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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 givers 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 patients 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