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

Question 1: What is 'Cheyne-Stokes' breathing?

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

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

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

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

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

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

Notify the supervising nurse immediately and document the patient's statement (Correct answer)
Try to convince the patient to stay in hospice
Contact the insurance company directly
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 5: Which setting is NOT a common location for hospice care delivery?

Emergency room (Correct answer)
Patient's home
Skilled nursing facility
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 6: The concept of 'dignity therapy' in palliative care focuses on:

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

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 7: Who is considered part of the hospice interdisciplinary team?

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

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 8: Spirituality in palliative care is best described as:

Attendance at religious services
Only formal religious practice
A clinical symptom requiring medication
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 9: If the nursing assistant suspects patient abuse or neglect, they are legally required to:

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

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

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

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

Talking about your own experiences
Interrupting to offer advice
Changing the subject when the patient is upset
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 12: What does 'comfort measures only' mean in a hospice plan of care?

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

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

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

Correct answer: Open-ended questions

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

Question 14: Which statement is most appropriate when offering condolences to a grieving family member?

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

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 15: What does 'anticipatory grief' mean?

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

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

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

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

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

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

Assisting the patient with bathing
Listening compassionately to the patient's concerns
Reporting changes in condition to the nurse
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 19: What does it mean when a hospice patient is in the 'actively dying' phase?

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

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 20: 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
Complete the bath as quickly as possible to minimize discomfort
Keep the patient fully exposed throughout to monitor skin condition
Expose only the body part being washed while keeping the rest covered (Correct answer)

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

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

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 22: Opioids used in hospice care are primarily prescribed to:

Hasten death
Sedate the patient permanently
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 23: What is the Kübler-Ross model in relation to end-of-life care?

Five stages of grief: denial, anger, bargaining, depression, and acceptance (Correct answer)
A medication protocol for dying patients
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 24: A hospice patient with left-sided weakness needs assistance with ambulation. Where should the nursing assistant position themselves?

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

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 25: 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 increase the TV volume
It has no effect on care delivery
The nursing assistant should avoid speaking near the patient

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

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

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

Physician Orders for Life-Sustaining Treatment (Correct answer)
Patient Orders for Legal Sustaining Treatment
Patient-Oriented Life Support Treatment
Palliative Options for Long-term Support and 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 28: When performing personal hygiene on a patient in the final stage of life, the nursing assistant should prioritize:

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

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

Post care plans in the patient's room for all visitors
Discuss patients in public areas for efficiency
Protect patient privacy and only share information on a need-to-know basis (Correct answer)
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 30: A family member asks the nursing assistant to share the patient's prognosis. The nursing assistant should:

Refer the family member to the nurse or physician for clinical questions (Correct answer)
Provide the prognosis based on their own assessment
Tell the family member the patient is going to die soon
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 31: What is the nursing assistant's role in family education about the dying process?

Tell the family everything they need to know independently
Reinforce information already given by the nurse, answer simple questions, and refer complex questions to the nurse (Correct answer)
Avoid discussing the dying process with the family
Provide detailed clinical lectures to 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 32: When a patient expresses anger, the best response from the nursing assistant is to:

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

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 33: Documentation in hospice care is important because it:

Provides a legal record of care, ensures continuity, and supports communication among the team (Correct answer)
Is only for billing purposes
Is optional for nursing assistants
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 34: How should the nursing assistant respond to a patient's spiritual or religious request that differs from their own beliefs?

Share their own religious views to help the patient
Respect the patient's beliefs without imposing their own and notify the chaplain (Correct answer)
Politely decline all religious discussions
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: Constipation in hospice patients is most commonly caused by:

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

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

Physician
Chaplain or spiritual care counselor (Correct answer)
Physical therapist
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 37: Anxiety in dying patients may be related to:

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

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

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

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

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

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

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

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

Leave them alone to rest
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

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

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

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

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

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 44: 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 45: What is a healthcare proxy?

A document listing all medications
A person designated to make healthcare decisions if the patient is unable to do so (Correct answer)
A type of insurance plan
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 46: Which pain scale uses faces to rate pain level and is commonly used with cognitively impaired patients?

Wong-Baker FACES Pain Scale (Correct answer)
Numeric Rating Scale (NRS)
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 47: Who on the hospice team is most responsible for psychosocial support and assessing family dynamics?

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

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

Inform the insurance company
Notify the supervising nurse and follow the agency's post-mortem care procedures (Correct answer)
Contact the funeral home immediately
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 49: What is the nursing assistant's appropriate role when providing nail care for a diabetic hospice patient?

Trim nails short and straight across using standard nail clippers
Soak feet extensively before trimming nails
File nails gently and report any abnormalities to the nurse; do not cut nails without specific orders (Correct answer)
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 50: 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 51: Which non-pharmacological comfort measure may help relieve pain in hospice patients?

Ordering laboratory tests
Administering IV fluids
Prescribing stronger opioids
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 52: 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 safely restrain the patient during care activities
To absorb moisture away from the patient's skin
To reduce friction and shear forces on the patient's skin during movement (Correct answer)

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

Anorexia-cachexia syndrome (Correct answer)
Dehydration alone
Hyperthyroidism
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 54: If a patient says, 'I feel like a burden to my family,' the most therapeutic response is:

'I'll ask your family if they agree.'
'Tell me more about how you're feeling.' (Correct answer)
'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 55: Which of the following best describes the hospice philosophy?

