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

Question 1: What is the primary goal of palliative care?

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

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

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
Contact the funeral home immediately

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 3: Which skin change may indicate the body is shutting down?

Cool, pale, or mottled skin beginning in the extremities (Correct answer)
Warm, pink, moist skin
Rash across the trunk
Increased elasticity of skin

Correct answer: Cool, pale, or mottled skin beginning in the extremities

As circulation decreases near death, the skin becomes cool and pale or develops mottled (blotchy purple-blue) discoloration beginning in the feet and knees.

Question 4: What is the role of the nursing assistant in hospice care?

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

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 5: Constipation in hospice patients is most commonly caused by:

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

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 6: If a patient says, 'I feel like a burden to my family,' the most therapeutic response is:

'Tell me more about how you're feeling.' (Correct answer)
'I'll ask your family if they agree.'
'Don't worry, your family is fine.'
'That is not true.'

Correct answer: 'Tell me more about how you're feeling.'

Encouraging the patient to share more promotes therapeutic communication, validates their feelings, and allows deeper support of emotional needs.

Question 7: What is 'informed consent' in healthcare?

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

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

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

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 9: When assisting a hospice patient with a bed bath, which approach best supports patient dignity?

Ask family members to leave only if the patient specifically requests it
Expose only the body part being washed while keeping the rest covered (Correct answer)
Keep the patient fully exposed throughout to monitor skin condition
Complete the bath as quickly as possible to minimize discomfort

Correct answer: Expose only the body part being washed while keeping the rest covered

Exposing only one body part at a time preserves privacy, maintains warmth, and respects the patient's dignity during personal care.

Question 10: Which Medicare benefit covers hospice services?

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

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

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

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 12: 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 13: Dyspnea in a dying patient is best described as:

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

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 14: Spirituality in palliative care is best described as:

A clinical symptom requiring medication
Only formal religious practice
Attendance at religious services
The dimension of life that relates to meaning, purpose, and connection—which may or may not include religion (Correct answer)

Correct answer: The dimension of life that relates to meaning, purpose, and connection—which may or may not include religion

Spirituality encompasses the search for meaning, purpose, and connection, and is broader than religion—it can be expressed in many forms regardless of religious belief.

Question 15: Which of the following is a physical sign that death may be approaching within hours to days?

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

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

Only when the patient requests it
Once per shift
Every 6 to 8 hours
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 17: Decreased urine output and dark-colored urine near the end of life usually indicate:

Need for increased IV fluids
Normal physiological changes as the body shuts down (Correct answer)
Kidney infection
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 18: Which of the following is a sign of psychosocial distress in a hospice patient?

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

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

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

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 20: What does 'anticipatory grief' mean?

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)
Complicated grief requiring hospitalization

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

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

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

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

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

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

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

Inform the supervising nurse of the family's request (Correct answer)
Comply but feel free to share if the patient asks
Immediately tell the patient their diagnosis
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 25: Hearing is believed to be one of the last senses to fade. How does this affect nursing assistant care?

It has no effect on care delivery
The nursing assistant should speak softly, identify themselves, and offer comforting words (Correct answer)
The nursing assistant should avoid speaking near the patient
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 26: Which type of question encourages a patient to share more about their feelings?

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

Correct answer: Open-ended questions

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

Question 27: Who on the hospice interdisciplinary team is primarily responsible for addressing spiritual needs?

Physical therapist
Chaplain or spiritual care counselor (Correct answer)
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 28: Mouth care in hospice is important primarily because:

It prevents pneumonia in all cases
It is required by insurance companies
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 29: What should the nursing assistant do if a patient expresses fear about dying?

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

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 30: What does 'DNR' stand for in hospice care?

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

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

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

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

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

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 33: Which of the following best describes 'terminal restlessness'?

A side effect of antibiotics
A sign of improving condition
Restlessness caused by caffeine
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 34: How should the nursing assistant respond to a patient's spiritual or religious request that differs from their own beliefs?

Respect the patient's beliefs without imposing their own and notify the chaplain (Correct answer)
Politely decline all religious discussions
Share their own religious views to help the patient
Ignore the request

Correct answer: Respect the patient's beliefs without imposing their own and notify the chaplain

Respecting the patient's beliefs without imposing personal views and involving the chaplain for spiritual support is the appropriate professional response.

Question 35: Which document outlines what life-sustaining treatments a patient does or does not want?

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

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

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

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 37: What does 'unconditional positive regard' mean in hospice care?

Only caring for patients you personally like
Agreeing with everything the patient says
Accepting and respecting the patient without judgment regardless of their beliefs or behaviors (Correct answer)
Giving the patient whatever they want

Correct answer: Accepting and respecting the patient without judgment regardless of their beliefs or behaviors

Unconditional positive regard means accepting and respecting the patient as a whole person without judgment, which is fundamental to a therapeutic caregiving relationship.

