10 exam-style questions with answers and explanations, straight from our 1,030-question bank. Tap an answer to check yourself. When you're ready, take the scored version in the free practice test.
The HPM exam has 200 questions and runs 4 hours 30 minutes.
These 10 free HPM questions are organized by exam domain, so you can see how each part of the Subspecialty Certification in Hospice and Palliative Medicine blueprint is tested. Reveal the answer and explanation under each question.
Domain 1: Approach to care (7-12%)
Question 1
A 16-year-old with relapsed sarcoma is insured through Medicaid. Her physicians certify a prognosis of less than six months despite treatment. She and her parents want home hospice support while she receives another disease-directed chemotherapy regimen. They have been told chemotherapy must stop before hospice can begin. Which statement about her coverage is accurate?
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Correct answer: A - She may receive hospice and treatment of the terminal illness concurrently.
Domain 2: Psycho-social and spiritual considerations (8-12%)
Question 2
Since learning that his glioblastoma has progressed, a retired teacher has worried that his grandchildren will know him only as 'the man who was sick.' He is not religious, still looks forward to visits, and denies persistent loss of pleasure or thoughts of self-harm. He wants to preserve stories about teaching and messages for his grandchildren. Which intervention is specifically designed to create the lasting record he describes?
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Correct answer: D - Dignity therapy with a patient-approved legacy document
Domain 3: Impending death (6-10%)
Question 3
Overnight, the daughter of a man with terminal pancreatic cancer calls because his breathing 'sounds like he is drowning.' He has been unresponsive for a day after steady decline, with mottled feet and minimal urine output. At the bedside, his face is relaxed and there is no accessory-muscle use. Gurgling is loudest over the throat; there are no basal crackles or other findings of pulmonary congestion. Comfort-focused care is documented. Which bedside response is most appropriate?
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Correct answer: C - Reposition him and explain pooled secretions while providing gentle mouth care.
Domain 5: Medical management (40-46%)
Question 4
During admission for dehydration, a woman with metastatic breast cancer reports that even bedsheets hurt. Her morphine dose was increased twice during the preceding week for worsening pain. She now has multifocal myoclonus and vivid visual hallucinations. Creatinine has risen from 0.9 to 2.7 mg/dL; calcium and glucose are normal. She is readily arousable, with a respiratory rate of 16/min. Recent imaging shows stable tumor burden. Which change most directly addresses the likely cause while preserving analgesia?
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Correct answer: C - Rotate to titratable parenteral fentanyl and treat dehydration.
Question 5
The medication administration record for a frail inpatient shows oral sustained-release morphine 60 mg every 8 hours plus three 20-mg oral immediate-release morphine doses during the last 24 hours. Pain is now controlled, but persistent morphine-associated nausea prompts rotation to oral hydromorphone solution. Renal and hepatic function are normal. The physician selects a 50% reduction of the calculated equianalgesic daily dose for incomplete cross-tolerance. For this rotation, use oral morphine 30 mg = oral hydromorphone 7.5 mg. Hydromorphone will be scheduled every 4 hours, with separate breakthrough medication and reassessment. Which scheduled dose should be prescribed?
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Correct answer: B - Hydromorphone 5 mg orally every 4 hours
Question 6
After several weeks of thoracic back pain, a man with prostate cancer metastatic to bone develops bilateral leg weakness and cannot void. Examination shows a sensory level at the umbilicus. He wants treatment aimed at preserving mobility. Urgent whole-spine MRI and spine-service consultation are being arranged. He has no contraindication to corticosteroids. What corticosteroid action is appropriate while imaging is pending?
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Correct answer: A - Give dexamethasone 16 mg orally or an equivalent parenteral dose now.
Question 7
Repeated high-volume vomiting continues in a woman with ovarian cancer and diffuse peritoneal disease. CT confirms complete small-bowel obstruction at multiple sites, without perforation. She passes neither stool nor flatus, is not a surgical candidate, and declines nasogastric decompression after an informed discussion. Parenteral analgesia and haloperidol provide partial symptom relief, but vomiting persists. Which addition directly reduces the gastrointestinal secretions contributing to the vomiting?
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Correct answer: A - Subcutaneous octreotide
Domain 6: Communication and teamwork (4-9%)
Question 8
At a family meeting for an intubated man with metastatic pancreatic cancer and septic shock, his wife says, 'He would accept a few hard days if he could get back to talking with us, but not weeks on machines.' She is his appointed surrogate. The clinicians believe recovery from the infection remains possible and propose a 72-hour trial of intensive treatment. What must be agreed on before the meeting ends?
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Correct answer: D - Specify recovery milestones and the plan if the trial does not meet them.
Domain 7: Ethical and legal decision making (6-10%)
Question 9
In a U.S. hospital, a ventilator-dependent man with advanced amyotrophic lateral sclerosis communicates through an eye-tracking device. He accurately explains his diagnosis, the benefits and burdens of continued ventilation, and that withdrawal is likely to lead to death. His reasons are consistent with long-standing values, and assessment finds no delirium or depression impairing the decision. He requests planned ventilator withdrawal. His wife says he has lost the right to decide because he can no longer speak. What governs this decision?
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Correct answer: C - His informed refusal governs despite his motor and speech impairment.
Domain 8: Prognostication and natural history of serious illness (6-10%)
Question 10
At a home visit, a woman with extensive metastatic lung cancer no longer gets out of bed and depends on caregivers for all personal care. She cannot carry out any usual activities. She remains able to converse and has no confusion, but her intake is now limited to a few sips of water. What Palliative Performance Scale version 2 score matches this combination of findings?