Certified Hospice and Palliative Nursing Assistant (CHPNA) — Questions and Answers

Question 1: Which of the following is an appropriate way to support the family during the active dying phase?

Insist family follow strict hospital routines
Discourage family from speaking to the patient
Restrict family visitation to reduce disruption
Educate the family about what to expect and encourage them to stay if they wish (Correct answer)

Correct answer: Educate the family about what to expect and encourage them to stay if they wish

Educating family about the dying process and encouraging their presence helps reduce fear and allows them to support their loved one during this critical time.

Question 2: Which of the following is an example of nonverbal communication?

Using medical terminology
Maintaining appropriate eye contact and a calm expression (Correct answer)
Writing a care plan
Asking an open-ended question

Correct answer: Maintaining appropriate eye contact and a calm expression

Nonverbal communication includes body language, facial expressions, eye contact, posture, and touch, all of which convey empathy and attentiveness.

Question 3: The concept of 'total pain' in palliative care includes:

Only physical pain
Pain that requires opioid medication
Pain from surgery only
Physical, emotional, social, and spiritual pain (Correct answer)

Correct answer: Physical, emotional, social, and spiritual pain

Dame Cicely Saunders introduced 'total pain' to describe the multidimensional suffering experienced by dying patients, encompassing physical, emotional, social, and spiritual dimensions.

Question 4: When performing a back massage for a hospice patient, which area should be avoided?

The shoulders and upper back
The lower back
Directly over the spine and bony prominences (Correct answer)
The sides of the back

Correct answer: Directly over the spine and bony prominences

Massaging directly over the spine or bony prominences can cause tissue damage, especially in patients with fragile skin or compromised circulation.

Question 5: What is 'complicated grief'?

Prolonged, intense grief that impairs functioning and does not follow a normal healing trajectory (Correct answer)
Grief experienced by children only
Grief that lasts less than two weeks
Grief that requires surgical treatment

Correct answer: Prolonged, intense grief that impairs functioning and does not follow a normal healing trajectory

Complicated grief (also called prolonged grief disorder) is an intense, prolonged grief response that significantly impairs daily functioning and does not improve over time.

Question 6: Which footwear is most appropriate for an ambulatory hospice patient to reduce fall risk?

Bare feet to feel the floor surface
Non-skid slippers or shoes with a firm sole (Correct answer)
Thick socks without shoes for comfort
Lightweight sandals for ease of putting on and off

Correct answer: Non-skid slippers or shoes with a firm sole

Non-skid footwear with a firm sole provides traction and stability, significantly reducing the risk of falls in ambulatory patients.

Question 7: What is the nursing assistant's role in spiritual care?

Prescribe spiritual activities
Observe and report spiritual concerns to the care team and provide respectful, non-judgmental presence (Correct answer)
Conduct religious rituals for the patient
Lead prayer sessions for patients

Correct answer: Observe and report spiritual concerns to the care team and provide respectful, non-judgmental presence

Nursing assistants observe patients for signs of spiritual distress, provide non-judgmental presence, and report concerns to the supervising nurse or chaplain.

Question 8: What is 'life review' in hospice care?

A process where the patient reflects on their life experiences, finding meaning and resolution (Correct answer)
A psychological test
A medical history assessment
A financial review for estate planning

Correct answer: A process where the patient reflects on their life experiences, finding meaning and resolution

Life review is a therapeutic process in which patients reflect on their life experiences and relationships, which can bring a sense of meaning, peace, and resolution near the end of life.

Question 9: What is 'death rattle' and how should the nursing assistant respond?

Noisy breathing from secretions in the throat; reposition gently and reassure the family (Correct answer)
Normal snoring; no action needed
A sign of pain; administer pain medication immediately
A type of cardiac arrhythmia; call 911

Correct answer: Noisy breathing from secretions in the throat; reposition gently and reassure the family

Death rattle refers to the gurgling or rattling sound caused by secretions pooling in the throat of a dying patient; repositioning and family education are appropriate responses.

Question 10: Before providing hair care to a hospice patient, what should the nursing assistant consider first?

The patient's cultural, personal, and religious preferences regarding their hair (Correct answer)
The most efficient method to complete hair care quickly
Whether the hair appears clean enough to delay washing
The patient's hair texture and the most efficient styling method

Correct answer: The patient's cultural, personal, and religious preferences regarding their hair

Cultural, personal, and religious beliefs may significantly influence how a patient wants their hair cared for, and these preferences must be respected in hospice care.

Question 11: Opioids used in hospice care are primarily prescribed to:

Hasten death
Sedate the patient permanently
Replace all other medications
Relieve pain and dyspnea (Correct answer)

Correct answer: Relieve pain and dyspnea

Opioids in hospice care are used to relieve pain and dyspnea (difficulty breathing), improving patient comfort and quality of life.

Question 12: A nursing assistant notices that a colleague is providing substandard care to a hospice patient. The appropriate action is to:

Wait to see if the behavior continues
Report the observation to the supervising nurse immediately (Correct answer)
Ignore it as it is not their responsibility
Confront the colleague in front of the patient

Correct answer: Report the observation to the supervising nurse immediately

Reporting substandard care to the supervising nurse is an ethical and professional obligation that protects patient safety and quality of care.

Question 13: What is 'informed consent' in healthcare?

A form signed only by physicians
Signing any form before treatment
A patient's voluntary agreement to a treatment after receiving complete information about risks, benefits, and alternatives (Correct answer)
Permission from the family for all procedures

Correct answer: A patient's voluntary agreement to a treatment after receiving complete information about risks, benefits, and alternatives

Informed consent requires that the patient receive complete information about proposed treatments and voluntarily agrees before any procedure or treatment begins.

Question 14: What is 'respite care' in the context of hospice?

