100+ Free CAQ-Palliative Practice Questions

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In the absence of an advance directive or appointed healthcare power of attorney, most state surrogate decision-making hierarchies prioritize:

Closest neighbor

Treating physician

The patient's employer

Spouse, then adult children, then parents, then siblings

to track

Same family resources

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2026 Statistics

Key Facts: CAQ-Palliative Exam

120

Total Items

NCCPA CAQ

3 hrs

Exam Time

NCCPA

$350

Exam Fee

NCCPA

3,000 hrs

Practice Required

Prior 6 yrs palliative-PA

NCCPA CAQ-Palliative is the PA subspecialty credential for hospice & palliative medicine. 120 items, 3 hours, $350. Eligibility: 3,000 hours palliative practice + 150 palliative CME. Master WHO analgesic ladder, MEDD opioid conversions, hospice eligibility (CMS 6-month prognosis), POLST, and SPIKES protocol for breaking bad news.

Sample CAQ-Palliative Practice Questions

Try these sample questions to test your CAQ-Palliative exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1According to the WHO analgesic ladder, which class of medications is recommended at Step 1 for mild pain?

A.Strong opioids such as morphine

B.Weak opioids such as codeine

C.Non-opioids such as acetaminophen or NSAIDs

D.Adjuvant agents such as gabapentin

Explanation: WHO Step 1 begins with non-opioids (acetaminophen, NSAIDs) +/- adjuvants. Step 2 adds weak opioids; Step 3 uses strong opioids.

2A patient is taking morphine 30 mg PO every 4 hours around the clock. What is the appropriate equivalent dose of IV morphine over 24 hours?

A.30 mg IV

B.60 mg IV

C.90 mg IV

D.180 mg IV

Explanation: PO:IV morphine ratio is 3:1. Total PO morphine = 180 mg/24h. IV equivalent = 180/3 = 60 mg/24h.

3When rotating opioids, the new opioid dose should be reduced by what percentage to account for incomplete cross-tolerance?

A.10-20%

B.25-50%

C.60-75%

D.Reduction is unnecessary

Explanation: Incomplete cross-tolerance requires a 25-50% dose reduction when rotating opioids to prevent overdose; methadone requires even greater caution.

4A patient takes morphine 60 mg PO every 12 hours of long-acting morphine. What is an appropriate breakthrough dose of immediate-release morphine?

A.5 mg PO q1h prn

B.12-24 mg PO q1h prn

C.60 mg PO q1h prn

D.Hold all breakthrough until next scheduled dose

Explanation: Breakthrough dose = 10-20% of 24-hour total. Total = 120 mg/24h. Breakthrough = 12-24 mg PO q1h prn.

5Which of the following should ALWAYS be prescribed prophylactically when starting a chronic opioid?

A.Ondansetron

B.Naloxone

C.A bowel regimen (e.g., senna +/- docusate)

D.Diphenhydramine

Explanation: Tolerance to opioid-induced constipation does not develop. A scheduled stimulant laxative (senna) +/- stool softener should always accompany chronic opioids.

6A hospice patient with refractory opioid-induced constipation has failed senna, docusate, polyethylene glycol, and bisacodyl. Which agent is FDA-approved specifically for opioid-induced constipation in palliative care?

A.Lactulose

B.Methylnaltrexone

C.Loperamide

D.Lubiprostone

Explanation: Methylnaltrexone is a peripherally acting mu-opioid antagonist approved for opioid-induced constipation refractory to standard laxatives without reversing analgesia.

7Which property makes methadone uniquely complex among opioids and requires methadone-specific conversion tables?

A.Linear dose-response across all doses

B.Short, predictable half-life

C.Non-linear, dose-dependent equianalgesic ratios and long, variable half-life

D.No QTc prolongation risk

Explanation: Methadone has dose-dependent equianalgesic ratios (higher morphine doses require larger reductions), variable half-life (15-60+ hours), QTc prolongation risk, and CYP interactions.

8A patient with metastatic prostate cancer to bone reports burning, shooting pain down the leg consistent with neuropathic pain. Which adjuvant is most appropriate to add?

A.Acetaminophen

B.Gabapentin

C.Ondansetron

D.Bisacodyl

Explanation: Gabapentinoids (gabapentin, pregabalin) and TCAs/SNRIs (duloxetine) are first-line adjuvants for neuropathic pain.

9A patient with epidural metastases and acute spinal cord compression has severe back pain. In addition to opioids and emergency MRI/neurosurgery consult, which adjuvant should be initiated immediately?

A.High-dose dexamethasone

B.Long-acting morphine

C.Gabapentin titration over 2 weeks

D.Methadone

Explanation: High-dose dexamethasone (10 mg IV bolus then 4 mg q6h) reduces cord edema in malignant spinal cord compression and is started immediately while imaging/RT/surgery is arranged.

