CHPN Exam Practice Tests: CHPN Exam Prep to Ensure Certification Success

Q1 of 151. When managing pain in adult patients with life-limiting conditions, which approach is most appropriate for ensuring effective pain control while minimizing side effects?

Q2 of 151. Mr. Johnson, a 68-year-old patient with small cell lung cancer, presents with progressive muscle weakness and difficulty swallowing. His oncologist suspects a paraneoplastic neurologic syndrome. Which of the following management strategies is most appropriate for alleviating his symptoms in a palliative care setting?

Q3 of 151. In the context of hospice and palliative care, which cardiac disorder is most likely to exhibit a pattern of rapid deterioration due to sudden arrhythmias?

Q4 of 151. John, a 68-year-old patient with end-stage liver disease, presents with significant ascites causing discomfort and respiratory difficulty. As his hospice and palliative care nurse, what is the most appropriate intervention to alleviate his symptoms?

Q5 of 151. When managing diabetes as a comorbidity in hospice and palliative care for an adult patient, which of the following considerations is most crucial in guiding treatment decisions?

Q6 of 151. Mary, a 68-year-old patient with metastatic breast cancer, reports increasing pain despite her current opioid regimen. As a hospice and palliative nurse, which aspect of the comprehensive pain assessment should you prioritize to effectively manage her pain?

Q7 of 151. Which type of pain is characterized by burning, tingling sensations and often associated with nerve damage, commonly seen in patients receiving chemotherapy?

Q8 of 151. John, a 68-year-old hospice patient with terminal cancer, is experiencing significant pain despite optimal opioid management. His healthcare team suspects that depression may be influencing his pain perception. Which of the following interventions is most likely to address the depressive symptoms contributing to his pain experience?

Q9 of 151. Which medication is most appropriate for managing neuropathic pain in a palliative care patient named John, considering its efficacy and side effect profile?

Q10 of 151. John, a 68-year-old patient with advanced cancer, experiences severe breakthrough pain despite being on a regular opioid regimen. The hospice team is considering adjusting his medication schedule to better manage his pain. Which scheduling strategy is most appropriate to address John’s breakthrough pain effectively?

Q11 of 151. When converting a patient from oral morphine to transdermal fentanyl, which of the following is the correct dosage equivalent? Assume the patient is currently on 60 mg of oral morphine every 12 hours.

Q12 of 151. A 68-year-old patient named Mr. Thompson, who is receiving palliative care for advanced pancreatic cancer, has been prescribed corticosteroids to manage his pain and inflammation. Considering the pharmacologic interventions with corticosteroids, what is a potential side effect that Mr. Thompson should be monitored for during his treatment?

Q13 of 151. When considering palliative sedation for a patient with advanced illness, which of the following criteria is most crucial in determining its necessity?

Q14 of 151. A 75-year-old patient, Mr. Thompson, is receiving hospice care for advanced pancreatic cancer and experiences significant pain. The healthcare team is considering non-pharmacologic interventions to complement his current pain management plan. Which intervention is most appropriate to implement in this scenario to enhance Mr. Thompson’s comfort?

Q15 of 151. In managing pain for a hospice patient named Mr. Smith, who experiences significant discomfort while lying supine, which positioning strategy would most effectively alleviate his pain based on contemporary research and theories?

Q16 of 151. Mr. Thompson, a 68-year-old patient with advanced pancreatic cancer, experiences severe abdominal pain despite optimal pharmacologic therapy. His healthcare team is considering palliative surgery to alleviate his symptoms. Which of the following surgical interventions is most likely to provide significant pain relief for Mr. Thompson?

Q17 of 151. What is a key benefit of counseling as a non-pharmacologic intervention in managing pain for hospice and palliative care patients like Mr. Thompson?

Q18 of 151. Mrs. Thompson, a 68-year-old patient in hospice care, has been experiencing chronic pain despite pharmacologic interventions. Her nurse suggests incorporating Reiki as a complementary therapy. Which potential benefit of Reiki should be highlighted to Mrs. Thompson to help manage her pain?

Q19 of 151. In the context of hospice and palliative care, which of the following statements best describes a primary benefit of massage therapy for patients experiencing pain?