Spiritual counseling for the patient
Emergency treatment for the patient
A type of pain medication
Short-term inpatient care to give the family caregiver a temporary rest (Correct answer)

Correct answer: Short-term inpatient care to give the family caregiver a temporary rest

Respite care provides temporary inpatient care for the hospice patient so that the primary family caregiver can rest and recharge.

Question 15: Which of the following best describes the hospice philosophy?

Exclusively hospital-based care
Comfort-focused care that affirms life and regards dying as a normal process (Correct answer)
Isolation of the patient from family
Aggressive treatment to prolong life

Correct answer: Comfort-focused care that affirms life and regards dying as a normal process

The hospice philosophy views dying as a natural part of life and focuses on providing comfort, dignity, and support to patients and families.

Question 16: When assisting a patient with a weak left arm to get dressed, which arm should be dressed first?

The right (stronger) arm first for patient comfort
The left (weaker) arm first (Correct answer)
Either arm — it does not matter
Have the patient dress themselves starting with either side

Correct answer: The left (weaker) arm first

Dressing the weaker arm first reduces the amount of manipulation needed and makes it easier to get the garment on without overstretching the affected limb.

Question 17: When providing perineal care to a female hospice patient, in which direction should the nursing assistant cleanse?

From front to back (Correct answer)
In a circular motion around the perineum
From back to front
Side to side across the perineum

Correct answer: From front to back

Cleansing from front to back (urethra toward rectum) prevents the introduction of fecal bacteria into the urinary tract, reducing infection risk.

Question 18: The concept of 'dignity therapy' in palliative care focuses on:

Treating pressure injuries
Physical therapy exercises
Medication management
Helping patients explore their life history and legacy to enhance sense of dignity and meaning (Correct answer)

Correct answer: Helping patients explore their life history and legacy to enhance sense of dignity and meaning

Dignity therapy is a psychotherapeutic intervention that helps patients reflect on their life, values, and legacy to maintain a sense of dignity and meaning near the end of life.

Question 19: What does 'comfort measures only' mean in a hospice plan of care?

No medications are given
Family members provide all care
Care is focused on relieving symptoms rather than curing disease (Correct answer)
The patient receives no medical attention

Correct answer: Care is focused on relieving symptoms rather than curing disease

Comfort measures only means the treatment plan focuses on alleviating symptoms and maximizing quality of life rather than pursuing curative interventions.

Question 20: Which of the following is a sign of psychosocial distress in a hospice patient?

Calmly discussing plans
Social withdrawal, increased crying, expressions of hopelessness (Correct answer)
Eating regular meals
Sleeping the recommended hours

Correct answer: Social withdrawal, increased crying, expressions of hopelessness

Signs of psychosocial distress include withdrawal from relationships, increased tearfulness, expressions of hopelessness or worthlessness, and loss of interest in activities.

Question 21: When performing passive range-of-motion exercises on a hospice patient, what is the key principle to follow?

Perform only on joints specifically ordered by the physician
Push joints until resistance is felt to maintain flexibility
Move each joint quickly to complete exercises efficiently
Support the joint above and below and move slowly within the pain-free range (Correct answer)

Correct answer: Support the joint above and below and move slowly within the pain-free range

Supporting the joint above and below while moving slowly within the pain-free range prevents injury and discomfort during passive range-of-motion exercises.

Question 22: When should the nursing assistant report a change in a patient's pain level?

Only when the family is present
Immediately when a significant change is observed (Correct answer)
Only at the end of the shift
Only if the patient asks them to

Correct answer: Immediately when a significant change is observed

Any significant change in a patient's pain level should be reported to the supervising nurse immediately so appropriate interventions can be made.

Question 23: When providing oral care to an unconscious hospice patient, what is the most important safety precaution?

Apply lip balm before cleaning the teeth
Use a full cup of water to rinse the mouth thoroughly
Use a hard-bristle toothbrush for thorough cleaning
Position the patient's head to the side to prevent aspiration (Correct answer)

Correct answer: Position the patient's head to the side to prevent aspiration

Turning the head to the side allows fluids to drain out and prevents aspiration into the airway in a patient who cannot protect their own airway.

Question 24: Which statement is most appropriate when offering condolences to a grieving family member?

'I am so sorry for your loss. I am here if you need anything.' (Correct answer)
'At least they are no longer suffering.'
'I know exactly how you feel.'
'You should feel better soon.'

Correct answer: 'I am so sorry for your loss. I am here if you need anything.'

Expressing sincere condolences and offering presence is most appropriate; avoid minimizing grief or making assumptions about how the person feels.

Question 25: Who on the hospice team is most responsible for psychosocial support and assessing family dynamics?

Physician
Hospice social worker (Correct answer)
Home health aide supervisor
Nursing assistant

Correct answer: Hospice social worker

The hospice social worker is trained to assess psychosocial needs, provide counseling, and support family dynamics and community resources.

Question 26: When communicating with a patient from a different cultural background, the nursing assistant should:

Speak louder to ensure understanding
Respect individual and cultural differences and ask about preferences (Correct answer)
Avoid the topic of death entirely
Assume all patients have the same beliefs

Correct answer: Respect individual and cultural differences and ask about preferences

Effective communication requires recognizing and respecting cultural differences in beliefs, rituals, communication styles, and end-of-life preferences.

Question 27: How often should a bedridden hospice patient typically be repositioned to prevent pressure injuries?

Every 6 to 8 hours
Once per shift
Only when the patient requests it
Every 2 hours (Correct answer)

Correct answer: Every 2 hours

Repositioning every 2 hours relieves prolonged pressure on bony prominences and reduces the risk of pressure injuries in immobile patients.

Question 28: HIPAA in hospice care requires the nursing assistant to:

Discuss patients in public areas for efficiency
Protect patient privacy and only share information on a need-to-know basis (Correct answer)
Post care plans in the patient's room for all visitors
Share patient information with anyone who asks

Correct answer: Protect patient privacy and only share information on a need-to-know basis

HIPAA requires all healthcare workers, including nursing assistants, to protect patient health information and only share it with authorized individuals for care purposes.