Question 38: What is the most important action a nursing assistant can take when a patient reports new or worsening symptoms?

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

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 39: When should the nursing assistant use touch as a communication tool in hospice care?

Never, as it is unprofessional
Only when the patient is unconscious
When appropriate and with the patient's consent, to convey comfort and empathy (Correct answer)
Only when discussing medications

Correct answer: When appropriate and with the patient's consent, to convey comfort and empathy

Appropriate touch, such as gently holding a hand with the patient's consent, can convey warmth, empathy, and compassion in palliative care settings.

Question 40: Which principle requires treating all patients fairly regardless of their background?

Beneficence
Justice (Correct answer)
Autonomy
Nonmaleficence

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

Ordering laboratory tests
Providing personal hygiene care and reporting changes to the nurse (Correct answer)
Assessing and diagnosing new conditions
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 42: Which ethical principle refers to a patient's right to make their own healthcare decisions?

Justice
Nonmaleficence
Autonomy (Correct answer)
Beneficence

Correct answer: Autonomy

Autonomy is the ethical principle that recognizes the patient's right to make informed decisions about their own healthcare, free from coercion.

Question 43: 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)
Assume all patients have the same beliefs
Avoid the topic of death entirely

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 44: 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 45: Social isolation in hospice patients can be reduced by:

Keeping all interaction to clinical care only
Removing the patient's phone
Limiting visits to protect the patient
Encouraging family visits, volunteer companionship, and meaningful social interaction within the patient's tolerance (Correct answer)

Correct answer: Encouraging family visits, volunteer companionship, and meaningful social interaction within the patient's tolerance

Encouraging family engagement, volunteer visits, and social interaction helps reduce isolation and supports the patient's emotional and psychosocial well-being.

Question 46: 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)
Tell the family everything they need to know independently
Provide detailed clinical lectures to the family
Avoid discussing the dying process with the family

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 47: What is 'double effect' in palliative care ethics?

When two medications are given simultaneously
The principle that an action intended to do good may have a foreseen but unintended harmful side effect (Correct answer)
When two team members provide the same care
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 48: When providing oral care to an unconscious hospice patient, what is the most important safety precaution?

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

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 49: Which of the following is an example of active listening?

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

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

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

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

Swelling of the extremities
Yellowing of the skin
Blotchy, purplish discoloration of the skin due to poor circulation (Correct answer)
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 52: Opioids used in hospice care are primarily prescribed to:

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

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 53: HIPAA in hospice care requires the nursing assistant to:

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

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

Massage edematous areas vigorously
Apply firm pressure to reduce swelling
Handle the skin gently, keep it clean and dry, and report any skin breakdown (Correct answer)
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 55: What is a healthcare proxy?

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

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

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

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

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

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 58: Documentation in hospice care is important because it:

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

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 59: Anxiety in dying patients may be related to:

Too much sleep
Overeating
Excessive physical activity
Fear of pain, the unknown, separation from loved ones, or unresolved issues (Correct answer)

Correct answer: Fear of pain, the unknown, separation from loved ones, or unresolved issues

Anxiety in terminal patients is often linked to fear of pain, uncertainty about what dying feels like, fear of being separated from loved ones, and unresolved emotional or spiritual issues.

Question 60: Which of the following best describes the hospice philosophy?

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

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

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

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 62: What is 'palliative sedation'?

Sedation to hasten death
Sedation used only during procedures
The use of sedative medications to reduce intractable suffering in terminally ill patients near death (Correct answer)
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 63: Which symptom is characterized by a persistent feeling of nausea and inability to eat?

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

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

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

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

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

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

Refuse and report the request to their supervisor (Correct answer)
Do it only once
Perform the task to avoid conflict
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 67: What does 'breakthrough pain' mean in palliative care?

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

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

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

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 69: The concept of 'total pain' in palliative care includes:

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

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

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

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

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

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

Restrict family visitation to reduce disruption
Insist family follow strict hospital routines
Discourage family from speaking to the patient
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 73: The concept of 'dignity therapy' in palliative care focuses on:

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

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

Immediately call a psychiatrist
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

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

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

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

From back to front
From front to back (Correct answer)
In a circular motion around the perineum
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 77: What is 'life review' in hospice care?

A psychological test
A medical history assessment
A process where the patient reflects on their life experiences, finding meaning and resolution (Correct answer)
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 78: What does POLST stand for in end-of-life care?

Physician Orders for Life-Sustaining Treatment (Correct answer)
Patient Orders for Legal Sustaining Treatment
Palliative Options for Long-term Support and Treatment
Patient-Oriented Life Support 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 79: 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 80: What does 'therapeutic communication' mean in hospice care?

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

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 81: Which of the following is an advance directive?

A discharge summary
A nursing care plan
A living will or healthcare proxy (Correct answer)
A physician's prescription

Correct answer: A living will or healthcare proxy

Advance directives are legal documents such as living wills or healthcare proxy designations that express a patient's wishes for future medical care.