10An 82-year-old with stage 4 CKD (eGFR 22) and bone pain should AVOID which class for chronic management?

A.Acetaminophen

B.NSAIDs

C.Topical lidocaine

D.Low-dose opioids titrated cautiously

Explanation: NSAIDs are contraindicated in advanced CKD due to risk of further renal decline, GI bleeding, and fluid retention; particularly avoided in elderly.

About the CAQ-Palliative Exam

NCCPA Certificate of Added Qualifications in Hospice and Palliative Medicine — for PAs in palliative or hospice practice. Covers pain management (WHO ladder, opioid rotation, MEDD), symptom management (dyspnea, nausea, delirium), goals-of-care communication and advance care planning, hospice eligibility (CMS LCDs), end-of-life/active dying care, psychosocial/spiritual care, special populations (peds, cardiac, oncology), and palliative ethics/legal.

Questions

120 scored questions

Time Limit

3 hours

Passing Score

Scaled (NCCPA-set)

Exam Fee

$350 (NCCPA)

CAQ-Palliative Exam Content Outline

25%

Pain Management

WHO ladder, opioid rotation, MEDD calculation, neuropathic adjuvants, methadone caution

20%

Symptom Management

Dyspnea (opioid), nausea (mechanism-targeted), constipation, delirium, anorexia, fatigue

15%

Communication / Goals of Care

SPIKES, NURSE, advance directives, POLST/MOLST, family meetings, prognostic disclosure

10%

Hospice Eligibility

CMS 6-month prognosis, LCDs (CHF, COPD, dementia FAST 7c, cancer), recertification, GIP

10%

End-of-Life / Active Dying

Death rattle (glycopyrrolate), terminal restlessness, withdrawal of life-sustaining therapy

Psychosocial / Spiritual

Demoralization vs depression, anticipatory grief, FICA spiritual assessment, bereavement

Special Populations

Pediatric palliative, advanced HF, COPD, oncology, neurodegenerative (ALS, dementia)

Ethics / Legal

Capacity vs competency, surrogate hierarchy, MAID/PAS, double effect, withdrawal vs withholding

How to Pass the CAQ-Palliative Exam

What You Need to Know

Passing score: Scaled (NCCPA-set)
Exam length: 120 questions
Time limit: 3 hours
Exam fee: $350

Keys to Passing

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

CAQ-Palliative Study Tips from Top Performers

1Master MEDD conversions, opioid rotation rules (25-50% dose reduction for incomplete cross-tolerance), and methadone cautions

2Memorize CMS hospice eligibility (≤6 months prognosis) and disease-specific LCDs (dementia FAST 7C, CHF NYHA IV)

3Drill SPIKES + NURSE communication frameworks for goals-of-care and breaking bad news

4Know mechanism-targeted antiemetics (CTZ → haloperidol; vestibular → meclizine; gut → metoclopramide; cortical → dexamethasone)

5Understand POLST/MOLST authority, surrogate decision-maker hierarchy, and capacity vs competency distinctions

Frequently Asked Questions

How is MEDD (morphine equivalent daily dose) used?

MEDD standardizes opioid dosing for safety, rotation, and policy thresholds. Approximate ratios (oral): morphine 30 mg = oxycodone 20 mg = hydrocodone 30 mg = hydromorphone 7.5 mg. Methadone is non-linear and dose-dependent — use specialized tables. CDC 2022 recommends caution above 50 MEDD/day and avoiding ≥90 MEDD without specialist input. When rotating opioids, reduce 25-50% for incomplete cross-tolerance.

What are CMS hospice eligibility criteria?

Medicare hospice requires: (1) Two physicians (referring + hospice medical director) certify life expectancy ≤6 months if disease runs its usual course, (2) patient elects hospice (waiving curative treatment for the terminal condition). Disease-specific Local Coverage Determinations (LCDs) provide criteria — e.g., dementia FAST score ≥7C plus ≥1 medical complication; CHF NYHA IV with optimized meds. Recertify every benefit period.

What is the SPIKES protocol for breaking bad news?

SPIKES: Setting (private, sit, no interruptions); Perception (find out what they know — "tell me what you understand"); Invitation (ask how much info they want); Knowledge (give a warning shot then info in small chunks, no jargon); Emotions (use NURSE — Name, Understand, Respect, Support, Explore); Strategy/Summary (next steps + plan). Originally Buckman/Baile for oncology — widely used.

How should I study for CAQ-Palliative?

Plan 80-120 hours over 10-14 weeks. Work the NCCPA CAQ Hospice and Palliative Medicine content blueprint, drill weighted-domain practice questions, complete required Category 1 CME, and submit experience requirements (typically ≥3,000 hours specialty practice in the prior 6 years and ≥150 specialty CME) before sitting the exam.