CHPN® Practice Test Question Bank

The following are free CHPN® practice test questions from the CHPN® Practice Question Bank:

1: A hospice patient with congestive heart failure and a do-not-resuscitate (DNR) order is planning a flight to visit family. The nurse should inform the family that:
(a) The airline crew is required to follow the DNR order
(b) A DNR order may not be honored on a commercial flight
(c) The family must bring a physician to ensure the DNR order is followed
(d) Airline policy mandates that CPR is always withheld for DNR patients

2: A patient with a Palliative Performance Scale (PPS) score of 70% is likely to exhibit which of the following characteristics?
(a) Requires total care, bedbound
(b) Ambulatory and can perform some self-care tasks
(c) Fully independent with no disease symptoms
(d) Confined to a wheelchair and unable to perform any self-care

3: Which of the following medications is least likely to cause central nervous system (CNS) side effects such as delirium when treating refractory terminal respiratory secretions?
(a) Scopolamine
(b) Atropine
(c) Hyoscyamine
(d) Skin

4: Which statement accurately differentiates anticipatory grief from bereavement?
(a) Anticipatory grief occurs only after a person is formally diagnosed with a terminal illness.
(b) Bereavement refers to emotional preparation for death, while anticipatory grief occurs only after the death.
(c) Anticipatory grief is experienced before death, while bereavement occurs after the loss.
(d) Anticipatory grief involves anger but bereavement does not.

5: A palliative care nurse discusses the principle of double effect with a new nurse. Which of the following scenarios best illustrates the principle of double effect?
(a) Using opioids for severe pain management in a patient with a prognosis of days, knowing that respiratory depression could occur as an unintended side effect
(b) Increasing opioid doses to deliberately cause respiratory arrest and hasten death
(c) Stopping a patient’s hydration because of the belief that fluids are unnecessary in the dying process
(d) Ordering a benzodiazepine and opioid together

Rationales:

Question 1:
Answer: (b)
Rationale:
(B) Correct. Airline crews are not mandated to follow DNR orders on flights, especially if the flight crosses state or national borders. The family should be aware that CPR may be initiated by the crew if the patient dies during the flight.
(A) Incorrect. Airline crews are not required by law to honor DNR orders.
(C) Incorrect. Bringing a physician is not a solution, as airline policies will still dictate what happens.
(D) Incorrect. Airlines do not automatically withhold CPR based on DNR orders; their policies vary, and some may initiate CPR unless otherwise directed.
Source: Air Travel at the End-of-Life
Exam domain category: Support/education/advocacy | Subcategory: Patient safety: environmental, physical, socioemotional


Question 2:
Answer: (a)
Rationale:
(B) Correct. A PPS score of 70% indicates the patient is ambulatory and can carry out some self-care activities, although they may require occasional assistance.
(A) Incorrect. Total care and bedbound status would be seen in a patient with a PPS score of 30% or lower.
(C) Incorrect. A patient who is fully independent with no symptoms would score 100% on the PPS, indicating no functional decline.
(D) Incorrect. A patient confined to a wheelchair unable to perform any self-care tasks would typically have a PPS score of 50%, which reflects more significant functional impairment.
Source: The Palliative Performance Scale
Exam domain category: Assessment and Planning | Subcategory: Life-limiting disease progression, complications, and treatment


Question 3:
Answer: (c)
Rationale:
(D) Correct. Glycopyrrolate is a quaternary amine that does not cross the blood-brain barrier, making it less likely to cause CNS toxicity such as delirium or sedation.
(A) Incorrect. Scopolamine is a tertiary amine and is more likely to cause CNS side effects, including delirium.
(B) Incorrect. Atropine, also a tertiary amine, crosses the blood-brain barrier and may cause CNS side effects.
(C) Incorrect. Hyoscyamine is another tertiary amine that can cause CNS side effects, including confusion and delirium.
Source: Death Rattle and Oral Secretions
Exam domain category: Symptom Management | Subcategory: Respiratory


Question 4:
Answer: (c)
Rationale:
(C) Correct. Anticipatory grief happens when individuals begin emotionally preparing for an impending death, while bereavement refers to the grief experienced after the loss.
(A) Incorrect. Anticipatory grief can begin at various points, not only after a formal diagnosis.
(B) Incorrect. Bereavement always follows the loss, not prior.
(D) Incorrect. Both forms of grief can involve various emotions, including anger.
Source: Grief and Bereavement
Exam domain category: Support/education/advocacy | Subcategory: Grief and loss support / bereavement services


Question 5:
Answer: (a)
Rationale:
(A) Correct. The principle of double effect supports the use of opioids for pain management, where the primary intention is relief of suffering, and any unintended adverse effect (like respiratory depression) is ethically permissible.
(B) Incorrect. Intentionally hastening death contradicts the principle of double effect.
(C) Incorrect. Discontinuing hydration may be appropriate but does not directly involve the principle of double effect.
(D) Incorrect. The principle of double effect is not about the act of combining two medications but rather about the ethical reasoning behind an action that has both a good effect (e.g., symptom relief) and an unavoidable harmful side effect (e.g., respiratory depression). The key is that the harmful effect must not be intended. Combining two medications does not invoke the principle of double effect.
Source: Bioethical Distinctions of End-of-Life Care Practices
Exam domain category: Support/education/advocacy | Subcategory: Ethical issues related to end of life