End-of-life care NCLEX-RN Practice Questions

End-of-life care NCLEX-RN Practice Questions focuses on the nurse’s role in supporting patients and families through the final stages of life while safeguarding dignity, autonomy, and comfort. In this topic-wise question bank, you will practice evidence-based nursing interventions such as therapeutic communication, symptom management (pain, dyspnea, delirium, secretions), ethical–legal considerations (DNR, advance directives, withdrawal of treatment), cultural and spiritual care, hospice eligibility, and postmortem protocols. Each question mirrors NCLEX-RN rigor from the Psychosocial Integrity domain, emphasizing safety, advocacy, and compassionate presence. Use these items to refine clinical judgment, prioritize comfort-focused care, navigate complex family dynamics, and document precisely. Ideal for reinforcing high-yield concepts and building confidence in end-of-life nursing practice.

Q1. A patient with metastatic cancer says, “I’m afraid of dying.” What is the nurse’s best initial response?

• “Many people feel that way. Let’s focus on keeping you comfortable.”
• “Try not to think about that; you’re doing well today.”
• “Tell me more about what you’re most afraid of.”
• “Your oncologist can better answer those concerns.”

Correct Answer: “Tell me more about what you’re most afraid of.”

Q2. A valid DNR order is in the chart. The patient becomes apneic and pulseless, and the family yells, “Do everything!” What should the nurse do?

• Start CPR while calling the provider to clarify the order
• Honor the DNR, continue comfort measures, notify the provider, and support the family
• Delay action until the ethics committee can evaluate the situation
• Begin bag-valve-mask ventilation only

Correct Answer: Honor the DNR, continue comfort measures, notify the provider, and support the family

Q3. Which assessment finding is most consistent with imminent death?

• Warm, flushed extremities and bounding pulses
• Cheyne–Stokes respirations with periods of apnea
• Increased urine output with frequent voiding
• Hypertension and photophobia

Correct Answer: Cheyne–Stokes respirations with periods of apnea

Q4. Which opioid order for end-of-life pain should the nurse question?

• Morphine sulfate IV infusion titrated to comfort
• Hydromorphone oral solution scheduled and PRN for breakthrough
• Transdermal fentanyl for stable, persistent pain
• Meperidine 75 mg IM every 3 hours PRN pain

Correct Answer: Meperidine 75 mg IM every 3 hours PRN pain

Q5. A dying patient develops noisy “death rattle” secretions. Which is the most appropriate nursing action?

• Perform deep oral suctioning every 30 minutes
• Place the patient supine and increase IV fluids
• Reposition to side-lying and administer prescribed anticholinergic
• Apply nonrebreather oxygen at 15 L/min

Correct Answer: Reposition to side-lying and administer prescribed anticholinergic

Q6. A patient with end-stage COPD is gasping with air hunger. Which action best relieves dyspnea at end of life?

• Administer prescribed low-dose morphine and provide a cool fan to the face
• Increase IV fluids to improve perfusion
• Perform aggressive chest physiotherapy
• Encourage deep breathing exercises every 10 minutes

Correct Answer: Administer prescribed low-dose morphine and provide a cool fan to the face

Q7. Family requests a feeding tube for a patient actively dying with poor intake. What is the nurse’s best response?

• “Feeding tubes are required in all end-of-life cases.”
• “Artificial nutrition always prolongs life meaningfully.”
• “Let’s discuss your goals and the potential burdens, like aspiration and fluid overload.”
• “We cannot discuss this until the ethics committee meets.”

Correct Answer: “Let’s discuss your goals and the potential burdens, like aspiration and fluid overload.”

Q8. Which document designates a surrogate to make health care decisions if the patient loses capacity?

• Living will
• Durable power of attorney for health care
• DNR order
• POLST (Physician Orders for Life-Sustaining Treatment)

Correct Answer: Durable power of attorney for health care

Q9. After death, the family requests time to perform a cultural washing ritual. What is the nurse’s best action?

