Certified Hospice and Palliative Licensed Nurse Practice Test

CHPLN test Format | Course Contents | Course Outline | test Syllabus | test Objectives

Exam Code: CHPLN
Exam Name: Certified Hospice and Palliative Licensed Nurse
Certifying Body: Hospice and Palliative Credentialing Center (HPCC)
Number of Questions: 100 multiple-choice questions
Time Allotted: 2 hours (120 minutes)
Passing Score: 75% (exact scaled passing score may vary slightly)
Exam Format: Computer-based testing (CBT)

- Patient Care: End-Stage Disease Process
- Identify specific patterns of disease progression- complications- and treatment for:
- Neoplastic conditions
- Neurological conditions
- Cardiac conditions
- Pulmonary conditions
- Renal conditions
- Gastrointestinal conditions
- Debility/decline in health status (e.g.- Frailty- Malnutrition- Cachexia)
- Dementia
- Hepatic conditions
- Hematologic conditions
- Altered immune disease (e.g.- HIV)
- Endocrine conditions
- Identify and respond to indicators of imminent death

- Patient Care: Pain and Comfort Management
- Data Gathering
- Identify pain and other distressing symptoms
- Identify causes of pain
- Identify types of pain
- Identify factors that may influence the patient's experience of pain (e.g.- fear of pain- depression- despair- cultural or spiritual issues)

- Pharmacologic Interventions
- Identify medications appropriate for severity and specific type of pain
- Administer analgesic and adjuvant medications (e.g.- NSAIDS- corticosteroids- anticonvulsants- opioids)
- Nonpharmacologic Interventions
- Identify the need for nonpharmacologic interventions
- Implement nonpharmacologic interventions (e.g.- massage- music- aromatherapy- and pet therapy)
- Respond to psychosocial and spiritual issues related to pain and other distressing symptoms
- Evaluation
- Identify and respond to medication side effects- interactions- and complications
- Evaluate efficacy of relief interventions (pharmacologic and nonpharmacologic)
- Identify side effects of interventional therapy (e.g.- antineoplastic- radiological- surgical)

- Patient Care: Symptom Management
- Manage symptoms related to Neurological conditions
- Aphasia
- Dysphagia
- Lethargy or sedation
- Myoclonus
- Paresthesia or neuropathies
- Seizures
- Extrapyramidal symptoms
- Spinal cord compression

- Manage symptoms related to Cardiovascular conditions
- Edema (including pulmonary)
- Syncope
- Manage symptoms related to Respiratory conditions
- Congestion
- Cough
- Dyspnea
- Pleural effusions

- Manage symptoms related to Hepatic conditions
- Encephalopathy
- Esophageal varices
- Ascites
- Manage symptoms related to Gastrointestinal conditions
- Constipation
- Diarrhea or bowel incontinence
- Nausea or vomiting
- Bleeding
- Bowel obstruction

- Manage symptoms related to Genitourinary conditions
- Bladder spasms
- Urinary incontinence
- Urinary retention
- Infections
- Manage symptoms related to Musculoskeletal conditions
- Impaired mobility
- Complications of immobility
- Fractures
- Weakness or activity intolerance

- Manage alterations in Skin and Mucous Membrane
- Dry mouth
- Oral lesions
- Pruritus
- Skin integrity- including wound care
- Excessive secretions
- Manage symptoms related to Psychosocial and Emotional conditions
- Anxiety
- Stages of grief (e.g.- anger- denial)
- Depression
- Impaired communication
- Sleep disturbances

- Manage symptoms related to Nutritional and Metabolic conditions
- Cachexia or wasting
- Dehydration
- Fatigue
- Manage symptoms related to the Immune System
- Fever
- Neutropenia
- Manage symptoms related to Mental Status Changes
- Agitation (including terminal restlessness)
- Confusion
- Delirium
- Dementia
- Hallucinations
- Manage symptoms related to Lymphedema