Q20 of 151. John, a 68-year-old hospice patient with advanced pancreatic cancer, is receiving palliative care to manage his severe abdominal pain. Despite being on a stable regimen of opioids, John reports persistent pain and new onset of nausea. As his nurse, what is the most appropriate next step in evaluating the efficacy of his pain management plan?

Q21 of 151. In managing pain for a hospice patient, which interaction should a nurse be most concerned about when administering opioids alongside other medications?

Q22 of 151. Mr. Thompson, a 68-year-old patient with advanced-stage brain cancer, is experiencing aphasia and has difficulty expressing his needs verbally. As his hospice nurse, what would be the most appropriate strategy to facilitate communication with Mr. Thompson?

Q23 of 151. Which of the following medications is most effective in managing myoclonus in a hospice and palliative care setting?

Q24 of 151. A 68-year-old patient named Mr. Thompson, receiving palliative care for advanced Parkinson’s disease, presents with new-onset muscle rigidity, tremors, and bradykinesia. His medication regimen includes levodopa/carbidopa and a recent addition of metoclopramide for nausea. What is the most likely cause of his extrapyramidal symptoms?

Q25 of 151. Which of the following interventions is most appropriate for managing increased intracranial pressure (ICP) in a hospice patient with limited treatment options?

Q26 of 151. Mrs. Johnson, a 78-year-old hospice patient with advanced heart failure, presents with worsening peripheral edema despite diuretic therapy. As her palliative care nurse, what is the most appropriate next step in managing her edema to improve comfort and quality of life?

Q27 of 151. In managing a hospice patient with Superior Vena Cava Syndrome, which of the following interventions is most appropriate to alleviate symptoms related to venous congestion?

Q28 of 151. Mr. Thompson, a 75-year-old hospice patient with advanced COPD, is experiencing significant respiratory congestion. As his nurse, you need to manage this symptom effectively. Which intervention is most appropriate to alleviate his congestion?

Q29 of 151. In managing pleural effusions in palliative care, which intervention is most effective in providing symptomatic relief for a patient with recurrent malignant pleural effusions?

Q30 of 151. Maria, a 68-year-old hospice patient, is experiencing severe constipation due to opioid use for pain management. As her palliative care nurse, what is the most appropriate first-line treatment to manage her constipation effectively?

Q31 of 151. What is the most effective initial non-pharmacological intervention for managing bowel incontinence in hospice patients?

Q32 of 151. John, a 68-year-old hospice patient with advanced pancreatic cancer, is experiencing persistent nausea despite initial treatment. As his palliative care nurse, you are considering adding a new medication to his regimen. Which of the following medications is most appropriate to address John’s chemotherapy-induced nausea and vomiting (CINV) at this stage?

Q33 of 151. In managing urinary incontinence in a palliative care setting, which intervention is most appropriate for minimizing skin breakdown and maintaining patient dignity?

Q34 of 151. John, a 78-year-old hospice patient with advanced prostate cancer, is experiencing urinary retention. As his nurse, you need to decide on the most appropriate initial intervention to relieve his discomfort. What should you consider first?

Q35 of 151. In hospice care, which intervention is most effective in preventing pressure ulcers in patients with impaired mobility?

Q36 of 151. Emily, a 68-year-old patient with advanced cancer, is experiencing severe oral mucositis due to her chemotherapy regimen. As her hospice and palliative care nurse, you need to manage her symptoms effectively. Which intervention is most appropriate for managing Emily’s oral mucositis?

Q37 of 151. Which of the following is the most effective initial pharmacological treatment for pruritis in a palliative care patient with liver dysfunction?

Q38 of 151. Sarah, a 68-year-old patient with advanced breast cancer, is experiencing tumor extrusion through the skin. As her hospice nurse, you need to manage this condition effectively. Which of the following interventions is most appropriate for managing Sarah’s tumor extrusion while ensuring comfort and preventing infection?

Q39 of 151. A hospice nurse is caring for a patient, Mr. Smith, who frequently exhibits anger and hostility towards staff. Which approach is most effective in managing these emotions in a palliative care setting?

Q40 of 151. John, a 68-year-old male with advanced cancer, is experiencing significant depression affecting his quality of life. As his hospice and palliative care nurse, you need to determine the most appropriate initial intervention to address his depression. Considering contemporary research and recognized theories in palliative care, what should be your first step?

Q41 of 151. In managing guilt among hospice patients, which intervention is most effective in addressing feelings of guilt related to perceived burden on family members?

