200+ Free ACHPN Practice Questions

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Question 1

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A 78-year-old patient with end-stage COPD has a Palliative Performance Scale (PPS) score of 40%. What does this indicate about the patient's functional status?

The patient is fully ambulatory with normal activity

The patient is mainly sitting or lying down, unable to do any work, and requires considerable assistance

The patient is totally bedbound and unable to do any activity

The patient is ambulatory but requires occasional assistance

to track

2026 Statistics

Key Facts: ACHPN Exam

175

Total Items

HPCC ACHPN Handbook

150 + 25

Scored + Unscored

HPCC ACHPN Exam

3.5h

Exam Time

HPCC ACHPN Handbook

75/99

Passing Score

HPCC scaled scoring

65.4%

First-Time Pass Rate

HPCC statistics

$355/$515

Member / Nonmember Fee

HPNA/HPCC 2026

4 years

Certification Valid

HPCC renewal policy

The ACHPN exam has a 65.4% national first-time pass rate. The exam contains 175 items (150 scored + 25 unscored pilot questions) administered over 3.5 hours. Content covers advanced assessment, complex symptom management, communication at end of life, and professional issues. Eligibility requires current APRN licensure, graduate degree with advanced pathophysiology, health assessment, and pharmacology courses, plus 500 supervised clinical hours.

Sample ACHPN Practice Questions

Try these sample questions to test your ACHPN exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 200+ question experience with AI tutoring.

1A 78-year-old patient with end-stage COPD has a Palliative Performance Scale (PPS) score of 40%. What does this indicate about the patient's functional status?

A.The patient is fully ambulatory with normal activity

B.The patient is mainly sitting or lying down, unable to do any work, and requires considerable assistance

C.The patient is totally bedbound and unable to do any activity

D.The patient is ambulatory but requires occasional assistance

Explanation: A PPS score of 40% indicates the patient is mainly sitting or lying down, unable to do any work, and requires considerable assistance. The Palliative Performance Scale ranges from 0% (death) to 100% (fully ambulatory, normal activity). A score of 40% typically indicates significant functional decline where the patient spends most of the day in bed or chair, with decreasing ability to perform activities of daily living.

2Which assessment tool is most appropriate for evaluating pain in a non-verbal patient with advanced dementia in the palliative care setting?

A.Numeric Rating Scale (NRS)

B.Faces Pain Scale-Revised (FPS-R)

C.PAINAD (Pain Assessment in Advanced Dementia) Scale

D.Visual Analog Scale (VAS)

Explanation: The PAINAD Scale is specifically designed for assessing pain in patients with advanced dementia who cannot self-report. It evaluates five behavioral indicators: breathing, negative vocalization, facial expression, body language, and consolability. Each item is scored 0-2, with a total score of 0-10. Unlike NRS, FPS-R, or VAS which require the patient to communicate their pain level, PAINAD relies on observable behaviors.

3A patient with metastatic pancreatic cancer presents with confusion, jaundice, and right upper quadrant pain. Laboratory studies show elevated bilirubin and alkaline phosphatase. What is the most likely cause of these findings?

A.Hepatic encephalopathy from liver metastases

B.Biliary obstruction from tumor compression

C.Drug-induced liver injury

D.Acute viral hepatitis

Explanation: The clinical picture of jaundice, right upper quadrant pain, and elevated bilirubin with elevated alkaline phosphatase is classic for biliary obstruction. In metastatic pancreatic cancer, tumor compression of the common bile duct is a common complication. The elevated alkaline phosphatase (a cholestatic enzyme) combined with bilirubin elevation strongly suggests obstructive jaundice rather than hepatocellular injury.

4When conducting a spiritual assessment using the FICA tool, which of the following questions addresses the "C" component (Community)?

A.What gives your life meaning?

B.Are you part of a religious or spiritual community?

C.How does your faith influence your healthcare decisions?

D.What spiritual practices help you most?

