The CHPN (Certified Hospice and Palliative Nurse) is a nursing certification awarded by HPCC.
HPCC publishes the official exam outline, eligibility rules and fees — see HPCC's official page before you book.
Twenty CHPN (Certified Hospice and Palliative Nurse) questions, with the answers hidden until you want them — covering Management, Pharmacology, Basics, Pathology and more. They are real cards from our 1000-card deck, not the 30 on the free preview page, so you can use both. Work through them cold, then use your score below to decide what to study next. HPCC publishes the official exam outline — check it for the real blueprint.
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A 78-year-old patient with end-stage COPD and a 6-month prognosis is admitted to hospice. During medication reconciliation, the nurse notes atorvastatin 40mg daily. What is the most appropriate evidence-based intervention regarding this medication?
Show answer →Discontinue the statin. In hospice/palliative care with a limited life expectancy (<1 year), the benefits of primary or secondary cardiovascular prevention are outweighed by the risks of side effects (myalgia, hepatotoxicity) and pill burden. Evidence shows no significant increase in mortality or cardiovascular events when statins are stopped in this population, and it often improves quality of life. HPCC Exam Tip: Prioritize comfort and quality of life over prevention in terminal diagnoses. Distractors often suggest continuing the medication until the active dying phase, which is incorrect; it should be addressed at the time of hospice enrollment.
A patient is prescribed Naloxegol (Movantik) for refractory OIC. What dietary education is essential regarding the metabolism of this medication?
Show answer →Naloxegol is a substrate of the CYP3A4 enzyme system. Patients must be instructed to avoid grapefruit and grapefruit juice, as they can inhibit metabolism, leading to increased plasma concentrations of the drug and potential side effects. HPCC Tip: The exam often tests drug-nutrient interactions for newer palliative medications. Also, note that Naloxegol should be taken on an empty stomach.
A patient on high-dose morphine develops involuntary muscle twitching and reports that even the touch of a bedsheet is painful. What is the most likely clinical syndrome?
Show answer →Opioid-Induced Neurotoxicity (OIN). Key features include myoclonus, hyperalgesia, allodynia, and delirium. HPCC Exam Tip: Distinguish OIN from disease progression; in OIN, increasing the opioid dose makes the pain worse (paradoxical pain). Management involves opioid rotation and hydration.
A nurse must administer Naloxone to a hospice patient with a respiratory rate of 5 and pinpoint pupils. How should it be administered to avoid a pain crisis?
Show answer →Dilute 0.4mg Naloxone in 10mL Normal Saline; administer 1-2mL (0.04mg) every 2-3 minutes. The goal is to reverse respiratory depression/obtundation without fully reversing analgesia. HPCC Tip: Avoid full bolus (0.4mg) doses in palliative care as it causes agonizing withdrawal and pain.
A patient with OIN-related delirium is severely agitated. Which medication class should be used with extreme caution or avoided as monotherapy for this specific delirium?
Show answer →Benzodiazepines. They can cause a paradoxical increase in confusion and agitation (disinhibition) in patients with OIN or hepatic/renal failure. Haloperidol is often preferred for agitation, but the definitive treatment is rotating the opioid to clear the toxic metabolites.
A patient with advanced lung cancer and a history of DVT requests a massage for leg pain. What is the nurse's priority assessment before proceeding?
Show answer →The priority is assessing for active DVT or high risk of embolism. Deep tissue massage is strictly contraindicated in patients with known/suspected DVT. Additionally, avoid direct pressure over bone metastases (fracture risk) and radiated skin. Light effleurage (gentle stroking) is generally safe, but the CHPN exam focuses on identifying safety contraindications first.
A hospice patient with bone metastases reports constant 4/10 pain currently managed with PRN ibuprofen. According to WHO Analgesic Ladder principles for persistent pain, what is the most appropriate modification to the current regimen?
Show answer →The WHO principle By the Clock dictates that persistent pain requires scheduled (around-the-clock) dosing rather than PRN-only administration. The goal is to maintain a therapeutic serum level to prevent pain from recurring. PRN doses (10-15% of the total daily dose) should be reserved for breakthrough pain. HPCC Exam Tip: Distinguish between persistent pain (needs scheduled meds) and episodic pain (needs PRN). Common distractor: Increasing the PRN dose instead of scheduling it.
The WHO principle By the Mouth is a core tenet of palliative care. In which clinical scenario would a nurse advocate for deviating from this principle according to the analgesic ladder?
