- Exam Overview: What the CHPNA Blueprint Covers
- Domain 1: Patient Care - Activities of Daily Living
- Domain 2: Patient Status and Environment
- Domain 3: Psychosocial/Spiritual Care
- Domain 4: Professional Skills
- How the Four Domains Fit Together on Test Day
- Mapping a Study Schedule to the Domains
- Registration, Fees, and Testing Windows
- Frequently Asked Questions
- The CHPNA exam covers four domains: ADLs, Patient Status/Environment, Psychosocial/Spiritual Care, and Professional Skills.
- The exam has 110 multiple-choice questions (100 scored, 10 unscored) in 2 hours 30 minutes.
- Passing requires a scaled score of 500 on a 200-800 scale; no reference materials are allowed.
- Content weighting isn't published by percentage - HPCC instead reports an ~20% recall / 80% application cognitive split.
Exam Overview: What the CHPNA Blueprint Covers
The Certified Hospice and Palliative Nursing Assistant (CHPNA) exam is built from a formal job analysis conducted by the Hospice and Palliative Credentialing Center (HPCC), the body that awards the credential. The 2026 candidate handbook reflects the 2024 job analysis, which organized everything a hospice or palliative nursing assistant does into four content domains. If you're just getting oriented to the credential itself, start with What Is CHPNA? or CHPNA Meaning before diving into domain-level prep.
Unlike some certification exams that publish exact percentage weights per domain, the CHPNA handbook describes cognitive distribution instead: roughly 20% of questions test straight recall of facts, while about 80% require you to apply knowledge to a patient scenario. That means memorizing terms alone won't carry you through the 110-question exam (100 scored, 10 unscored) delivered by PSI in 2 hours 30 minutes. For a broader breakdown of exam mechanics - timing, scoring, and format - see CHPNA Study Guide 2026: How to Pass on Your First Attempt.
Domain 1: Patient Care - Activities of Daily Living
This domain centers on the hands-on caregiving tasks that define the nursing assistant role in a hospice or palliative setting: bathing, grooming, toileting, positioning, feeding, mobility assistance, and skin care for patients who are often frail, bed-bound, or actively declining.
Patient Care: Activities of Daily Living
Questions in this domain test your ability to adapt standard ADL techniques to patients with limited mobility, high fall risk, cognitive decline, or active dying (terminal) trajectories.
- Safe transfer and repositioning techniques for patients at end of life
- Pressure-injury prevention and skin integrity checks
- Oral care and nutrition/hydration support as intake declines
- Recognizing when a change in ADL tolerance signals a status change to report
Expect scenario-based items rather than simple definitions - for example, choosing the best next action when a patient resists bathing due to pain, rather than just naming the correct bathing technique.
Domain 2: Patient Status and Environment
This domain covers observation and reporting: recognizing changes in vital signs, breathing patterns, skin color, level of consciousness, and pain behaviors, as well as maintaining a safe, clean, and comfortable physical environment for the patient.
Patient Status and Environment
Because nursing assistants work under RN supervision, this domain tests your ability to observe accurately and communicate findings - not to diagnose or treat.
- Recognizing signs of the dying process (changes in respiration, circulation, responsiveness)
- Infection control and standard precautions in the home or facility setting
- Safe equipment use: hospital beds, lifts, oxygen delivery devices
- Environmental comfort measures: lighting, noise, temperature, positioning for symptom relief
Many candidates underestimate how much this domain overlaps with basic safety protocols learned in prior CNA training - but the CHPNA exam frames every question inside a hospice or palliative context, so review scenario cues carefully. If you want a sense of how tough this content actually feels in practice, read How Hard Is the CHPNA Exam? Complete Difficulty Guide 2026.
Domain 3: Psychosocial/Spiritual Care of the Patient and Family/Caregivers
Hospice and palliative care is built around the whole person, not just physical symptoms. This domain tests communication, emotional support, cultural sensitivity, and respect for family and caregiver dynamics during a terminal illness.
Psychosocial/Spiritual Care
Questions here often present a family in distress, a patient expressing fear or anger, or a cultural/spiritual practice that must be respected - and ask you to choose the most therapeutic response.
- Active listening and non-verbal communication with dying patients
- Supporting family members through anticipatory grief
- Respecting diverse spiritual, cultural, and end-of-life traditions
- Knowing your scope: when to involve the RN, social worker, or chaplain
Key Takeaway
This domain rewards candidates who can identify the "most therapeutic" answer among several plausible-sounding options - practice reading every choice before selecting, since more than one may seem reasonable.
Domain 4: Professional Skills
The final domain covers the nursing assistant's role within the interdisciplinary hospice team: documentation, confidentiality, scope-of-practice boundaries, ethical conduct, and communication with the RN who supervises the assistant's practice.
Professional Skills
This domain checks whether you understand the legal and ethical framework surrounding hospice and palliative nursing-assistant work in the United States.
