Palliative & End-of-Life - 2026 Nursing Protocols: Final Exam
(Comprehensive) - Questions with Correct Answers
100 questions
1. The "invitation" step of SPIKES involves:
A. Asking how much information the patient wants to know
B. Inviting the media
C. Inviting all relatives without consent
D. Inviting the patient to leave
Correct Answer: A. Asking how much information the patient wants to know
Rationale: Patients vary in how much detail they want, and respecting this preference is
important. Including family requires the patient's permission.
2. A Do Not Resuscitate (DNR) order means:
A. No treatment of any kind will be given
B. CPR will not be performed if the heart stops or breathing stops, but other treatments
continue as appropriate
C. The patient will not receive pain medication
D. The patient is abandoned
Correct Answer: B. CPR will not be performed if the heart stops or breathing stops, but other
treatments continue as appropriate
Rationale: DNR addresses only resuscitation, and patients still receive care, including symptom
management. It does not mean withdrawing all care.
,3. Breakthrough pain in cancer is:
A. A transient flare of pain that occurs despite otherwise controlled persistent pain
B. Pain that never occurs with opioids
C. A sign of addiction
D. Pain only at night
Correct Answer: A. A transient flare of pain that occurs despite otherwise controlled
persistent pain
Rationale: Breakthrough pain is common and treated with as-needed short-acting medication.
It does not indicate addiction.
4. Stoic patients who say they "don't want to bother the nurse" should be:
A. Encouraged to report pain and assessed regularly
B. Assumed to be pain-free
C. Given less medication
D. Ignored
Correct Answer: A. Encouraged to report pain and assessed regularly
Rationale: Proactive assessment prevents undertreatment. Not complaining does not mean
comfort.
5. Abrupt discontinuation of opioids in a patient taking them regularly can cause:
A. Withdrawal symptoms such as anxiety, sweating, diarrhea and increased pain
B. No effects
C. Immediate sleep
D. Constipation
Correct Answer: A. Withdrawal symptoms such as anxiety, sweating, diarrhea and increased
pain
Rationale: Tapering prevents withdrawal. Patients should not stop opioids suddenly.
,6. An important safety strategy for opioids in the home is:
A. Never discussing safety
B. Allowing children to handle medications
C. Providing naloxone and teaching family members when and how to use it, when appropriate
to goals
D. Storing opioids in bathroom cabinets unlocked
Correct Answer: C. Providing naloxone and teaching family members when and how to use it,
when appropriate to goals
Rationale: Naloxone can reverse accidental overdose in household members. Safety education
is part of responsible prescribing.
7. A patient with lung cancer and stridor has:
A. Normal breathing
B. Pneumonia only
C. Upper airway obstruction, which may be relieved by steroids, stenting or radiation consistent
with goals, and requires urgent attention
D. Anxiety only
Correct Answer: C. Upper airway obstruction, which may be relieved by steroids, stenting or
radiation consistent with goals, and requires urgent attention
Rationale: Stridor indicates narrowing of the large airway and can progress to life-threatening
obstruction. Palliative interventions may relieve it.
8. When assessing dyspnea, the nurse should also ask about its effect on:
A. Only the respiratory rate
B. Only the oxygen saturation
C. Sleep, activities, eating, mood and quality of life
D. Nothing else
Correct Answer: C. Sleep, activities, eating, mood and quality of life
Rationale: Understanding impact guides goals and treatments. Numbers alone miss how
dyspnea affects life.
, 9. Ondansetron is most effective for nausea caused by:
A. Chemotherapy and radiation, through serotonin (5-HT3) blockade
B. Bowel obstruction
C. Vestibular problems
D. Anxiety alone
Correct Answer: A. Chemotherapy and radiation, through serotonin (5-HT3) blockade
Rationale: 5-HT3 antagonists are mainstays for treatment-related nausea. Constipation is a
common side effect.
10. Oral intake decisions near the end of life should be based on:
A. Calorie counts
B. Weight goals
C. The patient's wishes, comfort and ability to swallow safely
D. Family pressure alone
Correct Answer: C. The patient's wishes, comfort and ability to swallow safely
Rationale: Comfort and patient preference guide decisions. Nutritional targets become less
relevant.
11. Anxiety in patients with serious illness may be managed with:
A. Ignoring it
B. Restraints
C. Isolation
D. Supportive counseling, relaxation techniques and medications such as SSRIs or short-term
benzodiazepines
Correct Answer: D. Supportive counseling, relaxation techniques and medications such as
SSRIs or short-term benzodiazepines
Rationale: Combined approaches are effective. Untreated anxiety worsens suffering and other
symptoms.