Explanation: The FICA spiritual assessment tool stands for Faith/belief, Importance/influence, Community, and Address/Action in care. The "C" component specifically asks about religious or spiritual community support: "Are you part of a religious or spiritual community?" This helps identify potential sources of support during illness.

5A hospice patient with heart failure has the following findings: unable to maintain activity without symptoms, symptoms present at rest, and dependent on assistance for all ADLs. According to the New York Heart Association (NYHA) functional classification, what class is this patient?

A.Class I

B.Class II

C.Class III

D.Class IV

Explanation: NYHA Class IV is characterized by inability to carry out any physical activity without symptoms, with symptoms present even at rest. Class I patients have no limitation of physical activity; Class II have slight limitation with ordinary activity; Class III have marked limitation with less than ordinary activity. This patient's complete dependence for ADLs and symptoms at rest clearly indicate Class IV.

6Which of the following is a clinical indicator of imminent death (hours to days) in a hospice patient?

A.Increased appetite and thirst

B.Decreased urine output, mottling of extremities, and changes in breathing pattern

C.Elevated blood pressure and tachycardia

D.Improved mental status and increased social interaction

Explanation: Signs of imminent death (hours to days) include decreased urine output due to reduced renal perfusion, mottling (livedo reticularis) of extremities due to peripheral circulatory collapse, and changes in breathing pattern (Cheyne-Stokes respiration). These physiological changes indicate the body is shutting down.

7A patient with advanced dementia has experienced progressive weight loss, decreased oral intake over 3 months, and multiple aspiration events. According to hospice eligibility guidelines, what is the most appropriate next step?

A.Immediately place a percutaneous endoscopic gastrostomy (PEG) tube

B.Discuss goals of care and evaluate hospice eligibility

C.Initiate total parenteral nutrition (TPN)

D.Discharge from skilled nursing facility

Explanation: This patient exhibits classic signs of end-stage dementia: progressive weight loss, decreased oral intake, and aspiration events. According to NHPCO guidelines, these indicate a prognosis of 6 months or less. The most appropriate action is to discuss goals of care with the family and evaluate hospice eligibility. Artificial nutrition has not been shown to improve outcomes or survival in advanced dementia and may actually increase suffering.

8When assessing a patient with advanced cancer using the Edmonton Symptom Assessment System (ESAS), which symptom is rated on a scale of 0-10 along with pain, fatigue, and nausea?

A.Blood pressure

B.Heart rate

C.Drowsiness

D.Oxygen saturation

Explanation: The Edmonton Symptom Assessment System (ESAS) is a validated, multi-symptom assessment tool that rates nine symptoms on a 0-10 scale: pain, tiredness/fatigue, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, and wellbeing. It does not include vital signs like blood pressure, heart rate, or oxygen saturation.

9A 65-year-old patient with end-stage liver disease presents with asterixis (flapping tremor), confusion, and fetor hepaticus. These findings are most consistent with which condition?

A.Hepatic encephalopathy

B.Alcohol withdrawal

C.Wernicke encephalopathy

D.Brain metastases

Explanation: The triad of asterixis (flapping tremor when wrists are extended), confusion/altered mental status, and fetor hepaticus (sweet, musty breath odor) is pathognomonic for hepatic encephalopathy. This occurs when the failing liver cannot metabolize ammonia and other neurotoxins, leading to neuropsychiatric manifestations.

10Which factor in the Karnofsky Performance Status (KPS) scale differentiates a score of 60 from a score of 50?

A.Ability to work

B.Need for assistance

C.Presence of disease symptoms

D.Ability to care for self

Explanation: KPS 60 indicates the patient "requires occasional assistance but is able to care for most needs," while KPS 50 indicates the patient "requires considerable assistance and frequent medical care." The key differentiator is the level of assistance needed: occasional versus considerable. Both scores indicate the patient cannot work.

About the ACHPN Exam

The ACHPN certification is for advanced practice registered nurses (Nurse Practitioners and Clinical Nurse Specialists) specializing in hospice and palliative care. The exam covers 4 domains: Assessment and Data Collection (44 items, 29%), Intervention and Management (32 items, 21%), Education and Communication (36 items, 24%), and Professionalism and Practice (38 items, 25%).

