Palliative comfort NCLEX-RN Practice Questions

Palliative comfort NCLEX-RN Practice Questions

Preparing for the NCLEX-RN requires a solid understanding of how to deliver compassionate, evidence-based comfort care to patients with serious, life-limiting illness. This set of practice questions focuses on palliative comfort within the Basic Care & Comfort domain—prioritizing symptom management, communication, safety, and dignity at end of life. You’ll encounter realistic clinical scenarios covering pain, dyspnea, delirium, secretions, constipation, skin integrity, mouth care, hydration, and ethical considerations. The aim is to strengthen critical thinking, prioritize interventions, and ensure cultural sensitivity while addressing the needs of both patients and families. Use these questions to refine your clinical judgment, reinforce best practices, and build confidence in delivering high-quality palliative nursing care.

Q1. A hospice patient with end-stage COPD reports severe dyspnea at rest with normal oxygen saturation. Which nursing intervention is most appropriate to relieve breathlessness?

• Increase oxygen to 4 L/min via nasal cannula
• Position the patient upright and administer low-dose morphine as prescribed
• Encourage deep breathing exercises every hour
• Apply a scopolamine patch to decrease secretions

Correct Answer: Position the patient upright and administer low-dose morphine as prescribed

Q2. A patient on chronic opioids for cancer pain reports new constipation. Which action is the best initial nursing intervention?

• Start a stimulant laxative with or without a stool softener
• Increase fluid intake to 1.5 L/day and reassess in 72 hours
• Hold the opioid dose until bowel movement occurs
• Switch to acetaminophen to reduce constipation risk

Correct Answer: Start a stimulant laxative with or without a stool softener

Q3. A client with metastatic cancer is on extended-release morphine and reports breakthrough pain. Which is the most appropriate nursing action?

• Administer the prescribed immediate-release opioid rescue dose
• Crush the extended-release morphine to provide faster relief
• Delay the next scheduled opioid dose by 2 hours
• Offer nonpharmacologic measures only to avoid oversedation

Correct Answer: Administer the prescribed immediate-release opioid rescue dose

Q4. A dying patient exhibits noisy respiratory secretions (“death rattle”). Which intervention is most appropriate?

• Deep suctioning every 30 minutes
• Reposition to lateral side and consider an anticholinergic like glycopyrrolate
• Increase IV fluids to thin secretions
• Start a bronchodilator nebulizer

Correct Answer: Reposition to lateral side and consider an anticholinergic like glycopyrrolate

Q5. A family asks the nurse to “do everything” for their dying mother who has a valid DNR and is actively declining. What is the nurse’s best response?

• “I must follow your wishes and start resuscitation if needed.”
• “Let’s talk about your concerns and how we will continue all comfort-focused care under the DNR.”
• “I will call the physician to revoke the DNR immediately.”
• “We cannot discuss this; the DNR is final.”

Correct Answer: “Let’s talk about your concerns and how we will continue all comfort-focused care under the DNR.”

Q6. A patient with advanced heart failure reports pain 8/10 despite scheduled opioids. Which nursing action is the priority?

• Notify provider to titrate opioid dose and assess for breakthrough regimen adequacy
• Switch to NSAIDs immediately
• Apply ice to chest area
• Encourage ambulation to reduce pain perception

Correct Answer: Notify provider to titrate opioid dose and assess for breakthrough regimen adequacy

Q7. Which intervention best prevents pressure injury in a bedbound, cachectic hospice patient?

• Reposition every 2 hours with offloading bony prominences
• Increase protein to 150 g/day regardless of tolerance
• Massage reddened areas to improve circulation
• Use restraints to reduce friction from movements

Correct Answer: Reposition every 2 hours with offloading bony prominences

Q8. A terminal patient with agitation and hallucinations is diagnosed with delirium. Which medication is generally preferred initially?