- Patient Care: Treatments and Procedures
- Care for patients with the following treatments or procedures:
- Surgical alterations (including tubes- drains- and stomas)
- Rectal route for pain and symptom management
- Respiratory therapy (e.g.- oxygen- suction- inhalation treatments- tracheostomy care)
- Subcutaneous pain and symptom management
- Urinary drainage systems
- Maintain infection control procedures related to:
- Pathogens (e.g.- bloodborne- airborne)
- Precautions
- Chain of infection

- Care of Patient- Family- and Other Caregivers
- Resource Management
- Identify and respond to socioeconomic factors
- Identify and respond to environmental and safety risks
- Monitor controlled substances (including use- abuse- diversion)
- Monitor health status of family caregiver
- Recommend appropriate DME for patient well-being
- Inform patient/family how to access 24-hours a day: services- medications- equipment- supplies

- Psychosocial- Spiritual- and Cultural
- Respond to spiritual needs
- Identify and respond to cultural values and behaviors
- Respond to stages of grief
- Respond to loss of hope or meaning
- Facilitate nearing death awareness
- Respond to spiritual distress or unresolved spiritual issues
- Identify suicidal or homicidal ideation
- Identify unresolved interpersonal matters
- Respond to family dynamics

- Grief and Loss
- Encourage life review
- Provide emotional support regarding grief and loss for:
- adults
- children
- Provide care and support at time of death

- Patient and Family Education and Advocacy
- Caregiver Support
- Teach family and other caregivers techniques for patient care (e.g.- positioning- ostomy care)
- Monitor family and other care giver’s ability to provide care
- Monitor and respond to caregiver burnout
- Identify and respond to neglect and abuse

- Education
- Identify and respond to barriers to learning (e.g.- communication)
- Teach about the end-stage disease process
- Teach about pain and symptom relief
- Teach alternative methods of pain and symptom relief (e.g.- relaxation- distraction- humor- massage- aroma therapy)
- Teach about home safety (e.g.- oxygen- firearms- fall hazards- evacuation plan)
- Teach about medication administration- compliance- safety- and disposal
- Teach about the signs and symptoms of imminent death
- Teach about self care methods

- Advocacy
- Monitor needs for levels of care or increased services
- Facilitate communication between patient- family- and health care providers
- Encourage patient and family to participate in decision-making regarding treatment options
- Access appropriate interdisciplinary team (IDT) members and other resources to meet the needs of patient and family

- Interdisciplinary and Collaborative Practice Issues
- Coordinate and Collaborate
- Coordinate patient care with other health care providers
- Arrange for equipment- supplies- or medications
- Communicate with patient’s attending/primary care provider

- Practice Issues
- Identify and incorporate into practice standards (e.g.- HPNA standards- ANA standards- NHPCO standards) and guidelines (e.g.- National Consensus Project- WHO ladder- CDC)
- Identify and incorporate legal regulations into practice (e.g.- OSHA- Hospice Medicare Conditions of Participation- HIPAA)
- Adhere to documentation standards for levels of care
- Participate in evaluating educational materials for patients and family
- Participate in quality assurance- performance improvement processes
- Demonstrate awareness and knowledge of LPN/LVN scope of practice

- Professional Development
- Maintain boundaries between patient/family and staff
- Contribute to development of peers- colleagues- and others as preceptor- educator- or mentor
- Participate in self-care (e.g.- stress management)
- Read professional journals to remain current in practice
- Maintain personal continuing education plan to update knowledge
- Identify ethical concerns related to the end-of-life