Q42 of 151. Emily, a 68-year-old hospice patient with advanced cancer, reports significant sleep disturbances. She experiences frequent awakenings and has difficulty falling back asleep. As her hospice nurse, which intervention is most appropriate to address her sleep issues while considering her psychosocial and emotional needs?

Q43 of 151. In the context of palliative care, which nutritional intervention is most appropriate for managing cachexia in a patient with advanced cancer?

Q44 of 151. Mr. Johnson, a 78-year-old hospice patient with advanced cancer, presents with signs of dehydration, including dry mucous membranes and decreased urine output. His family is concerned about his fluid intake. As a palliative care nurse, what is the most appropriate initial action to address Mr. Johnson’s dehydration while respecting his comfort and quality of life?

Q45 of 151. When managing hyperkalemia in a hospice patient, which intervention is most appropriate to rapidly reduce serum potassium levels while considering the patient’s comfort and quality of life?

Q46 of 151. A 72-year-old hospice patient named Mrs. Thompson is experiencing lymphedema in her lower extremities, causing significant discomfort. As her palliative care nurse, which intervention would be most appropriate to manage her symptoms while considering her comfort and quality of life?

Q47 of 151. Which of the following is the most effective initial intervention for managing lymphedema in hospice and palliative care patients?

Q48 of 151. Mr. Thompson, a 78-year-old hospice patient with advanced pancreatic cancer, is experiencing terminal restlessness characterized by agitation and confusion. Which of the following interventions is most appropriate to address Mr. Thompson’s symptoms effectively?

Q49 of 151. A 72-year-old patient with advanced cancer is experiencing visual hallucinations. Which of the following interventions is most appropriate for managing these hallucinations in a hospice setting?

Q50 of 151. Sarah, a 68-year-old patient with advanced cancer, expresses her wish to focus on comfort rather than curative treatment. Her family, however, is hopeful for experimental treatments that may extend her life. As a hospice and palliative care nurse, what is the most appropriate approach to align Sarah’s care plan with her goals and expected outcomes?

Q51 of 151. Which strategy is most effective for optimizing resource allocation in hospice care to ensure comprehensive patient and family support?

Q52 of 151. Mr. Thompson, a 68-year-old patient with advanced lung cancer, is transitioning to hospice care. His family expresses concern about how to access necessary medications and durable medical equipment (DME). As his hospice nurse, what is the most appropriate initial step to educate the family on accessing these services?

Q53 of 151. In assessing fall risk for hospice patients, which factor is most critical to evaluate to prevent falls effectively?

Q54 of 151. Mr. Johnson, a 68-year-old patient with advanced pancreatic cancer, is under hospice care and receiving opioid therapy for pain management. As a hospice nurse, you are responsible for monitoring his controlled substances. Which of the following actions is most appropriate to ensure safe and effective monitoring of Mr. Johnson’s opioid use?

Q55 of 151. What is the most appropriate method for disposing of unused controlled substances in a home hospice setting to ensure safety and compliance with regulations?

Q56 of 151. Maria, a 68-year-old Hispanic patient with terminal cancer, expresses concern about her family’s role in her care. As her hospice nurse, how should you address Maria’s cultural needs effectively?

Q57 of 151. In hospice and palliative care, which communication strategy is most effective in ensuring that both the patient and family understand the care plan and feel supported emotionally?

Q58 of 151. Sarah, a 45-year-old woman, has recently lost her husband and is struggling with overwhelming grief. As her hospice and palliative nurse, you are tasked with providing emotional support. Which of the following strategies is most effective in helping Sarah process her grief according to contemporary research on grief counseling?

Q59 of 151. When providing death vigil support, what is the most crucial aspect a hospice nurse should assess to effectively support the family of a dying patient?

Q60 of 151. Sarah, a hospice nurse, is preparing to notify the family of Mr. Thompson, who has just passed away in a hospice facility. The family had requested not to be informed until all necessary documentation was completed. What should Sarah do first to ensure proper communication and respect for the family’s wishes?

Q61 of 151. During a hospice visit, which of the following actions is most crucial for a nurse to perform to support both patient and family coping mechanisms?

Q62 of 151. Jane is caring for her husband, who is in the advanced stages of a terminal illness. She expresses feelings of exhaustion and guilt for wanting personal time. As a hospice nurse, which strategy should you prioritize to support Jane’s well-being?