- Accurate, timely documentation and reporting to the supervising RN
- Patient confidentiality and information-sharing boundaries
- Recognizing and reporting abuse, neglect, or unsafe conditions
- Working within your certified scope - not performing tasks reserved for licensed staff
Because eligibility itself requires practicing under RN supervision - 500 hours in the preceding 12 months or 1,000 hours in the preceding 24 months - this domain essentially formalizes habits you should already be practicing on the job. Full eligibility details are covered in CHPNA Requirements 2026: Eligibility, Prerequisites & How to Qualify.
How the Four Domains Fit Together on Test Day
HPCC does not publish an exact percentage breakdown for how many of the 100 scored questions come from each domain. What is published is the cognitive-level split: about 20% recall, about 80% application. In practice, this means all four domains - Activities of Daily Living, Patient Status and Environment, Psychosocial/Spiritual Care, and Professional Skills - will include multiple scenario-based items requiring judgment, not just memorized facts.
| Domain | Core Focus | Typical Question Style |
|---|---|---|
| 1. Patient Care: ADLs | Bathing, feeding, mobility, skin care | Best-practice technique for a declining patient |
| 2. Patient Status and Environment | Observation, safety, infection control | Identify a reportable change or safety risk |
| 3. Psychosocial/Spiritual Care | Communication, grief, cultural respect | Choose the most therapeutic response |
| 4. Professional Skills | Documentation, ethics, scope of practice | Determine the correct action within scope |
To pass, you need a scaled score of 500 on a 200-800 scale - full detail on how that scale works is in CHPNA Passing Score 2026: Exactly What You Need to Pass. For the national data behind first-time and overall outcomes, see CHPNA Pass Rate 2026: What the Data Shows.
Mapping a Study Schedule to the Domains
Rather than studying generically, allocate blocks of time to each domain in the order they tend to trip up candidates: psychosocial scenarios and professional-skills boundary questions are often less intuitive than hands-on ADL content for experienced caregivers.
Domain 1 & 2 Review
- Refresh ADL techniques for high-acuity, end-of-life patients
- Drill observation/reporting scenarios for status changes
Domain 3 Focus
- Practice choosing the "most therapeutic" response in family/caregiver scenarios
- Review cultural and spiritual end-of-life variations
Domain 4 & Mixed Review
- Study documentation and scope-of-practice boundaries
- Take mixed-domain practice sets under timed conditions
For a structured week-by-week plan and a condensed reference before test day, pair this schedule with CHPNA Study Guide 2026: How to Pass on Your First Attempt and CHPNA Cheat Sheet 2026: One-Page Review of Must-Know Facts. You can also run full-length practice exams on our CHPNA practice test platform to simulate the 110-question, 2-hour-30-minute format before your scheduled date.
Registration, Fees, and Testing Windows
The CHPNA exam is delivered by PSI, either at a test center or via live remote proctoring. Initial examination fees are $190 for HPNA members and $280 for nonmembers. If your first attempt is unsuccessful, the reTEST Assured program offers one discounted retake at $135, available within one of the next three testing windows.
Certification lasts four years. Renewal requires qualifying practice hours plus either a successful re-examination or completion of the Hospice and Palliative Accrual for Recertification (HPAR) program, including its professional-development requirements. Note that a candidate who fails a renewal exam must continue through the examination route rather than switch to HPAR. For the full cost breakdown across initial, retake, and renewal scenarios, see CHPNA Certification Cost 2026: Complete Pricing Breakdown, and for exact deadlines by window, see CHPNA Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Once certified, many candidates use the four domains as a framework for job interviews too - hospice agencies and palliative care teams often ask behavioral questions tied directly to ADL support, status reporting, family communication, and professional boundaries. Browse CHPNA Jobs for a sense of where this credential is valued, and Is the CHPNA Certification Worth It? Complete ROI Analysis 2026 for a fuller ROI picture beyond just the exam.
Frequently Asked Questions
Four: Patient Care (Activities of Daily Living), Patient Status and Environment, Psychosocial/Spiritual Care of the Patient and Family/Caregivers, and Professional Skills.
No. The 2026 handbook describes cognitive-level distribution instead - approximately 20% recall and 80% application - rather than a percentage weight per domain.
Many candidates find Psychosocial/Spiritual Care and Professional Skills more challenging than the hands-on ADL and status-monitoring domains, since they require judgment about communication and scope rather than technique.
No. Reference materials are prohibited during the CHPNA exam, whether taken at a test center or through live remote proctoring with PSI.
The exam has 110 multiple-choice questions - 100 scored and 10 unscored - with 2 hours 30 minutes allowed to complete it.
Understanding all four domains - and how they translate into scenario-based questions rather than simple recall - is the foundation of an effective CHPNA study plan. Combine domain review with full-length timed practice on our practice test site to build the pacing and judgment the exam actually rewards.