Free CHPN Practice Test
The Certification Examination for Hospice and Palliative Nurses results in the awarding of the Certified Hospice and Palliative Nurse (CHPN) credential. This examination was developed by the National Board for Certification of Hospice and Palliative Nurses.
The CHPN exam is composed of 150 multiple-choice questions, each of which has four possible responses. There are 15 pretest questions, which do not count towards the final score. You will not be able to tell which questions are pretest questions. The exam takes approximately three hours to complete. The content of the CHPN exam is broken down into seven major categories: Patient Care: Life-limiting Conditions in Adult Patients (14% of the exam); Patient Care: Pain Management (25%); Patient Care: Symptom Management (27%); Care of Patient and Family (11%); Education and Advocacy (9%); Interdisciplinary/Collaborative Practice (8%); and Professional Issues (6%).
The content of the CHPN exam can also be categorized by the skill sets employed in correctly answering questions: 30% of the questions require recall of specific information; 50% of the questions require the application of knowledge to real-life situations; and 20% of the questions require analysis and synthesis of information to determine whether a suggested solution is appropriate. On some of the questions, several answer choices will be partially correct, though only one will qualify as the "best answer." The work environment of a hospice and palliative care nurse is rife with ambiguous problems situations, and the possession of a CHPN credential indicates the ability to make difficult choices.
1. A 51-year-old hospice patient with metastatic breast cancer is experiencing severe pain in association with daily dressing changes of an ulcerating malignant skin wound. These pain episodes are consistent with:
a. End-of-dose failure
b. Spontaneous pain
c. Incident pain
d. Psychic pain
2. A 57-year-old patient with end-stage heart failure expresses sadness that she can no longer volunteer in church because of the progression of her disease. The hospice nurse should do which of the following?
a. Remind the patient that it is not helpful to dwell on how her disease has limited her life.
b. Advise placement in an outpatient hospice facility given the progression of the heart disease.
c. Assist the patient in identifying other ways of staying involved with her church.
d. Remind the patient that things could be much worse.
3. The palliative care advanced practice nurse should be proficient in all of the following EXCEPT:
a. Providing consultation to other medical professionals in complicated palliative care cases
b. Providing direct education to patients and caregivers
c. Administering medication with the primary purpose of hastening death
d. Maintaining knowledge of current evidence-based evaluation and treatments in palliative care
4. Typical features of late-stage dementia include all of the following EXCEPT:
a. Urinary retention
b. Swallowing difficulty
c. Inability to walk
5. A 62-year-old hospice patient with lung cancer develops shortness of breath and facial swelling. The hospice nurse notes distended neck veins. The most likely explanation for these findings is:
a. Pleural effusion
c. Superior vena cava obstruction
1. C: Pain can be categorized in a variety of ways, and successful treatment of pain is dependent on a multidimensional and frequent assessment of the palliative care patient's pain. Treating pain well depends in part on assessing what type of pain a patient is experiencing, particularly when considering the onset and duration of action of the many different pain medications available. As the name suggests, spontaneous pain occurs spontaneously, and is not predictably associated with a particular movement or event. Incident pain is pain that occurs predictably in association with a particular event, such as walking, a dressing change, or coughing. Spontaneous pain and incident pain are different types of breakthrough pain. End-of-dose failure is pain that occurs as the time for the next dose of a scheduled pain medication approaches. In other words, the medicine is not lasting long enough. Psychic pain refers to pain that is primarily characterized by its impact on the patient's emotional state (eg, fear of dying, feeling helpless).
2. C: "Fading away" refers to the process through which patients and their loved ones go when facing a terminal illness, in which they come to terms with the change and loss that accompanies progressive illness and death. Like grief, the process of fading away may be characterized by stops and starts with multiple components of the process occurring simultaneously. "Redefining" involves making adjustments as tasks and routines in which the patient was previously able to engage in are no longer possible because of disease progression. Important nursing interventions for patients working through the redefining process include encouraging patients to express their feelings about what has changed, reminding patients of what remains possible, and assisting patients in finding new ways to engage in those activities that are meaningful to them.
3. C: Advanced practice nurses (eg, clinical nurse specialist, nurse practitioner) have completed a master's degree in nursing and maintain specialized knowledge and skills in their chosen specialty. Palliative care advanced practice nurses should be up-to-date with the latest literature and evidence-based guidelines of care. They are available both for direct patient care and education of patients, families, and other providers. They are a consultation resource in complicated or difficult cases. Administering medication for the express purpose of hastening death is not considered an appropriate palliative intervention, according to the policies of most palliative care organizations, including the American Nurses Association. This may be an evolving issue in palliative care, particularly with the passage of laws in some states that allow for the prescription of medications with the express purpose of hastening death in terminally ill patients.
4. A: Dementia is a progressive, generally irreversible disease characterized by impaired cognitive functioning, which may be caused by a variety of conditions, including AIDS, Alzheimer disease, trauma, and vascular disease. Dementia is usually a progressive disease, although specific stages of dementia are not clearly delineated. The patient in the late (ie, terminal or advanced) stage of dementia has severely impaired or complete loss of his or her ability to swallow, communicate, walk, or maintain continence. Palliative care patients with terminal dementia may experience any of the symptoms commonly seen in other terminally ill patients, including pain, infection, dyspnea, and agitation.
5. C: Superior vena cava obstruction in the palliative care patient is most commonly associated with tumors or lung cancer and results from obstruction of blood flow through the superior vena cava (SVC). Obstruction may result from either internal (eg, local cancer extension) or external (eg, bulky lymphadenopathy) compression of the SVC or may result from a clot in the SVC. Symptoms of SVC obstruction may present gradually or acutely and are often very distressing to the patient and family. The patient may complain of facial, arm, or neck swelling; shortness of breath; a feeling of fullness in the head; hoarseness; or dysphagia. Distended neck veins may be visible on examination. With rapid or complete obstruction, patients rapidly deteriorate as a result of increased intracranial pressure. Lymphedema typically results in extremity swelling, rather than facial swelling.
Last Updated: 09/11/2017