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Question: 1018
A 73-year-old patient with spinal metastases reports severe back pain and difficulty standing. The
patient�s serum creatinine is 1.8 mg/dL, and the provider orders ibuprofen 600 mg every 6 hours. What
should the LPN do?
A. Administer the ibuprofen as ordered
B. Suggest a topical lidocaine patch
C. Request a renal function reassessment
D. Use a heating pad on the back
Answer: C
Explanation: Ibuprofen is contraindicated in patients with renal impairment (creatinine 1.8 mg/dL) due to
the risk of further kidney damage. Requesting a renal function reassessment ensures safe medication use.
Administering ibuprofen risks worsening renal function. A lidocaine patch or heating pad may provide
pain relief but does not address the safety concern of ibuprofen in renal impairment.
Question: 1019
A hospice team needs to document detailed outcomes for a quality improvement initiative aimed at
reducing unnecessary hospitalizations. Which data point is most relevant for reporting?
A. Satisfaction with meal delivery
B. Number of completed antibiotic prescriptions
C. 30-day readmission rate
D. Family�s preferred funeral home
Answer: C
Explanation: The 30-day readmission rate specifically captures hospital utilization, which is the QI
project aim. The other data do not reflect hospitalization outcomes.
Question: 1020
A 73-year-old patient with heart failure and pulmonary edema has SpO2 87% and BP 150/92 mmHg.
Serum BNP is 1,800 pg/mL. Which intervention should the nurse implement first?
A. Position the patient in a semi-Fowler�s position
B. Apply BiPAP at 10/5 cm H2O
C. Increase oxygen to 6 L/min via high-flow cannula
D. Administer furosemide 40 mg IV over 5 minutes
Answer: A
Explanation: Pulmonary edema with elevated BNP (1,800 pg/mL) requires immediate positioning in a
semi-Fowler�s position to reduce preload and Boost breathing. This is a quick, non-invasive action.
Administer furosemide 40 mg IV over 5 minutes is effective but requires an order. Apply BiPAP at 10/5
cm H2O is invasive and requires setup. Increase oxygen to 6 L/min via high-flow cannula may help but
is not the first priority.
Question: 1021
A 73-year-old hospice patient with ovarian cancer reports abdominal pain rated 7/10, described as
cramping and associated with nausea. The patient is on ondansetron 8 mg PO q8h and morphine 10 mg
PO q4h. Labs show a serum albumin of 2.8 g/dL (normal: 3.5�5.0 g/dL). What is the most appropriate
next step?
A. Start hyoscyamine 0.125 mg PO q6h
B. Increase morphine to 15 mg PO q4h
C. Add metoclopramide 10 mg PO q6h
D. Switch to fentanyl 25 mcg/hr q72h
Answer: C
Explanation: The cramping abdominal pain and nausea suggest gastrointestinal dysmotility, common in
ovarian cancer with hypoalbuminemia indicating possible ascites or bowel involvement. Metoclopramide,
a prokinetic, addresses nausea and cramping. Increasing morphine may worsen nausea. Hyoscyamine is
less effective for nausea. Fentanyl is not indicated without renal or hepatic concerns.
Question: 1022
A 64-year-old patient with cirrhosis and hepatic encephalopathy has a serum ammonia of 110 �mol/L
and is lethargic. Lactulose 30 mL TID results in 1�2 soft stools daily. Labs: Na+ 128 mEq/L, K+ 3.1
mEq/L. What adjustment should be made to optimize encephalopathy management?
A. Add polyethylene glycol 17 g daily to increase bowel movements
B. Start rifaximin 550 mg BID
C. Increase lactulose to achieve 3�4 stools daily
D. Supplement potassium to normalize K+ levels
Answer: B
Explanation: Persistent encephalopathy with high ammonia despite lactulose suggests inadequate control.
Start rifaximin 550 mg BID is the best option to further reduce ammonia production. Add polyethylene
glycol 17 g daily is not standard for HE. Increase lactulose to achieve 3�4 stools daily risks dehydration,
given low Na+ and K+. Supplement potassium to normalize K+ levels addresses hypokalemia but not
encephalopathy directly.
Question: 1023
A 66-year-old patient with liver failure has ascites and a serum albumin of 2.8 g/dL. The family requests
home delivery of a hospital bed to Boost comfort. What is the LPN�s best action to coordinate care?
A. Request a dietary consult to increase albumin levels
