hospice nurse is admitting a 65-year-old patient with heart disease related to Down syndrome. Which of the following can the nurse expect when communicating with them and their family?
37. Eric is a 69-year-old with end-stage esophageal cancer who has just returned home from the hospital after having a PEG tube placed. His wife, Margaret, will be caring for him, and states that she learned how to give him his tube feedings in the hospital. What is the most effective manner of assessing Margaret's ability to perform this task?
38. If a patient and family are struggling financially, which member of the IDT may be most helpful in identifying available community resources for support?
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39. Lorna has metastatic ovarian cancer, and is in her final days of life. Throughout her hospice benefit period she has rated her pain as 8 or 9 out of 10 consistently, and has required increasing doses of pain medication to be comfortable. In the last 24 hours she has become non-verbal. Her son is concerned that she will not be able to communicate her suffering to him. What would be the most appropriate educational point to make to her son?

Interdisciplinary / Collaborative Practice

40. Which statement is most accurate regarding palliative/hospice interdisciplinary teams (IDT)?
41. According to Medicare guidelines, how often does a registered nurse need to make a visit to the patient's home for the purpose of supervising a hospice aide?
42. What would be the best option for involving the patient and family in the IDT discussion in the hospice residential setting, if they would like to participate?

Practice Issues

43. What is the best practice regarding use of the electronic health record in patient care?
44. You have recently started caring for a new patient who is a member of your church, and the patient permitted news of her hospice admission to be added to the weekly church announcements. At Bible study, a mutual friend asks how she is doing. What is the most appropriate response?
45. Although some variations in state laws exist, generally, a therapy, including palliative and end of life care, can be withheld or withdrawn under which condition?
46. The family of a hospice patient with advanced dementia requests the use of their Medicare benefit for continuous home care. The patient is bedbound, non-verbal, incontinent of urine, and exhibits no symptoms of discomfort. How should the nurse respond?
47. The hospice nurse is entering the house of a new patient. A person from the house next door comes to greet the nurse, introducing themselves as a close friend of the patient. They tell the nurse they are happy the patient has finally elected hospice to get the extra help. What will guide the nurse's response?
48. The nurse is discharging a well-liked patient from hospice services so the patient may enroll in a clinical trial. The nurse understands which of the following would violate professional boundaries?
49. A patient with gastrointestinal cancer is being assessed for hospice services. The patient has had their stomach and most of their intestines surgically removed. Total parenteral nutrition (TPN) is needed for all their nutritional needs. After a lengthy discussion with the hospice nurse, the patient remains adamant that they continue TPN but still wishes to be on hospice services. How does the nurse proceed?
50. The hospice nurse is contacted by a hospice volunteer. The volunteer reports that their patient has copious amounts of blood coming from an unknown area underneath the patient. After informing the volunteer that help is coming, what is the nurse's instruction?

CHPN Practice Test

Quality starts with who wrote the material.
Our practice exam writer
Melissa Robinson, Ph.D., RN, CHPN
, is an associate professor of nursing at Linfield College and on staff at the Providence Hospice in Oregon, where she works in long term care facilities, as well as in hospital and home settings. Melissa has been a CHPN for over thirteen years. She is widely published on the subject of distance learning and earned her doctorate in nursing education from Capella University.

Laurl Matey, MSN, RN, CHPN
, is an Oncology Nursing Specialist with the Oncology Nursing Society (ONS) and an adjunct professor at Grand Canyon University in the College of Nursing and Healthcare. She is a peer content reviewer for the Journal of Hospice and Palliative Nursing and for the Asian Pacific Journal of Oncology Nursing. Laurl earned her Master of Science in Nursing degree from the University of Pittsburgh.

Mary Spicketts, RN, CHPN, MSN
, is the Director of Education and Research at the Hospice of Michigan. She has been a CHPN and CHPPN for over 10 years. Mary has helped develop MSN level course curriculum for Western Governors University and has participated in two exam writing workshops with the Hospice and Palliative Nurses Association.

Sue Montgomery, RN, CHPN
, is a registered nurse and professional medical writer with over 28 years of nursing experience. She worked for 14 years as a CHPN at one of the nation's largest hospices in Florida. Sue has been published in the National Hospice and Palliative Care Organization’s national magazine, Insights.
The actual CHPN exam consists of 150 multiple choice questions over seven domains of practice for the care of adult patients and families.

  1. Patient Care: Assessment and Planning
  2. Patient Care: Pain Management
  3. Patient Care: Symptom Management
  4. Support, Education and Advocacy
  5. Practice Issues

Only 135 questions are scored. Fifteen of the questions are trial items being considered for future exams. Three hours are given to complete the exam.