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 Medicaid-enrolled 16-year-old with progressive osteosarcoma has a physician-certified prognosis of four months if the illness follows its normal course. She and her parents want home hospice support while continuing a medically necessary cancer-directed regimen covered by Medicaid. The family is told that hospice requires stopping that treatment. Under federal Medicaid requirements, which arrangement is appropriate?
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Correct answer: D - Permit hospice election without requiring discontinuation of the covered cancer-directed treatment.
Domain 2: Psycho-social and spiritual considerations (8-12%)
Question 2
A retired teacher receiving palliative care says, "My pain is controlled, and my family takes good care of me. But teaching gave my life its purpose. Now I do not know what I still have to give." He is not religious, continues to enjoy visits, and has no sustained depressed mood, anhedonia, or thoughts of self-harm. Which intervention most directly addresses the suffering he describes?
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Correct answer: A - Offer life review and a legacy project centered on what he values.
Domain 4: Grief and bereavement (4-8%)
Question 3
Nine months after her mother died of cancer, a 17-year-old reports nearly daily yearning for her. For the past six weeks, she has also avoided reminders of the death, felt that part of her identity died with her mother, found life meaningless, and been unable to resume friendships or school activities. The impairment exceeds her family's cultural expectations for mourning. She can still enjoy brief activities when not preoccupied with the loss and does not describe trauma-related flashbacks. Which diagnosis best accounts for this pattern?
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Correct answer: B - Prolonged grief disorder
Domain 5: Medical management (40-46%)
Question 4
A woman with a malignant chest-wall wound is comfortable between dressing changes on extended-release morphine. Atraumatic dressings have been optimized, but each daily change causes a brief, severe pain flare. Her prescribed immediate-release morphine helps when given afterward. A previous increase in the extended-release dose caused unwanted daytime drowsiness. Which adjustment best preserves alertness while improving procedural pain control?
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Correct answer: B - Time the prescribed immediate-release morphine to take effect before dressing changes.
Question 5
After several days of poor intake, a man taking morphine for metastatic bone pain develops visual hallucinations, multifocal myoclonus, and pain when a bedsheet brushes previously painless skin. His morphine dose was recently doubled. Creatinine has risen from 0.9 to 2.8 mg/dL. He remains arousable, with a respiratory rate of 16/min and adequate ventilation. His original focal bone pain is controlled. What change most directly addresses the new syndrome?
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Correct answer: C - Rotate away from morphine at a reduced equivalent dose and address dehydration.
Question 6
Despite drainage of a symptomatic pleural effusion, an opioid-naive patient with advanced lung cancer continues to experience distressing breathlessness. Evaluation identifies no untreated pulmonary embolism, infection, bronchospasm, or volume overload. Room-air oxygen saturation is 96%, renal function is normal, and he can swallow. A fan, upright positioning, and breathing coaching provide inadequate relief. Which additional treatment is most appropriate now?
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Correct answer: D - Offer a monitored trial of low-dose oral morphine.
Question 7
Persistent nausea prompts an opioid rotation in a patient whose pain responds to morphine. During the last 24 hours, she took morphine extended-release 60 mg orally every 12 hours and four actual doses of immediate-release morphine 15 mg; the rescue prescription permits a dose every four hours as needed. Renal and hepatic function are adequate. The prescriber selects oral hydromorphone liquid, using 25 mg oral morphine = 5 mg oral hydromorphone and a 50% reduction for incomplete cross-tolerance. The reduced daily amount will be divided into six scheduled doses, with separate rescue medication and close reassessment. What scheduled hydromorphone dose accounts for her actual opioid exposure?
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Correct answer: B - 3 mg orally every four hours
Domain 6: Communication and teamwork (4-9%)
Question 8
Before a biopsy-results visit, a patient's daughter says, "Please do not tell Dad it is cancer. He will lose hope." Her father has decision-making capacity, and his preferences about receiving medical information have not been established. The physician acknowledges the daughter's concern. Before deciding how to discuss the results, the physician should:
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Correct answer: A - Ask the patient how much he wishes to know and whom he wants involved.
Domain 7: Ethical and legal decision making (6-10%)
Question 9
A patient with advanced heart failure has an implantable cardioverter-defibrillator that also provides bradycardia pacing. Recent shocks have been painful. At a planned device-clinic visit, he demonstrates understanding that disabling shocks may allow a fatal ventricular arrhythmia and requests no further shocks, but wants pacing maintained. Which order implements his informed choice?
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Correct answer: C - Deactivate shock therapy while preserving bradycardia pacing.
Domain 8: Prognostication and natural history of serious illness (6-10%)
Question 10
At an oncology follow-up, a patient with metastatic colorectal cancer can walk a few steps indoors but spends roughly three-quarters of his waking day in bed or a recliner because of illness. He feeds himself and brushes his teeth but needs help bathing and dressing. He cannot work. These limitations have persisted for several weeks without an acute reversible illness. Which ECOG performance status should be recorded?