Question 29: Bereavement care by the hospice nursing assistant primarily involves:

Managing the estate of the deceased
Prescribing grief medications
Only attending the funeral
Offering condolences, a listening ear, and connecting the family to bereavement resources (Correct answer)

Correct answer: Offering condolences, a listening ear, and connecting the family to bereavement resources

The nursing assistant can support bereaved families by offering sincere condolences, compassionate listening, and referring them to the hospice bereavement counselor.

Question 30: Constipation in hospice patients is most commonly caused by:

Opioid medications, reduced mobility, and decreased intake (Correct answer)
Antibiotic use
High-fiber diet
Excessive fluid intake

Correct answer: Opioid medications, reduced mobility, and decreased intake

Constipation in hospice patients is commonly caused by opioid-induced slowing of the bowel, reduced physical activity, and decreased food and fluid intake.

Question 31: A family member asks the nursing assistant to share the patient's prognosis. The nursing assistant should:

Tell the family member the patient is going to die soon
Provide the prognosis based on their own assessment
Refer the family member to the nurse or physician for clinical questions (Correct answer)
Tell the family member not to ask questions

Correct answer: Refer the family member to the nurse or physician for clinical questions

Clinical information about prognosis is outside the nursing assistant's scope of practice and should be directed to the nurse or physician.

Question 32: A hospice patient refuses their morning bath. What is the most appropriate response by the nursing assistant?

Perform a partial bath while the patient is distracted with conversation
Skip all personal care for that entire day
Respect the refusal, inform the nurse, and document without forcing care (Correct answer)
Insist on the bath because it is required for hygiene and infection prevention

Correct answer: Respect the refusal, inform the nurse, and document without forcing care

Patients have the right to refuse care; the nursing assistant must respect this right, notify the nurse, and document the refusal without coercing the patient.

Question 33: What is the recommended water temperature when bathing a hospice patient?

Whatever temperature the patient requests without independent verification
Warm water around 105 to 110°F tested with a thermometer or the wrist (Correct answer)
Hot water around 115°F for thorough cleansing
Cool water around 65 to 70°F to prevent overheating

Correct answer: Warm water around 105 to 110°F tested with a thermometer or the wrist

Warm water around 105 to 110°F is comfortable and safe; testing with a thermometer or wrist prevents burns, especially for patients with decreased sensation.

Question 34: Which of the following is a physical sign that death may be approaching within hours to days?

Mottling of the skin, cooling of extremities, and changes in breathing (Correct answer)
Elevated blood pressure
Increased urine output
Increased appetite and energy

Correct answer: Mottling of the skin, cooling of extremities, and changes in breathing

Mottling (purplish blotchy skin discoloration), cooling of extremities, changes in breathing patterns, and decreased urine output are signs that death is approaching.

Question 35: What is the nursing assistant's role in family education about the dying process?

Reinforce information already given by the nurse, answer simple questions, and refer complex questions to the nurse (Correct answer)
Provide detailed clinical lectures to the family
Avoid discussing the dying process with the family
Tell the family everything they need to know independently

Correct answer: Reinforce information already given by the nurse, answer simple questions, and refer complex questions to the nurse

Nursing assistants reinforce teachings provided by the nurse, answer simple supportive questions, and refer clinical or complex questions to the nurse.

Question 36: What does 'anticipatory grief' mean?

Complicated grief requiring hospitalization
Grief that occurs years after a death
Grief that is unrelated to death
Grief experienced before a death occurs, as family and patients prepare for loss (Correct answer)

Correct answer: Grief experienced before a death occurs, as family and patients prepare for loss

Anticipatory grief is the mourning process that begins before a death occurs, as patients and families begin coping with the anticipated loss.

Question 37: What is the most important action a nursing assistant can take when a patient reports new or worsening symptoms?

Document the symptom and immediately notify the supervising nurse (Correct answer)
Adjust the patient's medication dosage
Reassure the patient without reporting
Wait until the next scheduled visit

Correct answer: Document the symptom and immediately notify the supervising nurse

The nursing assistant must document observed or reported symptoms and notify the supervising nurse promptly so that medical interventions can be initiated.

Question 38: What is the role of the nursing assistant in hospice care?

Prescribe medications
Provide personal care, assist with ADLs, and report changes to the nurse (Correct answer)
Create care plans independently
Diagnose new conditions

Correct answer: Provide personal care, assist with ADLs, and report changes to the nurse

Hospice nursing assistants provide personal care, assist with activities of daily living, and report any observed changes in the patient's condition to the supervising nurse.

Question 39: What does 'therapeutic communication' mean in hospice care?

Communicating only about physical symptoms
Therapy sessions led by the nursing assistant
Communication that promotes the emotional well-being and comfort of the patient (Correct answer)
Using medical terminology exclusively

Correct answer: Communication that promotes the emotional well-being and comfort of the patient

Therapeutic communication uses specific techniques to support emotional well-being, build trust, and comfort patients and families in difficult situations.

Question 40: A hospice patient with left-sided weakness needs assistance with ambulation. Where should the nursing assistant position themselves?

On the patient's left (weak) side (Correct answer)
Behind the patient to catch them if they fall backward
On the patient's right (strong) side
In front of the patient to guide them forward

Correct answer: On the patient's left (weak) side

Standing on the weak side allows the nursing assistant to provide the most support where the patient is most vulnerable to losing balance during ambulation.

Question 41: What does 'scope of practice' mean for a nursing assistant?

The legal and professional boundaries that define what a nursing assistant is permitted to do (Correct answer)
The geographic area where a nursing assistant can work
The hours a nursing assistant is allowed to work
The number of patients a nursing assistant can see per day

Correct answer: The legal and professional boundaries that define what a nursing assistant is permitted to do

Scope of practice refers to the legally and professionally defined range of duties and responsibilities a nursing assistant is trained and permitted to perform.

