Palliative & End-of-Life - 2026 Nursing Protocols: Practice Test
2 (Units 8-13) - Questions with Correct Answers
100 questions
1. Physical restraints in a delirious patient:
A. Are the first-line treatment
B. Should be avoided because they increase agitation, injury and distress
C. Calm the patient
D. Prevent all falls
Correct Answer: B. Should be avoided because they increase agitation, injury and distress
Rationale: Restraints worsen delirium and can cause harm. Close observation and addressing
causes are preferred.
2. Mirtazapine may be a helpful antidepressant in palliative care because it can also:
A. Improve sleep and appetite and has antiemetic properties
B. Cause severe insomnia
C. Reduce appetite
D. Cause constipation only
Correct Answer: A. Improve sleep and appetite and has antiemetic properties
Rationale: Its side effects of sedation and appetite stimulation can be beneficial. It also has
some antinausea effects.
3. Grief responses by patients themselves near the end of life, called preparatory grief, involve:
A. Grief only after death
B. No emotions
C. Mourning the losses of their own life and relationships
D. Only anger
Correct Answer: C. Mourning the losses of their own life and relationships
Rationale: Patients grieve impending losses, and support helps them process. It is distinct from
depression.
,4. Music therapy in palliative care has been shown to:
A. Worsen all symptoms
B. Reduce anxiety and pain and improve mood for some patients
C. Cure illness
D. Replace all medication
Correct Answer: B. Reduce anxiety and pain and improve mood for some patients
Rationale: Music therapy is a supportive intervention. It complements other care.
5. When a patient with delirium becomes agitated, the nurse should first:
A. Apply restraints
B. Leave the room
C. Argue with the patient
D. Ensure safety, use a calm voice, reduce stimulation and look for causes
Correct Answer: D. Ensure safety, use a calm voice, reduce stimulation and look for causes
Rationale: De-escalation and assessment are priorities. Restraints and arguing increase
agitation.
6. Psychostimulants such as methylphenidate in palliative care may cause:
A. Sedation
B. Insomnia, anxiety and tachycardia, so they are given in the morning or early afternoon
C. Constipation only
D. Hypoglycemia
Correct Answer: B. Insomnia, anxiety and tachycardia, so they are given in the morning or
early afternoon
Rationale: Timing doses earlier reduces sleep disturbance. They are stimulants, not sedatives.
,7. A symptom that helps distinguish depression from expected sadness in terminal illness is:
A. Fatigue
B. Persistent hopelessness, worthlessness, guilt or loss of pleasure in all activities
C. Poor appetite
D. Weight loss
Correct Answer: B. Persistent hopelessness, worthlessness, guilt or loss of pleasure in all
activities
Rationale: Physical symptoms overlap with illness, so psychological symptoms are more useful
indicators. Fatigue and appetite changes are common in illness.
8. Ketamine may be used in specialized palliative care settings for:
A. Constipation
B. Refractory pain and, in research settings, rapid-acting depression treatment
C. Nausea only
D. Infection
Correct Answer: B. Refractory pain and, in research settings, rapid-acting depression
treatment
Rationale: Ketamine's NMDA antagonism provides analgesic and rapid antidepressant effects. It
requires specialist guidance.
9. Fatigue in advanced illness is:
A. One of the most common and distressing symptoms, with multiple contributing causes
B. Rare
C. Always due to depression
D. Untreatable in all cases
Correct Answer: A. One of the most common and distressing symptoms, with multiple
contributing causes
Rationale: Causes include disease, anemia, medications, depression and poor sleep. Addressing
causes and energy conservation can help.
, 10. Antipsychotics such as haloperidol for delirium in palliative care are used to:
A. Manage distressing symptoms such as agitation or frightening hallucinations, not to treat the
underlying cause
B. Cure delirium
C. Treat infections
D. Prevent all delirium in every patient
Correct Answer: A. Manage distressing symptoms such as agitation or frightening
hallucinations, not to treat the underlying cause
Rationale: Evidence for antipsychotics in mild delirium is limited, and they may be most useful
for distressing agitation. Underlying causes should still be addressed.
11. Methylphenidate may be used for depression in patients with a short prognosis because it:
A. Has a rapid onset of effect, within days
B. Takes 6 to 8 weeks to work
C. Causes sedation
D. Is an antibiotic
Correct Answer: A. Has a rapid onset of effect, within days
Rationale: Psychostimulants can improve mood and energy quickly. SSRIs take weeks, which
may be too long for some patients.
12. Asking a patient directly about suicidal thoughts:
A. Causes suicide
B. Does not increase risk and is important for identifying patients who need help
C. Should be avoided in palliative care
D. Is unethical
Correct Answer: B. Does not increase risk and is important for identifying patients who need
help
Rationale: Direct questions open discussion and allow intervention. Patients with serious illness
can have suicide risk.
