Palliative and End-of-Life Care Practice Questions
17 free Palliative and End-of-Life Care practice questions for the NCLEX Exam. Tap an option to answer — you get instant feedback, the correct answer, and a detailed explanation for every question.
Which statement best defines palliative care in oncology according to the National Cancer Institute?
- A Care given only after curative treatment is no longer an option
- B Care that can be provided solely within a hospice facility
- C Care to improve quality of life at any stage, alongside curative treatment
- D Care that addresses only the patient's spiritual support needs
Correct answer: Care to improve quality of life at any stage, alongside curative treatment
The NCI defines palliative care as care to improve quality of life for patients with serious illness, applicable at any stage and not limited to end-of-life or hospice.
A key principle of palliative care is to assess the whole person. Which domain is not typically included?
- A Physical symptoms
- B Psychological/emotional needs
- C Social and cultural concerns
- D Only biomedical lab values
Correct answer: Only biomedical lab values
Palliative care emphasizes holistic care—physical, psychological, social, spiritual—not just lab/biomedical data.
In end-of-life care for a patient with advanced cancer, a nurse recognizes the importance of early goals of care discussions. Why?
- A Because discussing goals of care delays needed treatment
- B Because early talks align care with patient values and improve quality of life
- C Because patients rarely hold any preferences about their care
- D Because only the physician should ever speak with the family
Correct answer: Because early talks align care with patient values and improve quality of life
Research shows that early goals of care discussions with patient/family allow care that aligns with values and avoids unwanted aggressive interventions.
A patient with advanced oncology has escalating dyspnea and fatigue; the nurse recognizes these as common symptoms in end-of-life care. Which intervention is appropriate?
- A Continue full-dose curative chemotherapy as the primary goal
- B Frequently assess symptoms and provide comfort measures (e.g., low-dose opioids, positioning)
- C Reassure the patient that these symptoms require no intervention
- D Restrict oxygen and fluids to hasten the natural process
Correct answer: Frequently assess symptoms and provide comfort measures (e.g., low-dose opioids, positioning)
Dyspnea and fatigue are distressing end-of-life symptoms; palliative care emphasises frequent symptom assessment and comfort-focused interventions such as low-dose opioids and non-pharmacologic support.
Which ethical principle is most relevant when the oncology patient has lost decision-making capacity and no advance directive is present?
- A Justice, ensuring equal allocation of resources above all else
- B Autonomy alone, deferring entirely to the patient's current choices
- C Beneficence and non-maleficence, balanced with prior wishes or proxy decisions
- D Fidelity, keeping promises made to the patient over all other duties
Correct answer: Beneficence and non-maleficence, balanced with prior wishes or proxy decisions
When capacity is lost and no advance directive exists, care balances doing good (beneficence) and avoiding harm (non-maleficence) while honoring previously-expressed wishes or proxy decisions.
Which of the following differentiates hospice care from general palliative care in oncology?
- A Hospice can be initiated at any stage alongside curative treatment
- B Hospice begins when life expectancy is about 6 months or less and curative intent is stopped
- C Hospice is limited to surgical management of the underlying cancer
- D Hospice deliberately excludes the family from the plan of care
Correct answer: Hospice begins when life expectancy is about 6 months or less and curative intent is stopped
Hospice is palliative care for patients with limited life expectancy (about 6 months) when curative treatment is no longer pursued; general palliative care can run alongside curative therapy at any stage.
A nurse is caring for an oncology patient who expresses fear of being a burden. What is the best nursing response?
- A Quickly change the subject to a more positive topic
- B Explore the patient's fears and arrange family and psychosocial support
- C Reassure the patient that there is nothing to worry about
- D Treat the comment as a normal feeling needing no response
Correct answer: Explore the patient's fears and arrange family and psychosocial support
Addressing fear of being a burden is part of holistic palliative care; validating the patient's concerns and facilitating family and psychosocial support enhances quality of life.
An oncology nurse notes a patient has requested no further CPR and wants comfort measures only. What document should reflect this?
- A A routine laboratory results report in the chart
- B A do-not-resuscitate (DNR) or Allow-Natural-Death (AND) order
- C A daily vital-signs flow sheet documenting trends
- D A referral form for outpatient physical therapy
Correct answer: A do-not-resuscitate (DNR) or Allow-Natural-Death (AND) order
A request for no CPR and comfort measures only should be documented as a DNR/AND order to honour patient autonomy and prevent unwanted resuscitation.
In palliative oncology care, why is early integration of palliative services recommended?
- A Because it should be started only when the patient is imminently dying
- B Because early integration improves symptom control, quality of life, and sometimes survival
- C Because all curative therapy must be discontinued the moment it begins
- D Because its main purpose is to reduce the nursing team's workload
Correct answer: Because early integration improves symptom control, quality of life, and sometimes survival
Evidence supports early palliative care in oncology to improve symptom control, quality of life, and in some cases survival, rather than only providing comfort at the very end.