(Comprehensive) - Questions with Correct Answers
100 questions
1. The "invitation" step of SPIKES involves:
A. Asking how much information the patient wants to know
B. Inviting the media
C. Inviting all relatives without consent
D. Inviting the patient to leave
Correct Answer: A. Asking how much information the patient wants to know
Rationale: Patients vary in how much detail they want, and respecting this preference is
important. Including family requires the patient's permission.
2. A Do Not Resuscitate (DNR) order means:
A. No treatment of any kind will be given
B. CPR will not be performed if the heart stops or breathing stops, but other treatments
continue as appropriate
C. The patient will not receive pain medication
D. The patient is abandoned
Correct Answer: B. CPR will not be performed if the heart stops or breathing stops, but other
treatments continue as appropriate
Rationale: DNR addresses only resuscitation, and patients still receive care, including symptom
management. It does not mean withdrawing all care.
,3. Breakthrough pain in cancer is:
A. A transient flare of pain that occurs despite otherwise controlled persistent pain
B. Pain that never occurs with opioids
C. A sign of addiction
D. Pain only at night
Correct Answer: A. A transient flare of pain that occurs despite otherwise controlled
persistent pain
Rationale: Breakthrough pain is common and treated with as-needed short-acting medication.
It does not indicate addiction.
4. Stoic patients who say they "don't want to bother the nurse" should be:
A. Encouraged to report pain and assessed regularly
B. Assumed to be pain-free
C. Given less medication
D. Ignored
Correct Answer: A. Encouraged to report pain and assessed regularly
Rationale: Proactive assessment prevents undertreatment. Not complaining does not mean
comfort.
5. Abrupt discontinuation of opioids in a patient taking them regularly can cause:
A. Withdrawal symptoms such as anxiety, sweating, diarrhea and increased pain
B. No effects
C. Immediate sleep
D. Constipation
Correct Answer: A. Withdrawal symptoms such as anxiety, sweating, diarrhea and increased
pain
Rationale: Tapering prevents withdrawal. Patients should not stop opioids suddenly.
,6. An important safety strategy for opioids in the home is:
A. Never discussing safety
B. Allowing children to handle medications
C. Providing naloxone and teaching family members when and how to use it, when appropriate
to goals
D. Storing opioids in bathroom cabinets unlocked
Correct Answer: C. Providing naloxone and teaching family members when and how to use it,
when appropriate to goals
Rationale: Naloxone can reverse accidental overdose in household members. Safety education
is part of responsible prescribing.
7. A patient with lung cancer and stridor has:
A. Normal breathing
B. Pneumonia only
C. Upper airway obstruction, which may be relieved by steroids, stenting or radiation consistent
with goals, and requires urgent attention
D. Anxiety only
Correct Answer: C. Upper airway obstruction, which may be relieved by steroids, stenting or
radiation consistent with goals, and requires urgent attention
Rationale: Stridor indicates narrowing of the large airway and can progress to life-threatening
obstruction. Palliative interventions may relieve it.
8. When assessing dyspnea, the nurse should also ask about its effect on:
A. Only the respiratory rate
B. Only the oxygen saturation
C. Sleep, activities, eating, mood and quality of life
D. Nothing else
Correct Answer: C. Sleep, activities, eating, mood and quality of life
Rationale: Understanding impact guides goals and treatments. Numbers alone miss how
dyspnea affects life.
, 9. Ondansetron is most effective for nausea caused by:
A. Chemotherapy and radiation, through serotonin (5-HT3) blockade
B. Bowel obstruction
C. Vestibular problems
D. Anxiety alone
Correct Answer: A. Chemotherapy and radiation, through serotonin (5-HT3) blockade
Rationale: 5-HT3 antagonists are mainstays for treatment-related nausea. Constipation is a
common side effect.
10. Oral intake decisions near the end of life should be based on:
A. Calorie counts
B. Weight goals
C. The patient's wishes, comfort and ability to swallow safely
D. Family pressure alone
Correct Answer: C. The patient's wishes, comfort and ability to swallow safely
Rationale: Comfort and patient preference guide decisions. Nutritional targets become less
relevant.
11. Anxiety in patients with serious illness may be managed with:
A. Ignoring it
B. Restraints
C. Isolation
D. Supportive counseling, relaxation techniques and medications such as SSRIs or short-term
benzodiazepines
Correct Answer: D. Supportive counseling, relaxation techniques and medications such as
SSRIs or short-term benzodiazepines
Rationale: Combined approaches are effective. Untreated anxiety worsens suffering and other
symptoms.