2 (Units 8-13) - Questions with Correct Answers
100 questions
1. Physical restraints in a delirious patient:
A. Are the first-line treatment
B. Should be avoided because they increase agitation, injury and distress
C. Calm the patient
D. Prevent all falls
Correct Answer: B. Should be avoided because they increase agitation, injury and distress
Rationale: Restraints worsen delirium and can cause harm. Close observation and addressing
causes are preferred.
2. Mirtazapine may be a helpful antidepressant in palliative care because it can also:
A. Improve sleep and appetite and has antiemetic properties
B. Cause severe insomnia
C. Reduce appetite
D. Cause constipation only
Correct Answer: A. Improve sleep and appetite and has antiemetic properties
Rationale: Its side effects of sedation and appetite stimulation can be beneficial. It also has
some antinausea effects.
3. Grief responses by patients themselves near the end of life, called preparatory grief, involve:
A. Grief only after death
B. No emotions
C. Mourning the losses of their own life and relationships
D. Only anger
Correct Answer: C. Mourning the losses of their own life and relationships
Rationale: Patients grieve impending losses, and support helps them process. It is distinct from
depression.
,4. Music therapy in palliative care has been shown to:
A. Worsen all symptoms
B. Reduce anxiety and pain and improve mood for some patients
C. Cure illness
D. Replace all medication
Correct Answer: B. Reduce anxiety and pain and improve mood for some patients
Rationale: Music therapy is a supportive intervention. It complements other care.
5. When a patient with delirium becomes agitated, the nurse should first:
A. Apply restraints
B. Leave the room
C. Argue with the patient
D. Ensure safety, use a calm voice, reduce stimulation and look for causes
Correct Answer: D. Ensure safety, use a calm voice, reduce stimulation and look for causes
Rationale: De-escalation and assessment are priorities. Restraints and arguing increase
agitation.
6. Psychostimulants such as methylphenidate in palliative care may cause:
A. Sedation
B. Insomnia, anxiety and tachycardia, so they are given in the morning or early afternoon
C. Constipation only
D. Hypoglycemia
Correct Answer: B. Insomnia, anxiety and tachycardia, so they are given in the morning or
early afternoon
Rationale: Timing doses earlier reduces sleep disturbance. They are stimulants, not sedatives.
,7. A symptom that helps distinguish depression from expected sadness in terminal illness is:
A. Fatigue
B. Persistent hopelessness, worthlessness, guilt or loss of pleasure in all activities
C. Poor appetite
D. Weight loss
Correct Answer: B. Persistent hopelessness, worthlessness, guilt or loss of pleasure in all
activities
Rationale: Physical symptoms overlap with illness, so psychological symptoms are more useful
indicators. Fatigue and appetite changes are common in illness.
8. Ketamine may be used in specialized palliative care settings for:
A. Constipation
B. Refractory pain and, in research settings, rapid-acting depression treatment
C. Nausea only
D. Infection
Correct Answer: B. Refractory pain and, in research settings, rapid-acting depression
treatment
Rationale: Ketamine's NMDA antagonism provides analgesic and rapid antidepressant effects. It
requires specialist guidance.
9. Fatigue in advanced illness is:
A. One of the most common and distressing symptoms, with multiple contributing causes
B. Rare
C. Always due to depression
D. Untreatable in all cases
Correct Answer: A. One of the most common and distressing symptoms, with multiple
contributing causes
Rationale: Causes include disease, anemia, medications, depression and poor sleep. Addressing
causes and energy conservation can help.
, 10. Antipsychotics such as haloperidol for delirium in palliative care are used to:
A. Manage distressing symptoms such as agitation or frightening hallucinations, not to treat the
underlying cause
B. Cure delirium
C. Treat infections
D. Prevent all delirium in every patient
Correct Answer: A. Manage distressing symptoms such as agitation or frightening
hallucinations, not to treat the underlying cause
Rationale: Evidence for antipsychotics in mild delirium is limited, and they may be most useful
for distressing agitation. Underlying causes should still be addressed.
11. Methylphenidate may be used for depression in patients with a short prognosis because it:
A. Has a rapid onset of effect, within days
B. Takes 6 to 8 weeks to work
C. Causes sedation
D. Is an antibiotic
Correct Answer: A. Has a rapid onset of effect, within days
Rationale: Psychostimulants can improve mood and energy quickly. SSRIs take weeks, which
may be too long for some patients.
12. Asking a patient directly about suicidal thoughts:
A. Causes suicide
B. Does not increase risk and is important for identifying patients who need help
C. Should be avoided in palliative care
D. Is unethical
Correct Answer: B. Does not increase risk and is important for identifying patients who need
help
Rationale: Direct questions open discussion and allow intervention. Patients with serious illness
can have suicide risk.