Question 42: Depression is common in hospice patients. The nursing assistant's role is to:

Diagnose and treat depression independently
Ignore emotional symptoms and focus on physical care
Prescribe antidepressants
Recognize signs of depression and report them to the supervising nurse (Correct answer)

Correct answer: Recognize signs of depression and report them to the supervising nurse

While the nursing assistant cannot diagnose or treat depression, they play a vital role in recognizing symptoms and reporting them to the nurse for appropriate intervention.

Question 43: When performing personal hygiene on a patient in the final stage of life, the nursing assistant should prioritize:

Using full bed baths twice daily regardless of patient tolerance
Minimal handling to reduce discomfort, and maintaining dignity throughout (Correct answer)
Completing tasks as quickly as possible
Completing all tasks in a strict order

Correct answer: Minimal handling to reduce discomfort, and maintaining dignity throughout

In the final stage of life, care should be gentle, minimize discomfort, and always preserve the patient's dignity and sense of self.

Question 44: What does 'breakthrough pain' mean in palliative care?

Pain that occurs only at night
A sudden flare of pain occurring despite baseline pain control (Correct answer)
Pain caused by the medication itself
Pain that requires surgical intervention

Correct answer: A sudden flare of pain occurring despite baseline pain control

Breakthrough pain is a transient, sudden flare of intense pain that occurs despite a patient being on a scheduled pain medication regimen.

Question 45: Cultural awareness in end-of-life care is important because:

Cultural beliefs affect how patients and families experience grief, rituals, and death (Correct answer)
Cultural differences are irrelevant in medical care
All patients respond to death the same way
Culture only matters for language barriers

Correct answer: Cultural beliefs affect how patients and families experience grief, rituals, and death

Cultural beliefs, values, and practices strongly influence how patients and families understand death, grieve, and perform rituals—nursing assistants must be respectful and aware.

Question 46: What is the purpose of a 'comfort kit' (also called emergency kit) in hospice home care?

To provide medications for common end-of-life symptoms like pain, anxiety, and secretions without waiting for a pharmacy (Correct answer)
To be used only by physicians
To replace all regularly scheduled medications
To treat new infections at home

Correct answer: To provide medications for common end-of-life symptoms like pain, anxiety, and secretions without waiting for a pharmacy

A comfort kit contains pre-prescribed medications for common end-of-life symptoms (pain, anxiety, secretions, nausea) so symptoms can be managed quickly in the home setting.

Question 47: When preparing to transfer an ambulatory patient from the bed to a wheelchair, how should the chair be positioned?

At a 45-degree angle to the bed with brakes locked and footrests moved aside (Correct answer)
Directly in front of the patient facing them
Parallel to the bed with brakes unlocked to allow easy adjustment
As far from the bed as possible to give the patient room to pivot

Correct answer: At a 45-degree angle to the bed with brakes locked and footrests moved aside

Positioning the wheelchair at a 45-degree angle with locked brakes and cleared footrests minimizes transfer distance and significantly reduces fall risk.

Question 48: Which Medicare benefit covers hospice services?

Medicare Part B
Medicare Part C
Medicare Part A (Correct answer)
Medicare Part D

Correct answer: Medicare Part A

Hospice services in the US are covered under Medicare Part A for eligible beneficiaries with a terminal prognosis of 6 months or less.

Question 49: Which symptom is characterized by a persistent feeling of nausea and inability to eat?

Hyperthyroidism
Dehydration alone
Anorexia-cachexia syndrome (Correct answer)
Hyperglycemia

Correct answer: Anorexia-cachexia syndrome

Anorexia-cachexia syndrome is common in terminal illness and involves loss of appetite, weight loss, and metabolic changes that reduce the desire and ability to eat.

Question 50: A patient receiving hospice care asks about returning to curative treatment. What should the nursing assistant do?

Ignore the request
Report the request to the nurse or care team immediately (Correct answer)
Tell the patient it is not allowed
Contact the patient's insurance company

Correct answer: Report the request to the nurse or care team immediately

The nursing assistant should report the patient's request to the supervising nurse so the care team can discuss the patient's options, including the right to revoke hospice.

Question 51: Who on the hospice interdisciplinary team is primarily responsible for addressing spiritual needs?

Chaplain or spiritual care counselor (Correct answer)
Physical therapist
Physician
Nursing assistant

Correct answer: Chaplain or spiritual care counselor

The hospice chaplain or spiritual care counselor is trained to address spiritual needs, though all team members support holistic care and can alert the chaplain to patient needs.

Question 52: When a patient or family member requests a specific religious ritual, the nursing assistant should:

Only accommodate Christian requests
Facilitate the request by notifying the nurse and chaplain, and accommodate as able (Correct answer)
Decide whether the ritual is appropriate
Decline all religious requests

Correct answer: Facilitate the request by notifying the nurse and chaplain, and accommodate as able

The nursing assistant should respectfully facilitate religious and spiritual requests by notifying the appropriate team members and accommodating the patient's needs within policy.

Question 53: Which pain scale uses faces to rate pain level and is commonly used with cognitively impaired patients?

Wong-Baker FACES Pain Scale (Correct answer)
Visual Analog Scale (VAS)
McGill Pain Questionnaire
Numeric Rating Scale (NRS)

Correct answer: Wong-Baker FACES Pain Scale

The Wong-Baker FACES Pain Scale uses facial expressions to help patients who cannot verbally rate their pain, making it useful for cognitively impaired or pediatric patients.

Question 54: Which type of question encourages a patient to share more about their feelings?

Closed-ended questions (yes/no)
Rhetorical questions
Leading questions
Open-ended questions (Correct answer)

Correct answer: Open-ended questions

Open-ended questions invite the patient to share more detail and express their feelings, promoting therapeutic conversation.

Question 55: Which of the following is a common sign of uncontrolled pain in a non-verbal patient?

