Basic Care and Comfort
A nurse is caring for a terminally ill patient who reports unrelieved pain despite current opioid therapy. What is the nurse’s best action?
A. Contact the provider to request a change in the pain medication regimen
B. Encourage the patient to practice deep breathing exercises
C. Explain that some pain is expected at the end of life
D. Wait to see if the next scheduled dose provides relief
Correct Answer: A
Rationale: Palliative care prioritizes symptom control. Pain must be aggressively managed; contacting the provider for medication reassessment is essential.
A terminally ill client receiving opioid analgesics attempts to get out of bed unassisted and has an unsteady gait. What is the most appropriate safety intervention?
A. Place the bed in high position for easier transfers
B. Encourage the client to remain in bed as much as possible
C. Apply a vest restraint to prevent falls
D. Use a bed alarm and keep personal items within reach
Correct Answer: D
Rationale: Bed alarms and easy access to belongings promote fall prevention while maintaining dignity and autonomy.
Which task is appropriate for the nurse to delegate to a UAP (unlicensed assistive personnel) caring for a hospice patient?
A. Assess the patient’s response to morphine
B. Provide emotional support to the patient’s family
C. Turn and reposition the patient every 2 hours
D. Teach the family how to administer oral medications
Correct Answer: C
Rationale: Repositioning is within the UAP’s scope. Assessment, teaching, and emotional support require RN-level judgment.
A nurse is educating a patient newly enrolled in hospice care about advance directives. Which statement by the patient indicates a need for further teaching?
A. “I can name someone to make decisions for me if I can't speak.”
B. “I can change my advance directive at any time.”
C. “My doctor must follow my advance directive exactly as written.”
D. “This document tells others my preferences for life-sustaining treatments.”
Correct Answer: C
Rationale: While providers strongly consider advance directives, clinical judgment may still guide urgent decisions. This statement reflects a misunderstanding of how directives are applied.
Order: Acetaminophen 650 mg PO every 6 hours PRN for pain
Available: Acetaminophen 325 mg tablets
Question:
How many tablets will you administer per dose?
2 Tablets
A dying client expresses concern about becoming a burden to their family. What is the nurse’s best response to promote comfort and dignity?
A. “You don’t need to worry about your family right now.”
B. “Let’s talk about what’s most important to you at this time.”
C. “This is part of the dying process and happens to everyone.”
D. “Would you like to talk to a psychiatrist about your worries?”
Correct Answer: B
Rationale: Encouraging open communication honors the patient’s dignity and helps align care with personal goals.
A nurse is preparing to administer morphine 2 mg IV every 2 hours PRN for dyspnea in a palliative care patient. The client’s respiratory rate is 8 breaths per minute. What is the best action?
A. Administer the medication as ordered
B. Hold the dose and notify the provider
C. Document the respiratory rate and reassess in 1 hour
D. Give only 1 mg of the dose and monitor closely
Correct Answer: B
Rationale: Respiratory depression is a serious opioid side effect. Holding the dose and notifying the provider ensures safe medication practices.
Which task may the RN delegate to the LPN in a palliative care setting?
A. Perform a full admission assessment
B. Evaluate the effectiveness of pain control
C. Administer prescribed subcutaneous morphine
D. Discuss advance directives with the family
Correct Answer: C
Rationale: LPNs may administer medications, including subcutaneous opioids, depending on state laws and facility policy. Assessment and teaching are reserved for RNs.
Teaching About the Dying Process
A family member asks the nurse what to expect as their loved one nears death. Which explanation by the nurse is most accurate?
A. “They will pass away in their sleep without any changes.”
B. “Breathing may become irregular, and they may be less responsive.”
C. “Pain always increases in the last few hours of life.”
D. “You should try to stimulate them to stay awake as much as possible.”
Correct Answer: B
Rationale: Educating families on normal signs of dying—like Cheyne-Stokes respirations and decreased consciousness—helps reduce fear and supports informed caregiving.
Your patient is on strict I&O monitoring for fluid balance. During your 12-hour shift, the patient had the following intake and output:
Intake:
8 oz water at 0800
6 oz juice at 1000
100 mL IV flush at 1200
250 mL of IV fluid every 4 hours administered twice during your shift
What is the total in ml?
1020 ml
The nurse is caring for a patient in the final hours of life. Which of the following signs should the nurse expect?
A. Bounding pulse and warm extremities
B. Increased urine output and restlessness
C. Mottled skin and irregular breathing patterns
D. Increased appetite and dry mouth
Correct Answer: C
Rationale: As death approaches, common signs include peripheral mottling, Cheyne-Stokes respirations, and decreased perfusion.
During a home health visit, the nurse notices that a hospice patient has thick carpeting, poor lighting, and cluttered walkways. What should the nurse do first to promote safety?
A. Encourage the family to move the patient to a nursing home
B. Notify the hospice provider to reevaluate the environment
C. Recommend removing tripping hazards and improving lighting
D. Tell the family to stop the home visits until safety is improved
Correct Answer: C
Rationale: Environmental modifications such as removing fall risks and improving lighting enhance home safety for dying clients.
A hospice patient is actively dying. Which task should the nurse not delegate to the UAP?
A. Bathing the patient
B. Notifying the nurse of changes in respirations
C. Providing mouth care
D. Changing linens
Correct Answer: B
Rationale: Recognizing and interpreting changes in condition (e.g., respiratory status) requires clinical judgment and must be done by the nurse.
A patient’s spouse asks how they can help manage the patient’s comfort at home. What is the nurse’s best response?