Question 82: What is the purpose of the patient's rights document in hospice care?

To inform patients of their rights regarding care decisions, privacy, and grievance processes (Correct answer)
To authorize payment for services
To list the hospice agency's fees
To document the patient's medical history

Correct answer: To inform patients of their rights regarding care decisions, privacy, and grievance processes

The patient's rights document informs patients of their rights to participate in care planning, maintain privacy, file grievances, and make decisions about their own care.

Question 83: 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
Completing tasks as quickly as possible
Minimal handling to reduce discomfort, and maintaining dignity throughout (Correct answer)
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 84: Which assessment tool is used to evaluate pain in non-verbal or cognitively impaired patients?

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

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

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

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

Cognitive decline
Spiritual distress (Correct answer)
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 87: 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 88: Who is considered part of the hospice interdisciplinary team?

Only licensed medical professionals
Only the patient's family
Physician, nurse, social worker, chaplain, and nursing assistant (Correct answer)
Only physicians and nurses

Correct answer: Physician, nurse, social worker, chaplain, and nursing assistant

The hospice interdisciplinary team typically includes physicians, nurses, social workers, chaplains, nursing assistants, and volunteers working together.

Question 89: A patient receiving hospice care asks about returning to curative treatment. What should the nursing assistant do?

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

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 90: When a patient expresses anger, the best response from the nursing assistant is to:

Respond with equal firmness
Listen without judgment and acknowledge the patient's feelings (Correct answer)
Leave the room immediately
Tell the patient to calm down

Correct answer: Listen without judgment and acknowledge the patient's feelings

Acknowledging and validating a patient's feelings without judgment is therapeutic and helps the patient feel heard and supported.

Question 91: What is 'death rattle' and how should the nursing assistant respond?

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

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

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

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

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

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 94: Which communication technique involves restating the patient's message in your own words?

Clarification
Projection
Distraction
Paraphrasing (Correct answer)

Correct answer: Paraphrasing

Paraphrasing involves restating the patient's message in your own words to confirm understanding and show that you are listening.

Question 95: Which of the following is a core principle of hospice care?

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

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

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
Tell the family member the patient is going to die soon

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 97: Which organization accredits hospice programs in the United States?

ANA
CMS only
NHPCO
The Joint Commission (Correct answer)

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 98: 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)
Using clinical terminology to communicate with the patient
Making care decisions without input from patient or family
Limiting family visits to reduce crowding

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

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

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

'I know exactly how you feel.'
'At least they are no longer suffering.'
'I am so sorry for your loss. I am here if you need anything.' (Correct answer)
'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 101: What does 'beneficence' mean in healthcare ethics?

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

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

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

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 103: Bereavement care by the hospice nursing assistant primarily involves:

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

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 104: What does 'nonmaleficence' mean?

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

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 105: Which setting is NOT a common location for hospice care delivery?

Emergency room (Correct answer)
Skilled nursing facility
Patient's home
Inpatient hospice facility

Correct answer: Emergency room

Hospice care is typically provided in the home, nursing facilities, assisted living, or dedicated inpatient hospice units—not in emergency rooms.

Question 106: 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
Support the joint above and below and move slowly within the pain-free range (Correct answer)
Move each joint quickly to complete exercises efficiently
Push joints until resistance is felt to maintain flexibility

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 107: What does it mean when a hospice patient is in the 'actively dying' phase?

The patient is agitated and combative
The patient requires surgical intervention
The patient's condition is improving
The patient is in the final hours to days of life with significant physiological changes (Correct answer)

Correct answer: The patient is in the final hours to days of life with significant physiological changes

The 'actively dying' phase refers to the final hours to days before death, characterized by major physiological changes such as changes in breathing, circulation, and consciousness.

Question 108: Cultural awareness in end-of-life care is important because:

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

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 109: Which of the following is an example of nonverbal communication?

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

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 110: 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
Tell them to call a friend
Leave them alone to rest

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.

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

Questions

150 min

Time Limit

75%

To Pass

Checking for saved progress...

Exam Rules

You can skip questions and return to them later
Flag questions for review before submitting
No feedback shown until you submit the entire exam
Unanswered questions count as wrong — answer everything
10 pretest questions are mixed in and don't affect your score
Timer auto-submits when time runs out
Your progress is auto-saved every 30 seconds

These practice questions were written with AI tools. They are not real exam questions. Exam facts are checked against the official sources listed below. Not reviewed by a subject-matter expert. Editorial policy

Sources & references

Exam facts on this page (fees, format, dates, passing scores) are checked against these official sources; the date is our last check. Editorial policy

advancingexpertcare.org — Score validity, eligibility, test dates, test delivery, exam format, passing score, retake fee, retake policy, score release · verified Oct 2026