Increased appetite
Facial grimacing, moaning, or restlessness (Correct answer)
Relaxed facial muscles
Slow, deep breathing

Correct answer: Facial grimacing, moaning, or restlessness

Non-verbal signs of pain include facial grimacing, furrowing of brows, moaning, guarding, and increased restlessness or agitation.

Question 56: Which document outlines what life-sustaining treatments a patient does or does not want?

Living will (advance directive) (Correct answer)
Insurance form
Nursing assessment
Care plan

Correct answer: Living will (advance directive)

A living will is an advance directive that specifies a patient's wishes about life-sustaining treatments, such as ventilators or feeding tubes, in case they cannot communicate.

Question 57: Which principle requires treating all patients fairly regardless of their background?

Nonmaleficence
Justice (Correct answer)
Beneficence
Autonomy

Correct answer: Justice

Justice is the ethical principle that requires fair and equitable treatment for all patients, regardless of their background, beliefs, or social status.

Question 58: A patient expresses that they fear they have not lived a good life. This is best identified as:

Spiritual distress (Correct answer)
Cognitive decline
Physical pain
Financial distress

Correct answer: Spiritual distress

Expressing guilt, regret, or fear about one's life is a sign of spiritual distress and should be reported to the chaplain or nurse for appropriate follow-up.

Question 59: What does 'nonmaleficence' mean?

Promote health at all costs
Ensure equal treatment
Respect patient choices
Do no harm (Correct answer)

Correct answer: Do no harm

Nonmaleficence is the principle of doing no harm, meaning healthcare providers must avoid actions that cause unnecessary harm to the patient.

Question 60: What is 'double effect' in palliative care ethics?

When two team members provide the same care
The principle that an action intended to do good may have a foreseen but unintended harmful side effect (Correct answer)
When two medications are given simultaneously
A double dose of pain medication

Correct answer: The principle that an action intended to do good may have a foreseen but unintended harmful side effect

The doctrine of double effect justifies giving medications (like opioids) to relieve suffering even if they may secondarily hasten death, provided the primary intent is comfort.

Question 61: What is a healthcare proxy?

A document listing all medications
A type of insurance plan
A person designated to make healthcare decisions if the patient is unable to do so (Correct answer)
A physician who manages hospice care

Correct answer: A person designated to make healthcare decisions if the patient is unable to do so

A healthcare proxy (also called a healthcare power of attorney) is a person legally designated to make medical decisions on behalf of a patient who cannot make decisions for themselves.

Question 62: If the nursing assistant suspects patient abuse or neglect, they are legally required to:

Handle it within the care team without reporting
Wait to see if it happens again
Confront the abuser directly
Report it to the supervising nurse and follow mandatory reporting laws (Correct answer)

Correct answer: Report it to the supervising nurse and follow mandatory reporting laws

Nursing assistants are mandated reporters and must report suspected abuse or neglect to the supervising nurse and, if required, to state authorities.

Question 63: Which non-pharmacological comfort measure may help relieve pain in hospice patients?

Administering IV fluids
Prescribing stronger opioids
Ordering laboratory tests
Repositioning and gentle massage (Correct answer)

Correct answer: Repositioning and gentle massage

Non-pharmacological measures such as repositioning, gentle massage, heat/cold application, and relaxation techniques can help complement pain medication.

Question 64: What is 'mottling' in the context of end-of-life care?

Yellowing of the skin
Blotchy, purplish discoloration of the skin due to poor circulation (Correct answer)
Swelling of the extremities
A rash caused by medication

Correct answer: Blotchy, purplish discoloration of the skin due to poor circulation

Mottling is a blotchy, irregular purplish discoloration of the skin caused by slowing circulation as the body shuts down, typically starting in the knees and feet.

Question 65: Documentation in hospice care is important because it:

Is optional for nursing assistants
Provides a legal record of care, ensures continuity, and supports communication among the team (Correct answer)
Only needs to be done weekly
Is only for billing purposes

Correct answer: Provides a legal record of care, ensures continuity, and supports communication among the team

Accurate documentation provides a legal record, ensures all team members have current information for care continuity, and supports quality and accountability.

Question 66: The term 'imminently dying' refers to a patient expected to die within:

Hours to days (Correct answer)
1 month
6 months
1 week

Correct answer: Hours to days

Imminently dying means the patient is in the final hours to days of life, with observable physiological changes indicating death is very near.

Question 67: What does POLST stand for in end-of-life care?

Palliative Options for Long-term Support and Treatment
Physician Orders for Life-Sustaining Treatment (Correct answer)
Patient-Oriented Life Support Treatment
Patient Orders for Legal Sustaining Treatment

Correct answer: Physician Orders for Life-Sustaining Treatment

POLST (Physician Orders for Life-Sustaining Treatment) is a medical order form that translates a patient's end-of-life wishes into actionable medical orders.

Question 68: Which factor can make communication more challenging in hospice care?

Patients having too many options
Cultural differences, language barriers, and altered consciousness (Correct answer)
Patients being overly communicative
Too many care team members

Correct answer: Cultural differences, language barriers, and altered consciousness

Cultural differences, language barriers, cognitive changes, and altered states of consciousness can all make effective communication more challenging in hospice.

Question 69: Hospice care is typically provided to patients who have a prognosis of how long to live?

6 months or less (Correct answer)
3 months or less
24 months or less
12 months or less

Correct answer: 6 months or less

Hospice care in the US is generally available to patients with a terminal diagnosis and a prognosis of 6 months or less if the disease follows its normal course.

Question 70: Dyspnea in a dying patient is best described as:

Only occurring in patients with lung disease
The subjective sensation of difficulty or discomfort in breathing (Correct answer)
Always accompanied by low oxygen saturation
A normal side effect of all medications

Correct answer: The subjective sensation of difficulty or discomfort in breathing

Dyspnea is the subjective experience of breathlessness or difficulty breathing and can occur even when oxygen levels appear normal.

Question 71: What is the primary purpose of using a draw sheet when repositioning a patient up in bed?