• Haloperidol low dose as prescribed
• Lorazepam as monotherapy
• Diphenhydramine at bedtime
• Zolpidem as needed for sleep

Correct Answer: Haloperidol low dose as prescribed

Q9. Which nursing measure is most effective for managing xerostomia in a patient with mouth-breathing at end of life?

• Mouth care every 2–4 hours with soft swabs and saliva substitutes
• NPO to prevent aspiration
• Alcohol-based mouthwash every hour
• Ice chips only

Correct Answer: Mouth care every 2–4 hours with soft swabs and saliva substitutes

Q10. A patient with advanced dementia stops eating and drinking. The family requests tube feeding to prolong life. What response supports palliative principles?

• “Tube feeding will definitely prevent aspiration.”
• “Let’s discuss risks and benefits; artificial feeding may not improve comfort or survival in advanced dementia.”
• “We cannot provide tube feeds in hospice under any circumstances.”
• “I will start tube feeding immediately.”

Correct Answer: “Let’s discuss risks and benefits; artificial feeding may not improve comfort or survival in advanced dementia.”

Q11. A client on high-dose opioids has pinpoint pupils, a respiratory rate of 6/min, and is difficult to arouse. What is the priority action?

• Administer prescribed naloxone and support ventilation
• Apply warm blankets and monitor
• Encourage deep breathing
• Offer coffee and reassess in 30 minutes

Correct Answer: Administer prescribed naloxone and support ventilation

Q12. Which nonpharmacologic intervention best reduces dyspnea perception in a patient with terminal lung disease?

• Fan-directed cool air to the face with upright positioning
• Daily incentive spirometry
• Strict bedrest to conserve oxygen
• High-flow oxygen for all patients regardless of saturation

Correct Answer: Fan-directed cool air to the face with upright positioning

Q13. A patient with intractable cancer pain requests “enough medication to sleep through the pain,” knowing it may reduce alertness. This reflects which ethical principle?

• Nonmaleficence only
• Double effect: relieving suffering despite potential unintended sedation
• Justice in care allocation
• Veracity as the primary concern

Correct Answer: Double effect: relieving suffering despite potential unintended sedation

Q14. Which nursing action best supports dignity for a patient in the actively dying phase?

• Minimize communication to reduce stimulation
• Provide quiet presence, gentle hygiene, and honor personal/cultural rituals
• Discontinue mouth care to avoid aspiration
• Refuse family participation in care to maintain sterility

Correct Answer: Provide quiet presence, gentle hygiene, and honor personal/cultural rituals

Q15. A patient with metastatic breast cancer has opioid-induced nausea. What is the most appropriate intervention?

• Add an antiemetic such as ondansetron or haloperidol as prescribed
• Discontinue opioids immediately
• Switch to NSAIDs alone
• Provide clear liquids only for 48 hours

Correct Answer: Add an antiemetic such as ondansetron or haloperidol as prescribed

Q16. The nurse prepares to administer sublingual atropine drops for terminal secretions. Which assessment is most important before giving?

• Heart rate and presence of urinary retention risk
• Capillary blood glucose
• Pedal pulses bilaterally
• Bowel sounds in all quadrants

Correct Answer: Heart rate and presence of urinary retention risk

Q17. Which statement by the nurse best explains the focus of hospice care to a family?

• “Hospice aims to cure illness using aggressive treatments.”
• “Hospice focuses on comfort, symptom control, and quality of life when life expectancy is about six months or less.”
• “Hospice provides only psychosocial support; no medications are allowed.”
• “Hospice requires the patient to stay in the hospital.”

Correct Answer: “Hospice focuses on comfort, symptom control, and quality of life when life expectancy is about six months or less.”

Q18. A patient with dysphagia at end of life coughs during meals. Which nursing intervention is most appropriate?

• Encourage large sips of thin liquids
• Offer small amounts of thickened fluids and upright positioning during/after feeds
• Restrict all fluids
• Feed rapidly to reduce fatigue

Correct Answer: Offer small amounts of thickened fluids and upright positioning during/after feeds

Q19. A family reports their dying father is not responding. Which observation indicates active dying?