Q63 of 151. When assessing caregiver fatigue in a family caring for an adult hospice patient, which intervention is most effective in addressing the emotional burden experienced by caregivers?

Q64 of 151. Mr. Thompson, a 68-year-old patient with advanced cancer, is experiencing significant cognitive decline. His family is concerned about his ability to understand and adhere to his palliative care regimen. As his hospice nurse, how should you assess Mr. Thompson’s ability to learn and respond to barriers in his care?

Q65 of 151. When teaching families about end-stage disease progression, which aspect is most crucial to emphasize for effective symptom management?

Q66 of 151. A hospice nurse is educating the family of Mr. Thompson, a patient with advanced cancer, on managing his medication regimen at home. The nurse emphasizes the importance of understanding medication interactions to prevent adverse effects. Which of the following strategies should the nurse prioritize to ensure effective medication management by the family?

Q67 of 151. When monitoring the need for changes in levels of care for hospice patients, which factor is most indicative of requiring an increase in the level of care?

Q68 of 151. John, a 67-year-old patient with advanced cancer, is experiencing complex symptoms including severe pain, anxiety, and nutritional issues. As his hospice nurse, you recognize the need for comprehensive management. Which interdisciplinary team member should you prioritize referring John to first for immediate intervention?

Q69 of 151. When considering the withdrawal of life-sustaining therapies in a hospice setting, which principle should primarily guide the decision-making process for a Certified Hospice and Palliative Nurse?

Q70 of 151. During a routine assessment, Nurse Emily notices that Mr. Johnson, an elderly hospice patient, has developed pressure ulcers and appears dehydrated. His family insists they are providing adequate care. What should Nurse Emily prioritize in her approach to address potential neglect?

Q71 of 151. In hospice and palliative care, which team member is primarily responsible for coordinating the overall care plan to ensure it aligns with the patient’s goals and preferences?

Q72 of 151. A 78-year-old patient named Mr. Johnson is currently receiving routine home care under the Medicare hospice benefit. Due to a sudden decline in his condition, the hospice team is considering transferring him to a different level of care. Which of the following actions best coordinates this transfer according to Medicare guidelines?

Q73 of 151. In the context of palliative care, what is the most effective strategy for a hospice nurse to ensure seamless collaboration with an attending or primary care provider when managing a patient’s complex symptom burden?

Q74 of 151. Emily, a 78-year-old patient with advanced heart failure, is receiving hospice care. The interdisciplinary team is meeting to develop her individualized plan of care. Which of the following considerations is most crucial in ensuring her plan is effective and patient-centered?

Q75 of 151. A hospice nurse is uncertain about the extent of her responsibilities when dealing with a complex symptom management case. Which action best addresses the scope of practice issue?

Q76 of 151. A 72-year-old patient named Mr. Johnson is receiving palliative care for advanced cancer. The healthcare team is considering the American Pain Society guidelines to manage his pain effectively. Which of the following strategies best aligns with these guidelines for managing pain in palliative care patients?

Q77 of 151. Which of the following OSHA requirements is most critical for hospice and palliative care nurses to ensure workplace safety when handling hazardous drugs?

Q78 of 151. A hospice nurse, Sarah, is assessing a new patient, Mr. Thompson, who has advanced cancer. Sarah needs to develop a care plan that aligns with the current scope and standards of palliative care. Which of the following actions best demonstrates adherence to these guidelines?

Q79 of 151. In the context of hospice care, which of the following actions is most crucial for a nurse to effectively participate in continuous quality improvement activities?

Q80 of 151. Mr. Thompson, a 78-year-old patient with advanced cancer, expresses a desire to discontinue treatment and transition to hospice care. His family, however, insists on continuing aggressive treatment. As a hospice and palliative nurse, what is the most appropriate strategy to address this ethical concern while respecting Mr. Thompson’s autonomy?

Q81 of 151. Which of the following actions best exemplifies a hospice and palliative nurse’s participation in professional nursing activities focused on professional development?

Q82 of 151. John, a 68-year-old patient with advanced pancreatic cancer, is experiencing significant abdominal pain. His current medication regimen includes opioids, but his pain remains uncontrolled. As his hospice nurse, what is the most appropriate next step to manage John’s pain effectively?