Questions

175 scored questions

Time Limit

3.5 hours

Passing Score

Scaled 75 (0-99) or 500 (200-800)

Exam Fee

$515 ($355 HPNA members) (HPCC (Hospice and Palliative Credentialing Center) / PSI)

ACHPN Exam Content Outline

29%

Assessment and Data Collection

Medical history, physical examination, functional assessment, psychosocial/spiritual assessment, disease progression, prognostication, signs of imminent death, advance care planning, goals of care, and population-specific needs

21%

Intervention and Management

Diagnostics and procedures, pharmacologic therapies, non-pharmacologic interventions, complementary/alternative therapies, palliative care emergencies, palliative sedation, and life support devices

24%

Education and Communication

Teaching methods, communication theory and principles, communication strategies, cultural and spiritual competence, and the grief process

25%

Professionalism and Practice

Biomedical ethics, professional boundaries, scope of practice, opioid stewardship, hospice criteria, standards and guidelines, self-care, clinical decision-making, quality improvement, and professional development

How to Pass the ACHPN Exam

What You Need to Know

Passing score: Scaled 75 (0-99) or 500 (200-800)
Exam length: 175 questions
Time limit: 3.5 hours
Exam fee: $515 ($355 HPNA members)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ACHPN Study Tips from Top Performers

1Focus on the 29% Assessment and Data Collection domain - this is the largest section covering complex prognostication and assessment

2Master advanced pain management including opioid rotation, adjuvant therapies, and complex symptom management

3Study communication skills including breaking bad news, goals of care discussions, and family meetings

4Review ethical principles and professional issues including scope of practice, advance directives, and hospice regulations

5Practice questions on palliative emergencies: spinal cord compression, superior vena cava syndrome, and hypercalcemia

6Understand the difference between hospice and palliative care eligibility criteria and payment models

Frequently Asked Questions

What is the ACHPN exam?

The ACHPN (Advanced Certified Hospice and Palliative Nurse) is a certification for advanced practice registered nurses (NPs and CNSs) who specialize in hospice and palliative care. It is offered by the Hospice and Palliative Credentialing Center (HPCC).

How many questions are on the ACHPN exam?

The ACHPN exam contains 175 multiple-choice questions: 150 scored items and 25 unscored pilot items. You have 3.5 hours to complete the exam.

What is the ACHPN passing score?

The ACHPN passing score is a scaled score of 75 on a scale of 0-99, which is equivalent to 500 on a scale of 200-800. This equates to approximately 111-112 correct answers out of 150 scored items.

What are the ACHPN eligibility requirements?

To sit for the ACHPN exam, you must have: 1) Current unrestricted APRN license/certification, 2) Graduate/postgraduate/doctoral degree from an accredited NP or CNS program, 3) Official transcript showing advanced pathophysiology, health assessment, and pharmacology courses plus at least 500 supervised clinical hours, 4) 500 practice hours in the past 12 months or 1,000 hours in the past 24 months functioning as an NP or CNS in hospice/palliative care.

What is the ACHPN pass rate?

HPCC reports approximately 65.4% first-time pass rate for the ACHPN exam. Pass rates may vary by candidate preparation and experience level.

How much does ACHPN certification cost?

The ACHPN exam fee is $515 for non-members or $355 for HPNA members. This is for initial certification. Renewal fees are separate.

How long is ACHPN certification valid?

ACHPN certification is valid for 4 years. Renewal can be achieved through continuing education (contact hours in hospice/palliative care) or by re-taking and passing the examination.

What is the difference between CHPN and ACHPN?

CHPN (Certified Hospice and Palliative Nurse) is for registered nurses (RNs) at the bedside. ACHPN (Advanced Certified Hospice and Palliative Nurse) is for advanced practice registered nurses (APRNs) including Nurse Practitioners and Clinical Nurse Specialists who have graduate education and broader scope of practice including prescribing and advanced assessment.