To keep the patient warm during repositioning
To reduce friction and shear forces on the patient's skin during movement (Correct answer)
To safely restrain the patient during care activities
To absorb moisture away from the patient's skin

Correct answer: To reduce friction and shear forces on the patient's skin during movement

A draw sheet reduces friction and shear forces on the skin during repositioning, which helps prevent skin tears and pressure injuries in fragile patients.

Question 72: What is the primary goal of palliative care?

Provide only comfort medications
Extend life at all costs
Improve quality of life by relieving suffering (Correct answer)
Cure the underlying disease

Correct answer: Improve quality of life by relieving suffering

Palliative care focuses on improving quality of life by preventing and relieving suffering through early identification and treatment of pain and other problems.

Question 73: When speaking with a patient who has difficulty hearing, the nursing assistant should:

Avoid talking to the patient
Speak clearly, face the patient, and use simple gestures or written notes if needed (Correct answer)
Shout to be heard
Communicate only with the family

Correct answer: Speak clearly, face the patient, and use simple gestures or written notes if needed

Speaking clearly, facing the patient, reducing background noise, and using alternative communication methods like written notes helps ensure effective communication.

Question 74: What is 'palliative sedation'?

The use of sedative medications to reduce intractable suffering in terminally ill patients near death (Correct answer)
Sedation to hasten death
Sedation used only during procedures
Routine sedation for all hospice patients

Correct answer: The use of sedative medications to reduce intractable suffering in terminally ill patients near death

Palliative sedation involves administering sedatives to reduce consciousness and relieve refractory suffering in terminally ill patients when other symptom management has failed.

Question 75: Which of the following is an example of active listening?

Maintaining eye contact, nodding, and reflecting back what the patient says (Correct answer)
Changing the subject when the patient is upset
Interrupting to offer advice
Talking about your own experiences

Correct answer: Maintaining eye contact, nodding, and reflecting back what the patient says

Active listening involves giving full attention, using non-verbal cues like eye contact and nodding, and reflecting the patient's words to show understanding.

Question 76: What does 'beneficence' mean in healthcare ethics?

Follow the patient's every wish
Treat all patients equally
Do no harm
Act in the patient's best interest and promote their well-being (Correct answer)

Correct answer: Act in the patient's best interest and promote their well-being

Beneficence means acting in the patient's best interest and taking positive steps to promote their health and well-being.

Question 77: Which assessment tool is used to evaluate pain in non-verbal or cognitively impaired patients?

APGAR Score
Glasgow Coma Scale
PAINAD (Pain Assessment in Advanced Dementia) Scale (Correct answer)
Numeric Rating Scale (0–10)

Correct answer: PAINAD (Pain Assessment in Advanced Dementia) Scale

The PAINAD scale assesses pain in patients with advanced dementia by observing breathing, vocalization, facial expression, body language, and consolability.

Question 78: Which of the following best describes 'terminal restlessness'?

Restlessness caused by caffeine
A sign of improving condition
A side effect of antibiotics
Agitation, confusion, and purposeless movements occurring near the end of life (Correct answer)

Correct answer: Agitation, confusion, and purposeless movements occurring near the end of life

Terminal restlessness (also called terminal agitation) is a state of agitation, confusion, and involuntary movements that can occur in the final hours or days of life.

Question 79: A hospice patient reports that they have made peace with dying. The nursing assistant should:

Challenge the statement to assess for depression
Acknowledge this as a positive sign and document or report it to the nurse (Correct answer)
Tell the patient this is not possible
Immediately call a psychiatrist

Correct answer: Acknowledge this as a positive sign and document or report it to the nurse

Acceptance of dying can be a healthy sign of resolution; the nursing assistant should acknowledge it respectfully and communicate it to the care team.

Question 80: Which of the following comfort measures can help a patient experiencing dyspnea?

Positioning the patient upright and using a fan directed at the face (Correct answer)
Administering a diuretic medication
Increasing oral fluid intake
Placing the patient flat in bed

Correct answer: Positioning the patient upright and using a fan directed at the face

Elevating the head of the bed and directing a gentle fan toward the patient's face can reduce the sensation of breathlessness by stimulating receptors in the nasal passage.

Question 81: When performing skin care for a hospice patient with edema, the nursing assistant should:

Handle the skin gently, keep it clean and dry, and report any skin breakdown (Correct answer)
Massage edematous areas vigorously
Apply firm pressure to reduce swelling
Ignore minor skin changes

Correct answer: Handle the skin gently, keep it clean and dry, and report any skin breakdown

Edematous skin is fragile and at high risk for breakdown; gentle handling, keeping skin clean and dry, and promptly reporting any changes is essential.

Question 82: Mouth care in hospice is important primarily because:

It is required by insurance companies
It prevents pneumonia in all cases
It prevents tooth decay for future dental visits
It reduces xerostomia (dry mouth) and improves comfort (Correct answer)

Correct answer: It reduces xerostomia (dry mouth) and improves comfort

Regular mouth care helps relieve xerostomia (dry mouth), which is common in terminal patients due to reduced fluid intake and mouth breathing, improving overall comfort.

Question 83: In hospice care, bereavement support is provided for how long after a patient's death?

5 years
1 month
6 months
At least 13 months (Correct answer)

Correct answer: At least 13 months

Medicare-certified hospice programs are required to provide bereavement services to surviving family members for at least 13 months following the patient's death.

Question 84: Palliative care can be provided:

Alongside curative treatment at any stage of serious illness (Correct answer)
Only at the end of life
Only in hospitals
Only after all curative options have been exhausted

Correct answer: Alongside curative treatment at any stage of serious illness

Palliative care can be provided at any stage of a serious illness and can be given alongside curative or life-prolonging treatments.

Question 85: During personal care, which observation must be reported immediately to the nurse?