Show answer →The oral route is preferred for its simplicity and cost-effectiveness. However, deviations are necessary if the patient has severe nausea/vomiting, dysphagia, bowel obstruction, or is in the final hours of life with an inability to swallow. In these cases, the ladder persists but the route changes to transdermal, sublingual, subcutaneous, or intravenous. Strategy: HPCC questions often focus on the least invasive route that is still effective for the patient's specific condition.
A patient on Step 3 of the WHO ladder (Morphine 15mg ER BID) reports pain is 8/10. The nurse calculates the breakthrough pain (BTP) dose. What is the standard evidence-based percentage used for BTP dosing?
Show answer →Breakthrough pain (BTP) doses should generally be 10% to 15% of the total 24-hour scheduled opioid dose. For this patient (30mg/day), the BTP dose would be 3mg to 4.5mg of immediate-release morphine. Clinical Reasoning: If a patient requires >4 BTP doses in 24 hours, the baseline scheduled (Step 3) dose should be titrated upward. HPCC emphasizes the relationship between the ladder (baseline) and rescue (BTP) dosing.
A patient on high-dose Step 3 opioids experiences paradoxical increased pain sensitivity and diffuse myoclonus. What is this phenomenon, and how does it alter the ladder approach?
Show answer →Opioid-Induced Hyperalgesia (OIH). Unlike tolerance, where more drug provides relief, OIH makes the patient more sensitive to pain as the dose increases. The intervention is Opioid Rotation (switching to a different Step 3 agent at a 25-50% dose reduction) or adding a NMDA antagonist like Methadone or Ketamine. HPCC Distractor: Do not confuse OIH with Tolerance. In tolerance, increasing the dose helps; in OIH, increasing the dose hurts.
A patient’s Living Will specifies no heroic measures but does not mention Artificial Nutrition and Hydration (ANH). The family is divided on a PEG tube. How is this legally interpreted?
Show answer →In many states, ANH is a medical intervention that can be refused. However, some jurisdictions require clear and convincing evidence specifically regarding ANH if it is not explicitly mentioned. If the AD is vague (heroic measures), the DPOAHC must use substituted judgment. HPCC Tip: Specificity matters. General terms like heroic measures are often too vague for clear clinical guidance; the HPCC emphasizes the need for specific language regarding ANH and ventilators.
A patient is admitted to hospice. The nurse notes a DPOA-HC form in the chart from 2018 naming an ex-spouse. The patient’s current partner claims the patient revoked it verbally last month. How should the nurse proceed regarding the validity of the DPOA-HC?
Show answer →The written DPOA-HC remains in effect until a newer document is executed or the patient formally revokes it. While many states allow verbal revocation if the patient has capacity, the nurse must involve the physician to assess the patient's current capacity and intent. HPCC Exam Point: Revocation of a DPOA-HC typically requires the same level of capacity as creating one. The nurse should document the discrepancy and facilitate a formal update of the advance directive if the patient is capable. Until revoked, the legal document naming the ex-spouse is the standing order.
A DPOA-HC insists on continuing aggressive chemotherapy for a hospice patient with a Performance Status of 4, despite the oncologist stating it is medically futile. How should the nurse navigate this conflict?
Show answer →The nurse should facilitate a multi-disciplinary meeting to align goals of care, but recognize that a DPOA-HC cannot compel a provider to perform treatment that falls below the standard of care or is deemed non-beneficial. HPCC Exam Strategy: While the DPOA-HC has the right to refuse treatment, they do not have an unlimited right to demand futile or harmful treatment. The nurse's role is to bridge communication between the medical team's clinical assessment and the proxy's goals, often involving an ethics committee if the impasse continues.
Contrast POLST/MOLST with traditional Advance Directives (AD). Who is the intended population for a POLST, and what is its legal standing compared to an AD?
Show answer →POLST/MOLST are actionable medical orders intended for patients with advanced illness or frailty (life expectancy <1-2 years). Unlike an AD, which is a legal document for all adults that requires subsequent physician translation into orders, a POLST is valid immediately across care settings. HPCC Exam Tip: Distinguish that POLST complements an AD but does not replace it; if a patient is healthy, an AD is appropriate, but a POLST is premature. Rational: POLST converts patient preferences into immediately followable medical instructions for EMS and clinicians.
A patient with metastatic breast cancer reports a constant, gnawing ache in the lumbar spine that worsens with movement. What specific type of nociceptive pain is this, and which class of medications is most effective for the inflammatory component?
