Free ACHPN Practice Questions

Question 1

An 84-year-old nursing home resident with advanced Alzheimer disease is referred for hospice evaluation. She is FAST stage 7C, requires total assistance with all ADLs, and speaks fewer than six intelligible words per day. Over the past 12 months she has had no infections, no pressure injuries, and stable weight. Her serum albumin is 3.1 g/dL. Which assessment BEST reflects her hospice eligibility?

Accepted Answer

She does not clearly meet dementia criteria, which require a qualifying comorbid condition such as aspiration pneumonia or weight loss in addition to FAST 7C

Answer

She meets criteria, since FAST 7C marks the loss of independent ambulation

Answer

She meets criteria, since total dependence in all ADLs is independently sufficient

Answer

She fails criteria, since her serum albumin remains above the 2.5 g/dL cutoff

Question 2

A patient with metastatic prostate cancer has been taking oral morphine 120 mg daily with well-controlled pain but is developing intolerable sedation. The team elects to rotate to oral hydromorphone. Using an equianalgesic ratio of oral morphine 30 mg to oral hydromorphone 7.5 mg, and applying standard practice for incomplete cross-tolerance, the MOST appropriate starting total daily dose of hydromorphone is approximately:

Accepted Answer

15 mg

Answer

30 mg

Answer

24 mg

Answer

7.5 mg

Question 3

During a family meeting, the APRN explains that the CT scan shows widespread progression despite third-line chemotherapy. The patient's wife begins to cry and says, "So there's nothing left." According to the SPIKES protocol, the APRN's next action should be to:

Accepted Answer

Name the emotion and respond empathically

Answer

Clarify that hospice enrollment and symptom-directed treatments both remain fully available to her husband

Answer

Ask what she understood from the oncologist's most recent conversation with the family last week

Answer

Summarize the revised plan of care and schedule a follow-up meeting for later in the week

Question 4

A hospice patient with end-stage COPD is stable on routine home care. His wife, who is his sole caregiver, has become physically exhausted and tearful, and tells the APRN she cannot continue without a break. The patient's dyspnea is well controlled on his current regimen. The APPROPRIATE level of care is:

Accepted Answer

Inpatient respite care, for up to five consecutive days, to relieve the caregiver

Answer

General inpatient care, given her inability to sustain the current plan of care at home any longer

Answer

Continuous home care, supplying extended nursing hours until this caregiving crisis resolves

Answer

Routine home care, with added aide hours and volunteer support

Question 5

A 68-year-old woman with metastatic pancreatic cancer reports feeling "useless" and says she has become a burden. She denies wanting to die. During the visit she laughs warmly at a story about her grandson and engages enthusiastically when discussing his upcoming graduation. She reports poor appetite and fatigue. Which formulation BEST fits this presentation?

Accepted Answer

Demoralization, with hopelessness and lost purpose but preserved capacity for pleasure

Answer

Major depressive disorder, supported by the anhedonia, appetite loss, and fatigue that she describes

Answer

Anticipatory grief, an expected and largely self-limited response to the losses she now anticipates

Answer

Adjustment disorder with depressed mood, given how recent her terminal diagnosis is

Question 6

A patient with complete malignant bowel obstruction from ovarian cancer has persistent nausea and large-volume vomiting. He is not a surgical candidate and his goals are comfort-focused. Which medication is CONTRAINDICATED in this setting?

Accepted Answer

Metoclopramide

Answer

Octreotide

Answer

Haloperidol

Answer

Dexamethasone

Question 7

A hospice patient designates the hospice nurse practitioner as her attending. The patient is approaching her third benefit period. Regarding the NP's authority, the NP MAY:

Accepted Answer

Perform the required face-to-face encounter and attest to the clinical findings that support recertification

Answer

Recertify the terminal prognosis, since the patient designated the NP as attending

Answer

Certify the terminal prognosis whenever the hospice physician is unavailable

Answer

Recertify the prognosis if a hospice physician co-signs within 30 days

Question 8

A patient with renal cell carcinoma and a creatinine of 3.8 mg/dL has been escalated to oral morphine 400 mg daily over two weeks. He now reports that his pain is worse and more widespread, and is noted to have intermittent myoclonic jerks. Which action is MOST appropriate?

Accepted Answer

Rotate to an alternative opioid and hydrate

Answer

Increase the morphine dose by 50%, since the escalating pain suggests undertreatment

Answer

Add lorazepam to suppress the myoclonus while continuing his current opioid regimen

Answer

Administer naloxone, hold the next scheduled dose, and monitor him for withdrawal

Question 9

The adult children of a newly admitted patient meet the APRN in the hallway and ask that their father not be told his cancer has spread, explaining that in their family this knowledge would "take away his will to live." The BEST initial response by the APRN is to:

Accepted Answer

Explore what specifically worries them about their father knowing his diagnosis

Answer

Explain that the patient holds a legal right to be informed about his own diagnosis and prognosis

Answer

Agree to their request, in order to respect the family's cultural values

Answer

Request an ethics consultation to mediate the disagreement

Question 10

A 79-year-old man with metastatic lung cancer is admitted to the inpatient unit. He is intermittently drowsy, at times pulling at his lines and at other times withdrawn and difficult to rouse. His daughter reports he was "completely himself" two days ago. Using the Confusion Assessment Method, which combination is REQUIRED to diagnose delirium?

Accepted Answer

Acute onset with fluctuation, and inattention, plus disorganized thinking or altered consciousness

Answer

Inattention and disorganized thinking, plus either acute onset with fluctuation or an altered level of consciousness

Answer

Acute onset with a fluctuating course, and altered consciousness, plus disorganized thinking

Answer

Any three of the four core features, in any combination

Free ACHPN Practice Questions

Domain 1: Assessment and Data Collection

Question 1

Question 2

Question 3

Domain 2: Intervention and Management

Question 4

Question 5

Question 6

Domain 3: Education and Communication

Question 7

Question 8

Domain 4: Professionalism and Practice

Question 9

Question 10

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