The patient's hair is tangled and needs conditioning treatment
A new area of redness over a bony prominence that does not blanch when pressed (Correct answer)
The patient prefers a morning bath rather than an evening bath
The patient's skin is dry and needs moisturizing lotion

Correct answer: A new area of redness over a bony prominence that does not blanch when pressed

Non-blanchable redness over a bony prominence is a Stage 1 pressure injury that requires prompt nursing assessment and intervention to prevent progression.

Question 86: Which of the following is the nursing assistant's role in pain management?

Prescribing PRN pain medications
Ordering pain consultations
Adjusting opioid dosages
Observing and reporting pain, providing comfort measures, and assisting with positioning (Correct answer)

Correct answer: Observing and reporting pain, providing comfort measures, and assisting with positioning

The nursing assistant observes and reports pain cues, applies non-pharmacological comfort measures, and assists with positioning while the nurse manages medications.

Question 87: Which of the following is a core principle of hospice care?

Maximizing hospital admissions
Treating the patient and family as a unit of care (Correct answer)
Focusing solely on the patient's physical needs
Avoiding all pain medications

Correct answer: Treating the patient and family as a unit of care

Hospice care treats the patient and family together as the unit of care, providing support for both the dying individual and those who love them.

Question 88: A patient revokes their hospice election. The nursing assistant should:

Ignore the request until the next visit
Notify the supervising nurse immediately and document the patient's statement (Correct answer)
Contact the insurance company directly
Try to convince the patient to stay in hospice

Correct answer: Notify the supervising nurse immediately and document the patient's statement

Patients have the right to revoke hospice at any time; the nursing assistant must report this to the nurse immediately so the care team can respond appropriately.

Question 89: Hearing is believed to be one of the last senses to fade. How does this affect nursing assistant care?

The nursing assistant should speak softly, identify themselves, and offer comforting words (Correct answer)
The nursing assistant should avoid speaking near the patient
It has no effect on care delivery
The nursing assistant should increase the TV volume

Correct answer: The nursing assistant should speak softly, identify themselves, and offer comforting words

Because hearing may persist even when the patient is unresponsive, nursing assistants should speak gently, identify themselves, and offer words of comfort to the patient.

Question 90: After a patient's death, what is the nursing assistant's first responsibility?

Contact the funeral home immediately
Notify the supervising nurse and follow the agency's post-mortem care procedures (Correct answer)
Inform the insurance company
Remove all equipment from the room

Correct answer: Notify the supervising nurse and follow the agency's post-mortem care procedures

The nursing assistant should notify the supervising nurse immediately after a patient's death and follow the agency's protocols for post-mortem care.

Question 91: Which of the following is within the scope of practice for a hospice nursing assistant?

Ordering laboratory tests
Assessing and diagnosing new conditions
Providing personal hygiene care and reporting changes to the nurse (Correct answer)
Administering medications

Correct answer: Providing personal hygiene care and reporting changes to the nurse

Hospice nursing assistants are responsible for personal care, activities of daily living, comfort measures, and reporting observations to the supervising nurse.

Question 92: A family member tells the nursing assistant not to tell the patient their diagnosis. The nursing assistant should:

Immediately tell the patient their diagnosis
Comply but feel free to share if the patient asks
Inform the supervising nurse of the family's request (Correct answer)
Agree and withhold information from the patient

Correct answer: Inform the supervising nurse of the family's request

The nursing assistant should report the family's concern to the supervising nurse; disclosure decisions involve the full care team, physician, and ethical considerations.

Question 93: If a nursing assistant is asked by the physician to perform a task outside their scope of practice, they should:

Perform the task to avoid conflict
Refuse and report the request to their supervisor (Correct answer)
Do it only once
Comply if the family agrees

Correct answer: Refuse and report the request to their supervisor

Performing tasks outside of the nursing assistant's scope of practice is illegal and unsafe; refusing and reporting to a supervisor is the appropriate response.

Question 94: What is the Kübler-Ross model in relation to end-of-life care?

A medication protocol for dying patients
Five stages of grief: denial, anger, bargaining, depression, and acceptance (Correct answer)
A physical assessment scale
A pain assessment tool

Correct answer: Five stages of grief: denial, anger, bargaining, depression, and acceptance

Dr. Elisabeth Kübler-Ross described five stages of grief—denial, anger, bargaining, depression, and acceptance—that many dying patients and their families may experience.

Question 95: What is the nursing assistant's appropriate role when providing nail care for a diabetic hospice patient?

File nails gently and report any abnormalities to the nurse; do not cut nails without specific orders (Correct answer)
Trim nails short and straight across using standard nail clippers
Soak feet extensively before trimming nails
Use scissors to shape nails into a rounded form

Correct answer: File nails gently and report any abnormalities to the nurse; do not cut nails without specific orders

Diabetic patients have impaired circulation and healing; nail cutting requires a nurse or podiatrist order, and the nursing assistant should only file and report concerns.

Question 96: When a family member is distraught at the bedside of a dying patient, the nursing assistant should:

Tell them to stop crying
Offer presence, a calm demeanor, and empathetic support; notify the nurse (Correct answer)
Ignore the behavior
Ask them to leave the room

Correct answer: Offer presence, a calm demeanor, and empathetic support; notify the nurse

The nursing assistant should offer compassionate presence and emotional support to distressed family members and notify the nurse for additional support resources.

Question 97: What should the nursing assistant do if a patient expresses fear about dying?

Ignore the comment
Tell the patient everything will be fine
Listen compassionately and notify the nurse or social worker for follow-up support (Correct answer)
Change the subject to avoid the topic

Correct answer: Listen compassionately and notify the nurse or social worker for follow-up support

Active, compassionate listening and reporting the patient's emotional concerns to the nurse or social worker ensures the patient receives appropriate psychological and spiritual support.

Question 98: Decreased urine output and dark-colored urine near the end of life usually indicate:

Need for increased IV fluids
Kidney infection
Normal physiological changes as the body shuts down (Correct answer)
Medication side effects requiring immediate dose change

Correct answer: Normal physiological changes as the body shuts down

As a patient nears death, the kidneys slow down, resulting in decreased and more concentrated (darker) urine output, which is a normal part of the dying process.