B. Contact the physician to discuss paracentesis for ascites
C. Instruct the family to elevate the patient�s legs to reduce ascites
D. Arrange for hospital bed delivery through the hospice supplier
Answer: D
Explanation: Arranging for hospital bed delivery through the hospice supplier directly addresses the
family�s request to Boost patient comfort, aligning with coordination of equipment needs. Contacting
the physician for paracentesis addresses ascites but not the immediate comfort request. Instructing leg
elevation is ineffective for ascites management. Requesting a dietary consult is unlikely to significantly
improve serum albumin (2.8 g/dL) in end-stage liver failure.
Question: 1024
A patient with metastatic breast cancer and spinal lesions complains of �band-like� chest pain and
numbness below the nipple line. Which is the most concerning sign on neurological examination?
A. Brisk patellar reflexes
B. Diminished rectal tone
C. Positive Babinski reflexes
D. Weak handgrip
Answer: B
Explanation: Loss of rectal tone suggests spinal cord compression with loss of sphincter control, which is
an emergency.
Question: 1025
A 45-year-old patient with terminal pancreatic cancer expresses regret over not spending more time with
their children due to work commitments. The patient is visibly emotional and asks how to cope with
these feelings before passing. As a licensed nurse, what is the most therapeutic approach to encourage
life review and address their grief?
A. Encourage the patient to focus on positive memories and avoid dwelling on regrets
B. Guide the patient to write letters to their children expressing their feelings and memories
C. Facilitate a family meeting to discuss the patient�s regrets and seek forgiveness
D. Suggest distraction techniques like watching movies to reduce emotional distress
Answer: B
Explanation: Guide the patient to write letters to their children expressing their feelings and memories is
the most therapeutic approach, as it facilitates a structured life review, allowing the patient to process
regrets and leave a legacy. This aligns with hospice care�s focus on emotional closure. Encourage the
patient to focus on positive memories and avoid dwelling on regrets may minimize the patient�s feelings,
while Facilitate a family meeting to discuss the patient�s regrets and seek forgiveness could be
overwhelming without prior emotional preparation. Suggest distraction techniques like watching movies
to reduce emotional distress avoids addressing the grief directly, which is not therapeutic in this context.
Question: 1026
A 66-year-old hospice patient with a diagnosis of end-stage CHF is experiencing shortness of breath
despite being on maximum diuretic therapy. Her potassium level is 6.0mEq/L. Which of the following
interventions should be the initial focus of your teaching with the family?
A. Administering an increased dose of potassium chloride supplement
B. Arranging for a home oxygen cylinder setup and nasal cannula use
C. Increasing fluid intake to counteract dehydration
D. Recognizing early signs of hyperkalemia and contacting the hospice nurse immediately
Answer: D
Explanation: Recognizing early signs of hyperkalemia and contacting the hospice nurse immediately is
critical due to the elevated potassium (6.0mEq/L, normal 3.5�5.0mEq/L), which may cause life-
threatening arrhythmias. Administering more potassium chloride supplement would worsen
hyperkalemia. Home oxygen (oxygen therapy) might relieve dyspnea but does not address the potassium
imbalance, and increasing fluids could worsen CHF symptoms.
Question: 1027
A patient with refractory ascites undergoes paracentesis. Ascitic fluid analysis shows albumin 1.0g/dL
and serum albumin 2.6g/dL. What does the serum-ascites albumin gradient (SAAG) indicate?
A. Cardiac ascites
B. Malignant ascites
C. Portal hypertension
D. Pancreatic ascites
Answer: C
Explanation: SAAG = serum albumin - ascites albumin = 2.6 - 1.0 = 1.6g/dL. A SAAG =1.1g/dL is
diagnostic for portal hypertension. Cardiac ascites also shows high protein content; malignant and
pancreatic ascites show SAAG <1.1g/dL.
Question: 1028
A COPD patient in hospice presents with persistent cough, thick secretions, and congestion. Sputum