Q83 of 151. Which of the following paraneoplastic syndromes is most commonly associated with small cell lung cancer (SCLC)?

Q84 of 151. Mr. Thompson, a 72-year-old patient with advanced heart failure, is under hospice care. Recently, he has been experiencing increased fatigue and shortness of breath even at rest. He also exhibits signs of peripheral edema and orthopnea. Which of the following management strategies should be prioritized to alleviate his symptoms?

Q85 of 151. What is the most appropriate initial management strategy for a palliative care patient with refractory ascites secondary to liver cirrhosis?

Q86 of 151. Mrs. Johnson, a 68-year-old woman with advanced pancreatic cancer and type 2 diabetes, is under hospice care. She has been experiencing fluctuating blood glucose levels despite her reduced oral intake. As her hospice nurse, which approach would be most appropriate in managing her diabetes as a comorbidity?

Q87 of 151. When performing a comprehensive assessment of pain in a palliative care setting, which factor is most critical to consider to ensure an effective pain management plan?

Q88 of 151. John, a 68-year-old male with advanced pancreatic cancer, reports experiencing a burning sensation in his feet and sharp, shooting pains that occasionally radiate up his legs. Based on this description, what type of pain is John most likely experiencing?

Q89 of 151. How does depression most significantly influence the experience of pain in hospice patients?

Q90 of 151. Mr. Johnson, a 68-year-old hospice patient with advanced pancreatic cancer, is experiencing severe neuropathic pain that is not adequately controlled by his current opioid regimen. Which medication would be most appropriate to add to his treatment plan to specifically target the neuropathic component of his pain?

Q91 of 151. When scheduling pharmacologic interventions for pain management in hospice patients, which factor is most crucial to consider to ensure effective pain control?

Q92 of 151. John, a 68-year-old patient with advanced cancer, is currently receiving 60 mg of oral morphine every 4 hours for pain management. His healthcare team is considering converting him to a transdermal fentanyl patch for convenience and better compliance. What is the appropriate starting dose of the fentanyl patch for John?

Q93 of 151. In the context of hospice care, which of the following is a primary reason for using corticosteroids as an adjuvant medication in pain management?

Q94 of 151. John, a 68-year-old patient with advanced pancreatic cancer, is experiencing refractory pain despite optimal opioid management. His family is concerned about his constant distress and requests palliative sedation. As a hospice and palliative nurse, which of the following indicates the most appropriate need for initiating palliative sedation for John?

Q95 of 151. In the context of hospice and palliative care, which non-pharmacologic intervention is most effective for managing chronic pain in patients with advanced cancer?

Q96 of 151. John, a hospice patient with advanced cancer, experiences significant pain in his lower back and hips. As a hospice nurse implementing non-pharmacologic interventions, what is the most effective positioning strategy to alleviate John’s pain?

Q97 of 151. Which of the following is a primary goal of palliative surgery in managing pain for hospice patients?

Q98 of 151. Emily, a 68-year-old patient with terminal cancer, experiences significant pain despite pharmacologic interventions. Her hospice nurse is considering non-pharmacologic counseling interventions to complement her pain management plan. Which of the following counseling approaches is most likely to benefit Emily by addressing her emotional and psychological needs related to pain?

Q99 of 151. In the context of hospice care, how does Reiki primarily benefit patients in managing pain and enhancing overall well-being?

Q100 of 151. A hospice nurse is considering massage therapy for Mr. Thompson, a 68-year-old patient with advanced pancreatic cancer experiencing significant pain and anxiety. Which of the following is the most likely benefit of incorporating massage therapy into his care plan?

Q101 of 151. When evaluating the efficacy of a pain management plan for a hospice patient named Mr. Thompson, which of the following is the most comprehensive approach to ensure optimal outcomes?

Q102 of 151. John, a 72-year-old hospice patient with advanced pancreatic cancer, is experiencing severe pain despite being on high-dose morphine. The nurse suspects drug interactions are affecting the efficacy of the pain management regimen. Which of the following medications is most likely interacting with morphine to reduce its effectiveness?

Q103 of 151. In managing a patient with aphasia in a hospice setting, which intervention is most effective in enhancing communication?

Q104 of 151. Emily, a 70-year-old patient with advanced cancer, is experiencing myoclonus as a side effect of her opioid medication. As her palliative care nurse, you need to manage this symptom effectively. Which of the following interventions is most appropriate to address Emily’s myoclonus?