Question 99: Which organization accredits hospice programs in the United States?

ANA
The Joint Commission (Correct answer)
CMS only
NHPCO

Correct answer: The Joint Commission

The Joint Commission (TJC) is a major accrediting body for hospice programs in the US, though CMS certification is also required for Medicare reimbursement.

Question 100: What is the best way a nursing assistant can support a lonely hospice patient?

Provide companionable presence, engage in conversation, and report loneliness to the nurse (Correct answer)
Focus only on physical care tasks
Leave them alone to rest
Tell them to call a friend

Correct answer: Provide companionable presence, engage in conversation, and report loneliness to the nurse

Providing caring presence, engaging in meaningful conversation, and reporting persistent loneliness to the nurse helps address the psychosocial needs of isolated patients.

Question 101: What does 'DNR' stand for in hospice care?

Do Not Resuscitate (Correct answer)
Do Not Restrict
Do Not Respond
Do Not Report

Correct answer: Do Not Resuscitate

DNR stands for Do Not Resuscitate, an advance directive indicating that CPR should not be performed if the patient's heart stops or they stop breathing.

Question 102: Which of the following is appropriate post-mortem care by the nursing assistant?

Removing the body immediately
Administering medications
Performing CPR
Bathing the body, positioning it with dignity, and allowing family time (Correct answer)

Correct answer: Bathing the body, positioning it with dignity, and allowing family time

Post-mortem care includes bathing and positioning the body with dignity and respect, and allowing family members time to say goodbye before the body is removed.

Question 103: In hospice care, which principle should guide the nursing assistant when prioritizing personal care activities for a patient?

Limit care to essential tasks only to conserve staff time
Follow the patient's preferences and adjust care to what they can tolerate that day (Correct answer)
Complete all tasks on the care plan in the listed order regardless of patient preference
Focus on tasks the nursing assistant considers most important for hygiene

Correct answer: Follow the patient's preferences and adjust care to what they can tolerate that day

Hospice philosophy centers on patient autonomy and comfort; care should always be guided by the patient's current wishes and daily tolerance level.

Question 104: Which action by the nursing assistant best supports patient dignity at end of life?

Maintaining privacy, speaking respectfully, and honoring personal and cultural preferences (Correct answer)
Making care decisions without input from patient or family
Limiting family visits to reduce crowding
Using clinical terminology to communicate with the patient

Correct answer: Maintaining privacy, speaking respectfully, and honoring personal and cultural preferences

Maintaining privacy, communicating with respect, and honoring personal, cultural, and spiritual preferences are fundamental ways the nursing assistant supports patient dignity.

Question 105: When changing bed linens with a patient remaining in bed, what is the most important safety consideration?

Remove all pillows to create more working space
Keep side rails up when not actively working on that side and never leave the patient unattended (Correct answer)
Ask the patient to grip the side rail while you turn them
Work quickly to minimize the patient's exposure to cool air

Correct answer: Keep side rails up when not actively working on that side and never leave the patient unattended

Raising side rails when not actively working on that side and never leaving a patient unattended prevents falls from the bed during linen changes.

Question 106: Which of the following actions by the nursing assistant would violate professional boundaries?

Accepting a large monetary gift from the family (Correct answer)
Assisting the patient with bathing
Listening compassionately to the patient's concerns
Reporting changes in condition to the nurse

Correct answer: Accepting a large monetary gift from the family

Accepting significant gifts from patients or families violates professional boundaries and is prohibited by most hospice agencies and professional codes of conduct.

Question 107: What is 'Cheyne-Stokes' breathing?

Breathing that requires supplemental oxygen
Normal breathing at rest
Rapid, shallow breaths indicating pain
A pattern of breathing with cycles of increasing and decreasing depth followed by periods of apnea (Correct answer)

Correct answer: A pattern of breathing with cycles of increasing and decreasing depth followed by periods of apnea

Cheyne-Stokes respiration is a cyclical breathing pattern with gradual increases and decreases in depth and rate, interspersed with periods of apnea, often seen near death.

Question 108: Which behavior demonstrates professional conduct for a hospice nursing assistant?

Maintaining confidentiality, arriving on time, and following the care plan (Correct answer)
Performing tasks outside the scope of practice if asked
Sharing personal opinions about the patient's choices
Sharing patient stories on social media

Correct answer: Maintaining confidentiality, arriving on time, and following the care plan

Professional conduct includes maintaining confidentiality, reliability, adherence to the care plan, and practicing within the defined scope of the nursing assistant role.

Question 109: What is the nursing assistant's obligation when they make an error in care?

Ask the patient not to tell anyone
Report the error immediately to the supervising nurse and document it (Correct answer)
Conceal the error to avoid consequences
Do nothing and hope it resolves

Correct answer: Report the error immediately to the supervising nurse and document it

Nursing assistants must report errors immediately to the supervising nurse and document them accurately; transparency is an ethical and professional obligation.

Question 110: What is the recommended frequency for oral care in an unconscious hospice patient?

Only when visible soiling or crusting is present
Every 8 hours, once per nursing shift
Once daily in the morning
Every 2 to 4 hours to keep mucous membranes moist and prevent infection (Correct answer)

Correct answer: Every 2 to 4 hours to keep mucous membranes moist and prevent infection

Unconscious patients cannot swallow or produce normal saliva flow, making oral care every 2 to 4 hours essential to prevent drying, infection, and discomfort.

Certified Hospice and Palliative Nursing Assistant (CHPNA)

The CHPNA certifies nursing assistants who specialize in hospice and palliative care, demonstrating competency in supporting patients and families through serious illness, symptom management, and end-of-life care. It is administered by the Hospice and Palliative Credentialing Center (HPCC).

110

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150 min

Time Limit

75%

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