cultures show heavy growth of Pseudomonas aeruginosa. Which inhaled therapy can reduce mucus
viscosity and productive cough?
A. Levalbuterol
B. Inhaled corticosteroids
C. Hypertonic saline
D. Tiotropium
Answer: C
Explanation: Hypertonic saline inhalation increases water content in mucus, reducing viscosity and
making expectoration easier. Inhaled corticosteroids (inhaled corticosteroids), levalbuterol (levalbuterol),
and tiotropium (tiotropium) do not directly affect sputum viscosity.
Question: 1029
A 72-year-old hospice patient with a UTI is prescribed nitrofurantoin 100 mg twice daily. The patient�s
creatinine clearance is 20 mL/min. What should the LPN do?
A. Hold the dose and notify the provider
B. Administer the medication as ordered
C. Monitor for pulmonary toxicity
D. Request a repeat urinalysis in 48 hours
Answer: A
Explanation: Nitrofurantoin is contraindicated in patients with creatinine clearance <30 mL/min due to
the risk of toxicity and reduced efficacy. Holding the dose and notifying the provider is the safest action.
Administering the medication risks harm. Monitoring for pulmonary toxicity is relevant but secondary to
stopping the drug. A repeat urinalysis does not address the immediate safety concern.
Question: 1030
A complex care meeting is held to adjust medication for opioid-induced constipation. The nurse notes the
patient is on morphine 100mg/24h, with 4 days since the last BM, abdominal distension, and a K+ of
2.8mEq/L. What is the key collaborative action?
A. Order fleet enema immediately
B. Inform provider for lab review and patient assessment
C. Prescribe bisacodyl suppository without consulting the team
D. Encourage fluid intake only
Answer: B
Explanation: Significant hypokalemia (K+ of 2.8mEq/L, abdominal symptoms) warrants prompt provider
notification (Inform provider for lab review and patient assessment). A fleet enema or bisacodyl may not
be safe without assessment; more fluids alone (Encourage fluid intake only) is grossly insufficient.
Question: 1031
A patient complains of frequent watery stools and fecal incontinence after receiving broad-spectrum
antibiotics. What lab value should be prioritized to help guide further treatment?
A. Stool sodium
B. Serum amylase
C. Serum potassium
D. Stool leukocyte count
Answer: D
Explanation: Stool leukocyte count is useful for diagnosing infectious/inflammatory diarrhea, especially
post-antibiotic use (which raises concern for C. difficile). Stool sodium and serum amylase are not
directly instructive, while serum potassium is monitored but not diagnostic.
Question: 1032
A 61-year-old patient with multiple sclerosis experiences severe paresthesia in the hands, rated 7/10. The
patient is on pregabalin 150 mg twice daily, with a exact serum creatinine of 1.9 mg/dL (normal: 0.6�
1.2 mg/dL). What is the most appropriate intervention?
A. Add duloxetine 30 mg daily
B. Consult to adjust pregabalin dose due to renal impairment
C. Initiate amitriptyline 25 mg at bedtime
D. Start lidocaine 5% topical patch
Answer: B
Explanation: Pregabalin is renally excreted, and the elevated creatinine suggests impaired clearance,
potentially causing toxicity. Consulting to adjust the dose is the most appropriate step. Adding duloxetine
or amitriptyline increases the risk of side effects in renal impairment. Lidocaine patches are less effective
for diffuse paresthesia in this context.
Question: 1033
A 69-year-old hospice patient with liver failure and encephalopathy has ammonia 95 �mol/L. Lactulose
30 mL TID produces 3 stools/day. Labs: Na+ 129 mEq/L, K+ 3.2 mEq/L. What is the most appropriate
next step?
A. Add rifaximin 550 mg BID
B. Discontinue lactulose and start neomycin
C. Increase lactulose to 45 mL TID
D. Start branched-chain amino acids 4 g TID
Answer: A
Explanation: Persistent encephalopathy despite adequate lactulose dosing requires Add rifaximin 550 mg
BID to reduce ammonia production. Discontinue lactulose and start neomycin is risky due to toxicity.
Increase lactulose to 45 mL TID risks dehydration. Start branched-chain amino acids 4 g TID is
experimental and not standard.
Question: 1034
An LPN, acting as a preceptor, observes a colleague failing to maintain boundaries by sharing personal
family struggles with a patient�s spouse. What is the LPN�s most appropriate response?