Which scenario indicates that the nurse should begin end-of-life care planning?
- A Curative treatment is ongoing and the patient remains clinically stable
- B A 'no' to the surprise question (death within 6 months) or clear signs of decline
- C The patient declines to discuss any aspect of future care
- D The patient has already been formally admitted to a hospice program
Correct answer: A 'no' to the surprise question (death within 6 months) or clear signs of decline
Recognizing when death is foreseeable, such as a 'no' to the surprise question ('Would I be surprised if this patient died within 6 months?') or signs of decline, triggers timely end-of-life planning.
In caring for a dying oncology patient, which nursing intervention supports dignity-conserving care?
- A Setting aside the patient's spiritual or existential concerns
- B Supporting the patient's choices about comfort, meaning, legacy, and relationships
- C Focusing exclusively on life-extending medical interventions
- D Limiting visiting hours to reduce disruption on the unit
Correct answer: Supporting the patient's choices about comfort, meaning, legacy, and relationships
Dignity-conserving care honours patient values and supports legacy, comfort, and relationships, addressing psychosocial and spiritual domains in line with palliative principles.
A patient with advanced cancer is experiencing refractory nausea and vomiting despite standard therapy. What is the next step in symptom management?
- A Stop all antiemetic medication and reassess in a few days
- B Rotate the antiemetic class, add non-pharmacologic measures, and consult palliative care
- C Explain that nausea is expected and provide no further treatment
- D Increase the underlying chemotherapy dose to control the symptom
Correct answer: Rotate the antiemetic class, add non-pharmacologic measures, and consult palliative care
Refractory nausea and vomiting require escalation: rotating antiemetic classes, adding non-pharmacologic measures, and involving the palliative team for tailored symptom control.
Which statement about hydration and artificial nutrition in end-of-life oncology patients is correct?
- A Artificial nutrition must always be continued until the moment of death
- B Artificial hydration or nutrition may be withheld when burdens outweigh benefits
- C Artificial hydration has no effect on patient comfort in any situation
- D Nutrition should be maximised at end-of-life regardless of the patient's goals
Correct answer: Artificial hydration or nutrition may be withheld when burdens outweigh benefits
When comfort is the goal, decisions about artificial hydration and nutrition weigh benefit against burden and the patient's values; they may be withheld when burdens outweigh benefits.
A nurse is supporting the family of an oncology patient at end-of-life. Which statement aligns with best practice?
- A Restrict the family's access to the patient to protect the staff
- B Involve the family, share information, and support mourning and bereavement
- C Concentrate only on the patient and disregard the family's needs
- D Leave the family to cope on their own without any guidance
Correct answer: Involve the family, share information, and support mourning and bereavement
Palliative care supports the family as well as the patient, encouraging involvement, providing information, and preparing them for mourning and bereavement.
Which communication strategy is most appropriate when preparing to discuss prognosis with an oncology patient for whom death may be near?
- A Avoid any discussion of prognosis in order to protect the patient
- B Use clear, honest language, allow questions, and respect cultural and spiritual values
- C Rely on detailed technical jargon to convey the prognosis precisely
- D Offer reassuring but unrealistically optimistic predictions about outcome
Correct answer: Use clear, honest language, allow questions, and respect cultural and spiritual values
Honest, empathetic, culturally sensitive communication that allows time for questions and involves family is essential to align end-of-life care with patient goals.
In the dying phase of an oncology patient, what symptom indicates a need for immediate intervention?
- A Gradual slowing of respirations consistent with the current comfort plan
- B New agitation or delirium, chest pain, or uncontrolled hemorrhage
- C Mild generalized fatigue without other new findings
- D An occasional cough that resolves on its own
Correct answer: New agitation or delirium, chest pain, or uncontrolled hemorrhage
Sudden deterioration such as agitation or delirium, new chest pain, or uncontrolled bleeding signals a crisis in the dying patient and requires prompt palliative intervention; gradual respiratory slowing is an expected part of dying.
A nurse is aware that spiritual distress is common at end of life. Which nursing intervention is most supportive?
- A Redirect the patient away from any spiritual questions
- B Assess spiritual concerns, offer chaplain support, and explore meaning and legacy
- C Attend only to the patient's physical symptoms and treatments
- D Proceed on the assumption that spirituality is not relevant
Correct answer: Assess spiritual concerns, offer chaplain support, and explore meaning and legacy
Addressing spiritual and existential distress is integral to palliative care, helping patients explore meaning, values, and legacy as they face dying; chaplain support is a key resource.