Q105 of 151. Which of the following symptoms is most characteristic of tardive dyskinesia, an extrapyramidal side effect commonly encountered in hospice and palliative care patients on long-term antipsychotic therapy?

Q106 of 151. Mr. Johnson, a 68-year-old patient with terminal brain cancer, is experiencing increased intracranial pressure (ICP). As a hospice nurse, you are tasked with managing his symptoms. Which intervention is most appropriate to alleviate his discomfort related to increased ICP while considering his palliative care goals?

Q107 of 151. In managing edema in a hospice patient with heart failure, which intervention is most appropriate to prioritize for immediate symptom relief?

Q108 of 151. Mr. Thompson, a 68-year-old patient with advanced lung cancer, presents with facial swelling, shortness of breath, and distended neck veins. As his hospice nurse, you suspect Superior Vena Cava Syndrome (SVCS). Which immediate intervention is most appropriate to alleviate his symptoms?

Q109 of 151. In managing respiratory congestion in a hospice patient, which intervention is most effective for reducing secretions?

Q110 of 151. Mrs. Thompson, a 75-year-old hospice patient with advanced lung cancer, is experiencing increasing dyspnea due to pleural effusion. As her palliative care nurse, you need to manage her symptoms effectively. Which intervention is most appropriate for immediate symptom relief in this scenario?

Q111 of 151. In managing nausea for a hospice patient named Mr. Thompson with advanced cancer, which of the following interventions is most appropriate and evidence-based?

Q112 of 151. Mrs. Thompson, a 78-year-old patient with advanced dementia, is experiencing frequent bowel incontinence. As her hospice nurse, you are tasked with managing this symptom to improve her quality of life. Considering her condition and the principles of palliative care, which of the following interventions is most appropriate?

Q113 of 151. In managing nausea in palliative care patients, which of the following interventions is most appropriate for addressing anticipatory nausea?

Q114 of 151. A 78-year-old hospice patient, Mr. Thompson, with advanced prostate cancer, is experiencing urinary incontinence. As his hospice nurse, you need to manage this symptom effectively while ensuring his comfort and dignity. Which of the following interventions is most appropriate for managing his urinary incontinence?

Q115 of 151. In managing urinary retention in a hospice patient, which of the following interventions is most appropriate to initiate first?

Q116 of 151. John, a 75-year-old patient with advanced Parkinson’s disease, has been bedridden for several weeks. As his hospice nurse, you are assessing him for complications due to immobility. Which of the following is the most immediate concern you should address in John’s care plan?

Q117 of 151. In managing xerostomia (dry mouth) in palliative care patients, which intervention is most effective for maintaining mucous membrane integrity?

Q118 of 151. Mrs. Thompson, a 68-year-old hospice patient with advanced liver disease, reports severe pruritus that is significantly affecting her quality of life. As her nurse, you are considering pharmacological interventions to alleviate her symptoms. Which of the following medications is most appropriate for managing pruritus in this context?

Q119 of 151. In managing a patient with tumor extrusions, which of the following strategies is most effective in preventing infection and promoting healing?

Q120 of 151. John, a 68-year-old patient with terminal cancer, frequently expresses anger towards the hospice staff. As his palliative care nurse, what is the most appropriate initial approach to manage his anger and hostility?

Q121 of 151. Which of the following symptoms is most indicative of clinical depression in a hospice and palliative care patient, considering the overlap with common end-of-life symptoms?

Q122 of 151. Sarah, a hospice nurse, is caring for Mr. Thompson, a terminally ill patient who expresses deep guilt about not being able to fulfill his family responsibilities. Sarah wants to help Mr. Thompson manage his guilt effectively. Which approach should Sarah prioritize to address Mr. Thompson’s feelings of guilt?

Q123 of 151. In managing sleep disturbances in hospice and palliative care patients, which intervention is most supported by evidence for improving sleep quality?

Q124 of 151. Maria, a 68-year-old patient with advanced pancreatic cancer, is experiencing significant weight loss and fatigue. Her appetite is poor, and she reports early satiety. As her hospice nurse, which nutritional intervention would be most appropriate to help manage her symptoms?

Q125 of 151. Which of the following is the most indicative symptom of dehydration in a palliative care patient, such as Mr. Johnson, who is experiencing advanced illness?