A. Discuss the importance of professional boundaries privately
B. Encourage the colleague to continue sharing to build rapport
C. Report the incident to the unit manager immediately
D. Suggest the colleague attend a patient-family communication course
Answer: A
Explanation: Discuss the importance of professional boundaries privately is the most appropriate, as it
corrects the behavior directly and supports professional development. Encourage the colleague to
continue sharing risks further boundary violations. Report the incident to the unit manager is premature.
Suggest the colleague attend a communication course is less immediate than direct discussion.
Question: 1035
A 59-year-old patient with ALS exhibits severe myoclonus, disrupting sleep and causing distress. The
patient is on clonazepam 0.5 mg at bedtime, with a exact serum sodium of 132 mEq/L (normal: 135�
145 mEq/L). What is the most appropriate intervention?
A. Administer levetiracetam 500 mg twice daily
B. Start baclofen 10 mg three times daily
C. Initiate fluid restriction for hyponatremia
D. Increase clonazepam to 1 mg at bedtime
Answer: D
Explanation: Increasing clonazepam to 1 mg at bedtime is appropriate to control myoclonus, as it is
effective and already prescribed. Adding levetiracetam or baclofen introduces new medications
unnecessarily. Fluid restriction addresses hyponatremia but not myoclonus, the primary concern.
Question: 1036
An LPN/LVN is caring for a patient with a sodium level of 128 mEq/L due to SIADH in hospice care.
According to HIPAA, what is the correct procedure for sharing lab results with the patient�s authorized
caregiver?
A. Fax the results to the caregiver�s office
B. Text the results to the caregiver�s phone
C. Share results verbally in a public area
D. Provide a printed copy in a sealed envelope
Answer: D
Explanation: HIPAA requires secure transmission of protected health information, such as a sodium level
of 128 mEq/L, by providing a printed copy in a sealed envelope to the authorized caregiver. Fax the
results to the caregiver�s office risks interception. Share results verbally in a public area violates privacy.
Text the results to the caregiver�s phone is not secure.
Question: 1037
A 69-year-old patient with terminal lung cancer has a PCO2 of 50 mmHg and reports drowsiness. The
family is concerned about the patient�s ability to communicate. What is the LPN�s best action to
facilitate communication?
A. Facilitate a family meeting with the interdisciplinary team
B. Arrange for a speech therapist to assess communication
C. Administer oxygen at 3 L/min to Boost alertness
D. Instruct the family to use written communication
Answer: A
Explanation: Facilitating a family meeting with the interdisciplinary team addresses the family�s concerns
about communication and the patient�s drowsiness (PCO2 50 mmHg), ensuring collaborative discussion
of care options. Administering oxygen requires a physician�s order and may not address drowsiness.
Arranging a speech therapist is inappropriate for drowsiness-related issues. Using written communication
does not address the underlying cause or family concerns.
Question: 1038
A hospice patient�s family is experiencing anticipatory grief. Which finding most commonly
distinguishes anticipatory grief from pathological grief?
A. Complete loss of function and persistent suicidal ideation
B. Hopefulness for resolution and some positive emotions
C. Psychotic symptoms
D. Total withdrawal from social interaction
Answer: B
Explanation: Anticipatory grief often features periods of hope or positive feeling alongside sadness and
loss. Pathological grief includes functional loss, suicidality, psychosis, or persistent social withdrawal.
Question: 1039
A 62-year-old patient with advanced dementia is admitted to hospice with a PPS score of 30%. The
patient is nonverbal, bedbound, and has a exact history of aspiration pneumonia. The family reports
increased agitation and grimacing during repositioning. Which intervention best addresses the patient�s
symptoms and disease trajectory?
A. Start artificial nutrition via a nasogastric tube to Boost strength
B. Initiate a trial of lorazepam 0.5 mg PO every 6 hours for anxiety
C. Order a chest X-ray to evaluate for recurrent aspiration pneumonia