Show answer →This is Deep Somatic Pain (Bone Pain). Pathophysiology: Metastatic infiltration of the periosteum triggers nociceptors via prostaglandin release and mechanical pressure. Best medication class: NSAIDs (e.g., Ibuprofen, Naproxen) or corticosteroids (e.g., Dexamethasone). Rationale: These agents target the inflammatory soup (prostaglandins) at the site of the lesion. HPCC Tip: Bone pain is a classic somatic presentation on the CHPN exam and often requires multimodal therapy.
Explain the Convergence-Projection Theory as it relates to a patient with pancreatic cancer experiencing pain in the mid-back (T10-L2).
Show answer →This describes Referred Pain. Pathophysiology: Visceral afferent fibers (from the pancreas) and somatic afferent fibers (from the skin/muscle of the back) converge on the same second-order neurons in the dorsal horn of the spinal cord. The brain misinterprets the signal as originating from the somatic area (the back) rather than the viscera. HPCC Exam Point: Referred pain is a hallmark of visceral pathology; always assess for the primary organ source when pain patterns don't match local injury sites.
Describe the role of Silent Nociceptors in the context of visceral inflammation and how they contribute to the transition from acute to chronic pain states.
Show answer →Silent (Sleepy) Nociceptors: These are afferent fibers that are normally unresponsive to mechanical stimuli. Pathophysiology: In the presence of inflammation (the inflammatory soup of bradykinin, H+, prostaglandins), these receptors become sensitized and awaken. They then respond to even low-intensity mechanical stimulation (allodynia). Rationale: This recruitment increases the total nociceptive input to the spinal cord, driving central sensitization. Exam Insight: Aggressive early management of inflammation is crucial to prevent the awakening of these receptors.
When assessing a patient with bone metastases, the nurse asks, Does the pain increase when you attempt to sit up or walk? Which specific component of the PQRSTU mnemonic is being addressed, and what clinical phenomenon is likely being identified?
Show answer →This addresses Provocation (P). Specifically, the nurse is assessing for Incident Pain, a subtype of Breakthrough Pain (BTP) that is precipitated by a known trigger (movement, coughing, or procedures). Clinical Pearl: Identifying incident pain is critical for the plan of care, as it may require pre-medication before activity rather than just increasing the baseline long-acting opioid dose. HPCC emphasizes recognizing that P includes both what makes pain worse (provokes) and what makes it better (palliates).
A patient reports that their morphine ER controls pain for only 8 hours despite being prescribed every 12 hours. In the Timing (T) assessment, how should the nurse document this, and what is the recommended intervention?
Show answer →This is documented as End-of-Dose Failure. Timing (T) in PQRSTU assesses the duration and pattern of pain. End-of-dose failure occurs when the analgesic blood level drops below the minimum effective concentration before the next scheduled dose. Exam Tip: HPCC distinguishes this from breakthrough pain (which occurs despite controlled baseline pain). The intervention for end-of-dose failure is to increase the frequency of the dose (e.g., move from q12h to q8h) or increase the dose itself, rather than relying solely on PRN medications.
A patient with advanced lung cancer presents with facial edema, jugular venous distention, and dyspnea (SVC Syndrome). When is palliative radiation therapy the treatment of choice over chemotherapy?
Show answer →Radiation therapy is the primary treatment for Superior Vena Cava (SVC) Syndrome caused by non-small cell lung cancer (NSCLC) or other radio-sensitive solid tumors. Strategy: If the tumor is highly chemo-sensitive (e.g., Small Cell Lung Cancer or Lymphoma), chemotherapy is often the first-line systemic treatment. For NSCLC, RT is superior for rapid localized debulking. Nursing Assessment: Monitor for airway compromise. Clinical Pearl: While SVC syndrome was historically viewed as a 24-hour emergency, modern practice allows for a focused diagnostic workup (biopsy) before starting RT, unless the patient has stridor or hemodynamic instability. RT provides relief in 70-90% of cases within 7-14 days.
17–20 correct
Strong. Move to the hardest material and timed drilling rather than re-reading topics you already know.
12–16 correct
A normal mid-prep score. Work the topics you missed one at a time — the topic pages below are built for exactly that.
Under 12 correct
Early days. Go topic by topic instead of taking more mixed tests: pick your weakest area below and drill it until the questions feel routine.
Management questions
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Pharmacology questions
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Basics questions
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Pathology questions
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Assessment questions
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