A. “Make sure to give IV pain medications on time.”
B. “Keep the environment calm and offer gentle care when needed.”
C. “It’s best to let the hospice nurse do everything.”
D. “Encourage them to get out of bed every hour.”
Correct Answer: B
Rationale: Educating caregivers on non-invasive comfort measures and emotional support is essential in home-based palliative care.
Order: 1000 mL Normal Saline IV to infuse over 8 hours
Drop Factor: 15 gtt/mL
Question:
What is the IV flow rate in drops per minute (gtt/min) round to the nearest whole number?
Formula:
(Volume to infuse × Drop factor) ÷ Time in minutes
(1000 mL × 15) ÷ (8 × 60) = 15,000 ÷ 480 = 31.25 ≈ 31 gtt/min
A family member is crying at the bedside of a patient receiving end-of-life care. What is the most therapeutic nursing response?
A. “Try not to cry in front of the patient.”
B. “I’ll give you some time alone.”
C. “It’s okay to cry. You’re showing your love and support.”
D. “Let’s talk about resuscitation decisions.”
Correct Answer: C
Rationale: Validating emotions and offering presence supports both the patient and the family during the grieving process.
A patient with advanced Parkinson’s disease and dysphagia is on comfort care. Which intervention helps prevent aspiration during oral intake?
A. Positioning the patient supine during feeding
B. Encouraging fast eating to prevent fatigue
C. Feeding small amounts while sitting upright
D. Using a straw for all fluids
Correct Answer: C
Rationale: Feeding small amounts in an upright position minimizes aspiration risk and aligns with safe swallowing practices.
A UAP tells the nurse that a palliative care patient’s family is upset and wants to talk to someone about “what happens next.” What should the nurse do?
A. Tell the UAP to explain the dying process
B. Instruct the UAP to call the chaplain
C. Personally speak with the family as soon as possible
D. Ask the UAP to distract the family with a new task
Correct Answer: C
Rationale: Communication about the dying process must come from a licensed nurse or provider. This is not appropriate to delegate.
A family member says, “Mom isn’t eating much anymore—should I force her to eat something?” What is the nurse’s best response?
A. “Yes, nutrition is essential even in the final days.”
B. “Try giving her supplements through a feeding tube.”
C. “This is normal near the end of life; let her eat or drink as she wishes.”
D. “Call the provider immediately—this is a sign of decline.”
Correct Answer: C
Rationale: Loss of appetite is expected in the dying process. Forcing food may cause more discomfort. Education should focus on comfort, not correction.
Weight-Based Dosage (mg/kg)
Order: Ceftriaxone 50 mg/kg IM once
Patient Weight: 22 lbs
Available: Ceftriaxone 1 g vial
Question:
How many milligrams should the patient receive?
Order: 50 mg/kg
Weight: 22 lbs → Convert to kg
22 ÷ 2.2 = 10 kg
A nurse is caring for a terminally ill patient with metastatic cancer who is experiencing increasing confusion, restlessness, and periods of apnea. The patient’s spouse states, “I think they’re scared. Shouldn’t we wake them up and talk to them?”
Which nursing response demonstrates appropriate clinical judgment and prioritization of comfort in end-of-life care?
A. “Let’s gently wake them up so they can talk to you.”
B. “These changes are expected as the body begins to shut down. We’re keeping them comfortable.”
C. “I will ask the provider to increase the pain medication.”
D. “They may be scared. Do you think they would want to see other family members?”
Correct Answer: B
Rationale: This question tests knowledge of the dying process, emotional support, and appropriate comfort care. Confusion, apnea, and restlessness are common signs of active dying. Reassurance and explanation of the natural process while ensuring comfort are key priorities.
A hospice patient at home is on nasal cannula oxygen for comfort. The family wants to light candles during prayer. What should the nurse instruct?
A. “It’s safe as long as the oxygen is turned off briefly.”
B. “Open a window while lighting candles near the patient.”
C. “Oxygen is flammable. Please avoid open flames around the patient.”
D. “It’s okay if the oxygen tubing is at least 3 feet away from the candle.”
Correct Answer: C
Rationale: Oxygen supports combustion. Fire safety is a critical teaching point in any environment with supplemental oxygen.
A family requests that their loved one’s body be turned to face east after death per religious custom. The nurse is busy with a new admission. What is the appropriate delegation?
A. Delegate the task to the UAP with instructions
B. Tell the family they must wait until the RN is free
C. Refuse the request due to time constraints
D. Tell the LPN to notify the chaplain instead
Correct Answer: A
Rationale: Respecting cultural rituals is part of holistic care. With direction, UAPs can carry out non-clinical postmortem care tasks.
A patient with end-stage heart failure elects to enroll in hospice care. During the nurse's education session, the patient states, “I don’t want to be hooked up to machines, but I’m scared my family will want everything done to save me.” What is the most appropriate nursing response?
A. “Let’s complete a DNR form so they can’t override your wishes.”
B. “If your family insists, the medical team will have to follow their direction.”
C. “Would you like help completing an advance directive that communicates your choices clearly?”
D. “It’s best to let your family make those decisions when the time comes.”
Correct Answer: C
Rationale: This question requires clinical judgment, ethical sensitivity, and a deep understanding of patient autonomy and legal preparation. Helping the patient formally document their preferences ensures their wishes are followed and reduces conflict with family members.
Order: Regular insulin 0.1 units/kg/hr IV infusion
Patient weight: 70 kg
Question:
How many units of regular insulin should be administered per hour?
Order: 0.1 units/kg/hr
Weight: 70 kg
0.1 units × 70 kg = 7 units/hr