D. Administer haloperidol 0.5 mg IM every 4 hours as needed for agitation
Answer: D
Explanation: In advanced dementia with a PPS of 30%, agitation and grimacing are likely due to pain or
discomfort, and haloperidol 0.5 mg IM every 4 hours as needed is appropriate for managing agitation in
this context. Initiating a trial of lorazepam 0.5 mg PO every 6 hours for anxiety is less appropriate, as
benzodiazepines can worsen confusion in dementia patients. Ordering a chest X-ray to evaluate for
recurrent aspiration pneumonia is not aligned with hospice goals, as it does not address comfort. Starting
artificial nutrition via a nasogastric tube to Boost strength is contraindicated, as it increases aspiration
risk and does not Boost outcomes in end-stage dementia.
Question: 1040
A 70-year-old hospice patient with multiple myeloma reports a new onset of hip pain after a minor fall.
X-ray confirms a femoral neck fracture. The patient�s hemoglobin is 9.8 g/dL. What is the most
appropriate nursing action?
A. Administer morphine 5 mg IV every 4 hours
B. Immobilize the hip with a pillow
C. Encourage ambulation with a walker
D. Apply a traction splint to the affected leg
Answer: B
Explanation: A femoral neck fracture in a hospice patient with multiple myeloma requires immobilization
to reduce pain and prevent further injury. Using a pillow to immobilize the hip is a non-invasive,
appropriate action for comfort-focused care. Morphine may be needed but requires a provider order. A
traction splint is invasive and not suitable for hospice care. Ambulation is contraindicated due to the
fracture and anemia (hemoglobin 9.8 g/dL).
Question: 1041
An LPN is reading a journal article about self-care strategies for hospice nurses. A patient�s exact death
has left the LPN feeling emotionally drained. Which self-care intervention should the LPN prioritize?
A. Engage in high-intensity exercise to release stress
B. Work additional shifts to stay distracted
C. Take a temporary leave of absence from work
D. Participate in a peer support group for hospice nurses
Answer: D
Explanation: Participate in a peer support group for hospice nurses is the most appropriate, as it provides
emotional support and shared experiences to address grief. Engage in high-intensity exercise may help
but doesn�t address emotional needs directly. Take a temporary leave of absence is extreme and avoids
processing emotions. Work additional shifts exacerbates burnout.
Question: 1042
A hospice patient with severe mitral regurgitation and orthopnea has NT-proBNP of 3,680pg/mL. ABG:
pH 7.35, PaCO2 43mmHg, PaO2 60mmHg. What parameter indicates successful management of
pulmonary edema?
A. Increased serum sodium
B. Reduction of jugular venous distention
C. Stable platelet count
D. WBC improvement
Answer: B
Explanation: Reduction in jugular venous distention reflects successful reduction of venous pressure and
pulmonary congestion. Serum sodium, platelet count, and WBC are unrelated.
Question: 1043
A 72-year-old patient with end-stage renal disease is on hospice care at home. The family reports
difficulty affording the patient's medications due to limited income and lack of insurance coverage. The
patient�s monthly income is $1,200, and medication costs exceed $400 monthly. What is the most
appropriate action for the hospice nurse to take to address this socioeconomic barrier?
A. Contact a local pharmacy to negotiate a discount on medications
B. Tell the family to prioritize essential medications and skip non-essential ones
C. Suggest the family reduce the frequency of medication doses to cut costs
D. Refer the family to a social worker for assistance with financial aid programs
Answer: D
Explanation: Refer the family to a social worker for assistance with financial aid programs is the most
appropriate action, as it addresses the socioeconomic barrier by connecting the family with resources like
Medicaid, pharmaceutical assistance programs, or hospice foundation grants, which can cover medication
costs without compromising care. Contact a local pharmacy to negotiate a discount may help but is less
comprehensive and not always feasible. Suggest the family reduce the frequency of medication doses or