• Respectfully allow the ritual and ensure privacy unless contraindicated by required coroner involvement
• Decline all rituals to preserve evidence
• Proceed immediately with organ procurement discussions
• Move the body to the morgue without delay

Correct Answer: Respectfully allow the ritual and ensure privacy unless contraindicated by required coroner involvement

Q10. Which statement best reflects a preschool child’s understanding of death?

• Death is permanent and universal
• Death is temporary and may be caused by their thoughts (magical thinking)
• Death happens only to older people
• Death is abstract and symbolic

Correct Answer: Death is temporary and may be caused by their thoughts (magical thinking)

Q11. The team plans withdrawal of mechanical ventilation per patient’s prior wishes. What is the nurse’s primary role?

• Ensure medications are withheld to avoid sedation
• Focus on symptom control and comfort while honoring the patient’s goals
• Document the act as euthanasia to ensure transparency
• Ask the family to perform all suctioning to promote participation

Correct Answer: Focus on symptom control and comfort while honoring the patient’s goals

Q12. Which statement about palliative sedation is accurate?

• It is the same as euthanasia because it hastens death
• It aims to relieve intractable suffering by lowering consciousness, with intent focused on comfort
• It can be initiated without consent if the nurse believes it is best
• It is used only after discontinuing all analgesics

Correct Answer: It aims to relieve intractable suffering by lowering consciousness, with intent focused on comfort

Q13. A patient near death expresses a wish to donate corneas. What is the nurse’s best action?

• Promise the family that donation will definitely occur
• Notify the organ procurement organization per policy and avoid determining medical suitability
• Ask the family to sign consent immediately
• Begin cooling the body to preserve tissue

Correct Answer: Notify the organ procurement organization per policy and avoid determining medical suitability

Q14. Postmortem care is planned for a patient scheduled for autopsy. Which action should the nurse avoid?

• Leaving IV lines and endotracheal tubes in place
• Placing an identification tag as per policy
• Removing all tubes and devices before transfer
• Covering the body and ensuring dignity

Correct Answer: Removing all tubes and devices before transfer

Q15. In a state where medical aid in dying is restricted, a patient asks about hastening death. What is the nurse’s best response?

• Decline to discuss and leave the room
• Provide nonjudgmental support and refer to the provider and institutional resources per policy and law
• Share personal beliefs about assisted dying
• Suggest the family research options without involving the team

Correct Answer: Provide nonjudgmental support and refer to the provider and institutional resources per policy and law

Q16. Which instruction to family is most appropriate for a patient actively dying and unresponsive?

• “Avoid speaking as the patient cannot hear you now.”
• “Talk to them; hearing may persist, and your presence can be comforting.”
• “Ask complex questions to stimulate alertness.”
• “Use only written notes to avoid overstimulation.”

Correct Answer: “Talk to them; hearing may persist, and your presence can be comforting.”

Q17. A patient’s living will declines artificial nutrition. The family requests a feeding tube. What should the nurse do?

• Follow the family wishes because they are present
• Honor the patient’s living will and continue comfort-focused care
• Start tube feeding while awaiting ethics review
• Discharge the patient to avoid conflict

Correct Answer: Honor the patient’s living will and continue comfort-focused care

Q18. After a patient’s death, which documentation is most essential by the nurse?

• A summary of the shift tasks completed
• Exact time of death, assessment findings, notifications made, disposition of personal belongings
• Family members’ opinions about the care
• Religious affiliation and funeral preferences

Correct Answer: Exact time of death, assessment findings, notifications made, disposition of personal belongings

Q19. A dying patient becomes delirious and attempts to climb out of bed. Which intervention should the nurse question?

• Administer prescribed haloperidol for distressing agitation
• Employ calm environment and family presence
• Apply bilateral wrist restraints as the first-line approach
• Assess for reversible causes such as urinary retention or pain

Correct Answer: Apply bilateral wrist restraints as the first-line approach

Q20. A patient with a DNR is scheduled for surgery tomorrow. What is the nurse’s best action regarding code status?