Aggressive treatment to prolong life
Comfort-focused care that affirms life and regards dying as a normal process (Correct answer)
Isolation of the patient from family
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 56: When a patient or family member requests a specific religious ritual, the nursing assistant should:

Decline all religious requests
Decide whether the ritual is appropriate
Facilitate the request by notifying the nurse and chaplain, and accommodate as able (Correct answer)
Only accommodate Christian 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 57: Palliative care can be provided:

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

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

Prescribing grief medications
Managing the estate of the deceased
Offering condolences, a listening ear, and connecting the family to bereavement resources (Correct answer)
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 59: 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
Create care plans independently
Prescribe medications

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 60: 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)
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
Directly in front of the patient facing them

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

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

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 62: 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)
Reassure the patient without reporting
Adjust the patient's medication dosage
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 63: Depression is common in hospice patients. The nursing assistant's role is to:

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

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

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

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

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

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

Nonmaleficence
Justice (Correct answer)
Autonomy
Beneficence

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 67: 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 68: Which of the following is an advance directive?

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

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 69: A hospice patient with dysphagia is being assisted with a meal. What position is safest to reduce aspiration risk?

Sitting upright at 90 degrees or as close as tolerated (Correct answer)
Semi-reclined at 30 degrees
Lying flat in bed
Turned to the left side

Correct answer: Sitting upright at 90 degrees or as close as tolerated

An upright position of 90 degrees uses gravity to direct food and liquid down the esophagus rather than into the airway, reducing aspiration risk.

Question 70: Which assessment tool is used to evaluate pain in non-verbal or cognitively impaired patients?

APGAR Score
PAINAD (Pain Assessment in Advanced Dementia) Scale (Correct answer)
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 71: A patient expresses that they fear they have not lived a good life. This is best identified as:

Physical pain
Cognitive decline
Spiritual distress (Correct answer)
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 72: Which behavior demonstrates professional conduct for a hospice nursing assistant?

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

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

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

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

When two medications are given simultaneously
A double dose of pain medication
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

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

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

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 76: 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 77: Which factor can make communication more challenging in hospice care?

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

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

Listen compassionately and notify the nurse or social worker for follow-up support (Correct answer)
Ignore the comment
Change the subject to avoid the topic
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 79: Which document outlines what life-sustaining treatments a patient does or does not want?

Nursing assessment
Living will (advance directive) (Correct answer)
Insurance form
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 80: In hospice care, which principle should guide the nursing assistant when prioritizing personal care activities for a patient?

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

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

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

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

Once per shift
Only when the patient requests it
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 83: What does 'breakthrough pain' mean in palliative care?

Pain caused by the medication itself
Pain that requires surgical intervention
A sudden flare of pain occurring despite baseline pain control (Correct answer)
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 84: What is the primary goal of palliative care?

Improve quality of life by relieving suffering (Correct answer)
Extend life at all costs
Provide only comfort medications
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 85: 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 86: When changing bed linens with a patient remaining in bed, what is the most important safety consideration?

Ask the patient to grip the side rail while you turn them
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

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 87: What is 'informed consent' in healthcare?

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
A form signed only by physicians

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 88: 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 89: 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)
Ignore minor skin changes
Massage edematous areas vigorously
Apply firm pressure to reduce swelling

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

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

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

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

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

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

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 93: Mouth care in hospice is important primarily because:

It prevents pneumonia in all cases
It prevents tooth decay for future dental visits
It is required by insurance companies
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 94: Cultural awareness in end-of-life care is important because:

Culture only matters for language barriers
All patients respond to death the same way
Cultural beliefs affect how patients and families experience grief, rituals, and death (Correct answer)
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 95: Which of the following is a common sign of uncontrolled pain in a non-verbal patient?

Facial grimacing, moaning, or restlessness (Correct answer)
Increased appetite
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 96: What is 'life review' in hospice care?

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

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

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

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 98: 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
Therapy sessions led by the nursing assistant
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 99: What is the recommended frequency for oral care in an unconscious hospice patient?

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)
Only when visible soiling or crusting is present

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.

Question 100: Which of the following is within the scope of practice for a hospice nursing assistant?

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

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 101: Social isolation in hospice patients can be reduced by:

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

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

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)
Perform only on joints specifically ordered by the physician

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 103: Which skin care measure is most effective in preventing pressure injuries in a bedridden hospice patient?

Leaving protective dressings in place indefinitely without changing
Applying talcum powder liberally to all skin folds
Keeping the skin clean and dry and using a moisture barrier as needed (Correct answer)
Massaging bony prominences vigorously to increase circulation

Correct answer: Keeping the skin clean and dry and using a moisture barrier as needed

Keeping skin clean and dry while using moisture barriers prevents maceration and skin breakdown that leads to pressure injuries.

Question 104: What is 'complicated grief'?

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

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

6 months
1 month
5 years
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 106: What is 'palliative sedation'?

Sedation to hasten death
The use of sedative medications to reduce intractable suffering in terminally ill patients near death (Correct answer)
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 107: When providing oral care to an unconscious hospice patient, what is the most important safety precaution?

Apply lip balm before cleaning the teeth
Position the patient's head to the side to prevent aspiration (Correct answer)
Use a full cup of water to rinse the mouth thoroughly
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 108: When should the nursing assistant report a change in a patient's pain level?

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

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

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

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

Prescribing PRN pain medications
Adjusting opioid dosages
Ordering pain consultations
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.

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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