prioritize essential medications risks patient safety and violates hospice care standards, as it could lead to
inadequate symptom management.
Question: 1044
A 63-year-old hospice patient with lung cancer reports chest pain rated 6/10, described as sharp and
worse with inspiration. The patient is on morphine 5 mg PO q4h. Labs show a D-dimer of 2.5 �g/mL
(normal: <0.5 �g/mL). What is the most likely cause of the pain?
A. Costochondritis
B. Pericarditis
C. Pleuritic pain
D. Tumor invasion
Answer: C
Explanation: The sharp, inspiratory pain and elevated D-dimer suggest pleuritic pain, likely from a
pulmonary embolism or pleural involvement in lung cancer. Costochondritis is movement-related.
Pericarditis causes pain relieved by sitting forward. Tumor invasion is less likely without constant pain.
Question: 1045
A 64-year-old patient with end-stage renal disease has a stage II pressure ulcer on the heel, with a 2 cm x
2 cm shallow crater and minimal exudate. The patient�s serum albumin is 3.0 g/dL. Which dressing is
most appropriate?
A. Hydrogel dressing, changed daily
B. Alginate dressing, changed every 2 days
C. Silver-impregnated foam, changed every 3 days
D. Transparent film dressing, changed every 5�7 days
Answer: A
Explanation: A hydrogel dressing, changed daily, is appropriate for a stage II pressure ulcer with minimal
exudate, as it maintains a moist environment to promote healing in a patient with low albumin (3.0
g/dL). Alginate is better for high-exudate wounds (Alginate dressing, changed every 2 days). Silver-
impregnated foam is used for infected wounds, not indicated here (Silver-impregnated foam, changed
every 3 days). Transparent film is unsuitable for open craters (Transparent film dressing, changed every
5�7 days).
Question: 1046
A patient with terminal liver disease and coagulopathy (INR 2.6, platelets 35,000) develops constant,
severe right flank pain unrelieved by acetaminophen. What is the most appropriate next pharmacological
intervention?
A. Morphine
B. High-dose NSAIDs
C. Fentanyl patch
D. Regional nerve block
Answer: C
Explanation: Fentanyl is effective, with less risk of metabolite accumulation in liver dysfunction than
morphine. NSAIDs are contraindicated due to bleeding risk. Regional nerve block might be risky due to
coagulopathy. Morphine may accumulate, worsening sedation/toxicity.
Question: 1047
An LPN is developing a self-care plan after a patient�s death triggers unresolved grief. Which
intervention is most appropriate for emotional processing?
A. Take a short-term leave to avoid triggers
B. Increase clinical workload to stay distracted
C. Attend a grief counseling session with a professional
D. Write a letter to the patient�s family
Answer: C
Explanation: Attend a grief counseling session with a professional is the most appropriate, as it provides
structured support for processing grief. Increase clinical workload exacerbates emotional strain. Take a
short-term leave avoids processing grief. Write a letter to the patient�s family risks boundary violations.
Question: 1048
A patient with end-stage heart failure has a BNP of 1,200 pg/mL and reports severe fatigue. The nurse is
teaching about symptom relief. Which intervention should the nurse prioritize?
A. Administer furosemide 40 mg IV as prescribed to reduce fluid overload
B. Encourage high-intensity exercise to Boost cardiac output
C. Increase dietary sodium to stabilize electrolyte levels
D. Use a fan to blow air across the face for comfort
Answer: A
Explanation: Elevated BNP (1,200 pg/mL, normal <100 pg/mL) indicates fluid overload in heart failure.
Administering furosemide as prescribed reduces fluid, alleviating fatigue and dyspnea. High-intensity
exercise is contraindicated, increasing sodium worsens fluid retention, and a fan is less effective for
fatigue.
Question: 1049
A home hospice nurse finds that the patient�s home has loose scatter rugs, dim lighting and extension
cords across walkways. What standardized tool should the nurse use to document fall risk?
A. Braden Scale
B. Glasgow Coma Scale
C. Morse Fall Scale
D. Barthel Index
Answer: C
Explanation: The Morse Fall Scale is validated for assessing fall risk based on home hazards, while the
other options assess different domains.
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