• Automatically suspend the DNR during surgery
• Clarify perioperative code status with the patient and surgeon (required reconsideration)
• Cancel surgery due to the DNR
• Change the DNR to full code until discharge

Correct Answer: Clarify perioperative code status with the patient and surgeon (required reconsideration)

Q21. Which statement about hospice care is accurate?

• Hospice requires stopping all medications
• Hospice eligibility typically requires a prognosis of 6 months or less and focuses on comfort
• Hospice excludes care in the home setting
• Hospice prohibits palliative radiation for symptom relief

Correct Answer: Hospice eligibility typically requires a prognosis of 6 months or less and focuses on comfort

Q22. To prevent skin injury at end of life, which approach best balances comfort and integrity?

• Reposition every 2 hours even if it causes severe pain
• Reposition for comfort with gentle support surfaces; avoid painful turns
• Strict bedrest with no movement
• Apply tight restraints to prevent sliding

Correct Answer: Reposition for comfort with gentle support surfaces; avoid painful turns

Q23. A patient on scheduled opioids for end-of-life pain needs a bowel regimen. Which order is best?

• Start senna stimulant laxative with a stool softener, scheduled
• Begin laxatives only after constipation occurs
• Use fiber supplements exclusively
• Stop opioids to prevent constipation

Correct Answer: Start senna stimulant laxative with a stool softener, scheduled

Q24. Family witnesses Cheyne–Stokes breathing and fears the patient is suffocating. Which response is best?

• “This pattern is common near the end of life; we are giving medicines to ease any distress.”
• “We must intubate immediately to stop this.”
• “They need to be awakened frequently to breathe regularly.”
• “This means pain medications caused respiratory failure.”

Correct Answer: “This pattern is common near the end of life; we are giving medicines to ease any distress.”

Q25. A patient takes long-acting morphine for persistent pain. Which breakthrough pain prescription is most appropriate?

• Immediate-release opioid at 10–15% of the total daily dose every 1–2 hours PRN
• Acetaminophen 325 mg once daily PRN
• Only nonpharmacologic measures between long-acting doses
• Another long-acting opioid dose every hour PRN

Correct Answer: Immediate-release opioid at 10–15% of the total daily dose every 1–2 hours PRN

Q26. A patient expresses existential distress and asks, “What was the point of my life?” What is the nurse’s best action?

• Change the subject to medication schedules
• Offer presence, explore meaning, and offer a chaplain/spiritual care consult if desired
• Tell them not to worry because everything will be fine
• Provide a religious lecture

Correct Answer: Offer presence, explore meaning, and offer a chaplain/spiritual care consult if desired

Q27. A family member angrily says, “You’re not doing enough!” What is the most therapeutic response?

• “Calm down or you’ll have to leave.”
• “I can see how hard this is. Tell me what worries you most right now.”
• “That’s not true; we’re doing everything possible.”
• “You should discuss this only with the physician.”

Correct Answer: “I can see how hard this is. Tell me what worries you most right now.”

Q28. An unconscious patient has dry mucosa and cracked lips. Which nursing intervention is best?

• Offer large sips of water every 15 minutes
• Provide frequent oral care with moist swabs and apply lip balm
• Use lemon–glycerin swabs regularly
• Withhold all oral care to prevent aspiration

Correct Answer: Provide frequent oral care with moist swabs and apply lip balm

Q29. Which order for severe end-of-life pain should the nurse question due to safety concerns?

• Crush extended-release morphine tablets for faster action
• Start IV morphine and titrate to comfort
• Use sublingual opioid when IV access is not available
• Add adjuvants such as gabapentin for neuropathic pain

Correct Answer: Crush extended-release morphine tablets for faster action

Q30. During the final hours of life, which nursing approach best supports patient and family needs?

• Perform full vital signs every 15 minutes
• Cluster care, minimize unnecessary assessments, dim lights, and allow uninterrupted family time
• Encourage frequent visitors and loud conversations
• Maintain NPO status and avoid mouth care

Correct Answer: Cluster care, minimize unnecessary assessments, dim lights, and allow uninterrupted family time

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