Certified Hospice and Palliative Nurse (CHPN) Exam Review
The Certified Hospice and Palliative Nurse is specialized in treating patients while they are dealing with end of life issues, usually in a setting outside of the hospital. Many of these nurses work for hospice organizations and also help with making community resources available. The family of the dying patient is also helped by the Hospice and Palliative Nurse.
In order to take the Certified Hospice and Palliative Nurse exam, the applicant must be currently licensed as a Registered Nurse. It is recommended that the RN complete at least 2 years of employment caring for patients with end of life issues. There are no specific continuing education credit hour requirements.
The exam consists of 150 questions and 3 hours are allotted to complete the exam. The cost of the exam is $295 for members of the Hospice and Palliative Nurses Association (HPNA) and $395 for non-members. The exam is offered twice a year, in March and September, and the testing location is mailed to the applicant along with their admission ticket.
The exam consists of questions on all of the major body systems in regards to changes that are seen toward the end of life. The management of these symptoms is the primary focus of the RN who is a Certified Hospice and Palliative Nurse. Pain is also a major issue with the dying patient and approximately one-quarter of the exam consists of questions testing the RN's knowledge of management of pain in the dying patient. Issues with caring for the families along with professional issues are also components of the exam.
Certified Hospice and Palliative Nurse certification is valid for 4 years. The fee for renewal is $260 for HPNA members and $360 for non-members. The RN must retake the examination in order to maintain Hospice and Palliative Nurse certification.
CHPN Practice Test
1. A 67-year-old terminally ill patient wishes to receive comfort care measures in his home. The patient's physician recommends placement in a hospice facility so that Medicare will cover the cost of hospice care. Which of the following statements most accurately describes the Medicare hospice benefit?
a. The Medicare hospice benefit applies to patients who have a life expectancy of 12 months or less
b. The Medicare hospice benefit does not cover the cost of medications used to treat symptoms of terminal illness
c. The Medicare hospice benefit covers the cost of hospice services in multiple settings, including the patient's home
d. Services provided under the Medicare hospice benefit vary from state to state
2. A 24-year-old palliative care patient with terminal osteosarcoma takes oral narcotics regularly for the treatment of bone pain. Because of a misunderstanding at the pharmacy, his prescription for narcotic medication is filled 48 hours late, and he develops symptoms of opiate withdrawal, which is most consistent with which of the following?
a. Psychological dependence (i.e., addiction) on narcotic medication
b. Physical dependence on narcotic medication
c. Tolerance to narcotic medication
d. Underuse of prescribed narcotic medication
3. The primary goal of palliative sedation, also known as "terminal" or "total" sedation, in the patient with a terminal illness is:
a. Relief of intractable pain or suffering
b. Hastening of death
c. Improved oxygenation
d. Reduction in opioid medication doses
4. A home hospice patient becomes progressively less mobile and is ultimately bed-bound. A common complication of immobility in the palliative care patient is:
b. Pathological fractures
c. Pressure ulcers
5. Assessment of a palliative care patient's spiritual or religious beliefs should encompass which of the following?
a. Screening for spiritual beliefs that may conflict with the palliative care nurse's religious practices
b. Encouraging the patient to join a religious community if they do not already belong to one
c. Asking about spiritual customs or rituals around illness and death that are meaningful to the patient
d. Assessing spiritual or religious beliefs only if the patient volunteers information about religion and spirituality
CHPN Answers and Explanations
1. C: The Medicare hospice benefit is a federal program for Medicare-eligible patients with an estimated life expectancy of 6 months or less. Because Medicare is a federally funded program, eligibility requirements and benefits do not vary from state to state. The cost of all supplies and medications being used in relation to the terminal illness are covered under the Medicare hospice benefit. Hospice care may be provided in multiple settings, including home, outpatient, and inpatient settings. A patient need not have a ''Do not resuscitate'' order to qualify for the Medicare hospice benefit. Patients who have activated the Medicare hospice benefit may opt to return to "regular" Medicare (i.e., Medicare Part A) at any time.
2. B: Patients who are taking opiates chronically become physically dependent on the medication and will experience symptoms of drug withdrawal if the medication is discontinued suddenly or the dose is dropped dramatically. It is important for the palliative care nurse to understand the differences between physical dependence, tolerance, and addiction to pain medications. Physical dependence occurs when the body adapts to the effects of opiate medications (taken chronically) to the degree that rapid discontinuation or rapid dose decreases result in withdrawal symptoms. Tolerance to opiate medications describes the phenomenon of the body adjusting to a stable dose of medication, resulting in a need for increased amounts of the medication to achieve the same effect. Psychological dependence (or addiction) on opiate medications is characterized by a lack of control over use of the medication, compulsive use, and continued use despite harmful effects.
3. A: The essence of palliative care involves the relief of pain and suffering in the terminally ill patient. Palliative (or terminal) sedation describes the use of sedative agents (e.g., benzodiazepines, barbiturates) to treat pain or suffering in the dying patient when other treatment measures are ineffective. Palliative sedation is employed to relieve intractable symptoms in the dying patient, not to expedite the dying process. Palliative sedation is somewhat controversial as some argue that it is the ethical equivalent to euthanizing a dying patient given that death may be hastened with the use of sedative medications. Palliative sedation is more often administered for relief of intractable physical symptoms, such as dyspnea, pain, or agitation, than for so-called "psychic" suffering. As with other decisions made in palliative care, honest discussion between providers and the patient and family members about the use of palliative sedation should occur.
4. C: The dying patient becomes progressively less mobile as his or her illness progresses. There are numerous complications associated with immobility, some of which should be prevented when possible to avoid causing discomfort in the dying patient. Complications of immobility include muscle weakness due to atrophy, constipation, joint stiffness and pain, urinary tract infection, increased clotting risk, and pressure ulcers. Pathologic fractures, myoclonus, and pruritus are commonly present in the terminally ill patient but are not increased with immobility. Pressure ulcers can be prevented or minimized with the use of turning and positioning techniques, maintenance of optimal nutritional status (when appropriate), and wound management.
5. C: Spirituality and religion may play a large part in how the terminally ill patient experiences and responds to the dying process. Assessing the role of religious or spiritual beliefs in each patient's life is an important component of a patient's assessment and should, ideally, take place as early as possible in the relationship between patient and palliative care providers. Some patients may have extensive involvement in a religious or spiritual community, while others may have deep personal beliefs, which are not necessarily associated with an official organization or community. Patients who do not identify strongly with spiritual or religious beliefs should not be urged to do so. Spiritual and religious beliefs may influence a patient's beliefs about why they are ill, which medical interventions they are willing to pursue, rituals they would like around the time of death, and potential sources of comfort during the dying process. Although, at times, a patient's religious and spiritual beliefs may differ from the nurse's personal beliefs, the primary purpose is not to seek out differences but to discover what will be most meaningful and helpful to the patient.
CHPN Exam Overview
Last Updated: 04/18/2018