• Steady, regular respirations at 16/min
• Cool extremities with mottling and Cheyne–Stokes breathing
• Increased urine output
• Increased appetite

Correct Answer: Cool extremities with mottling and Cheyne–Stokes breathing

Q20. Which instruction is most appropriate for safe home use of transdermal fentanyl in palliative care?

• Cut the patch to adjust the dose as needed
• Apply heat over the patch to increase absorption
• Change the patch on schedule and avoid external heat to prevent overdose
• Remove the patch during nighttime to reduce sedation

Correct Answer: Change the patch on schedule and avoid external heat to prevent overdose

Q21. A patient requests to discuss advance directives. What is the nurse’s best initial action?

• Provide the forms and explore the patient’s values and goals for care
• Tell the patient to discuss only with an attorney
• Inform the family that they will decide all care
• Delay the discussion until discharge

Correct Answer: Provide the forms and explore the patient’s values and goals for care

Q22. A terminal cancer patient has severe bone pain despite opioids. Which adjuvant is most appropriate to suggest to the provider?

• Acetaminophen for hepatotoxicity risk
• Bisphosphonates or corticosteroids for bone pain
• Antibiotics for potential infection
• Anticoagulants to improve circulation

Correct Answer: Bisphosphonates or corticosteroids for bone pain

Q23. The nurse observes family arguing loudly at the bedside of a dying patient. What is the best immediate nursing action?

• Ask family to leave and return after the patient dies
• Invite family to a quiet space, acknowledge emotions, and refocus on the patient’s comfort and wishes
• Call security to remove the family
• Ignore the situation to avoid conflict

Correct Answer: Invite family to a quiet space, acknowledge emotions, and refocus on the patient’s comfort and wishes

Q24. A palliative patient on long-term opioids becomes tolerant. Which statement reflects appropriate nursing understanding?

• Increasing the dose for pain control is expected and appropriate
• Opioids must be stopped immediately to prevent addiction
• Tolerance indicates drug-seeking behavior
• Switching to NSAIDs will provide equivalent analgesia

Correct Answer: Increasing the dose for pain control is expected and appropriate

Q25. Which intervention most effectively prevents terminal restlessness related to unmet needs?

• Restrict visitors to reduce stimulation
• Assess for pain, urinary retention, constipation, hypoxia, and medication effects
• Increase lighting in the room
• Encourage prolonged daytime napping

Correct Answer: Assess for pain, urinary retention, constipation, hypoxia, and medication effects

Q26. A patient is receiving palliative sedation for refractory suffering. Which nursing priority is essential?

• Maintain curative treatments simultaneously
• Ongoing assessment and documentation of proportionality, consent, and comfort goals
• Continuous stimulation to assess alertness
• Hold all comfort medications to avoid interactions

Correct Answer: Ongoing assessment and documentation of proportionality, consent, and comfort goals

Q27. The nurse cares for a patient with terminal liver failure and pruritus. Which comfort measure is most appropriate?

• Hot showers and alcohol-based lotions
• Cool baths, emollients, and keep nails short
• Increased dietary fat intake
• Strong detergents for skin cleansing

Correct Answer: Cool baths, emollients, and keep nails short

Q28. A bedbound patient refuses frequent repositioning due to pain. What is the nurse’s best response?

• “If you refuse, we cannot help you.”
• “Let’s premedicate for pain and use pillows to gently offload pressure while minimizing movement.”
• “We will not reposition you anymore.”
• “I will apply restraints to assist with turning.”

Correct Answer: “Let’s premedicate for pain and use pillows to gently offload pressure while minimizing movement.”

Q29. A palliative patient with renal failure and uremic nausea is poorly responsive to standard antiemetics. Which adjunct might the nurse anticipate?

• Metoclopramide for prokinetic effect if gastroparesis suspected
• Codeine for antitussive properties
• Aluminum hydroxide for constipation
• High-dose benzodiazepines as first-line

Correct Answer: Metoclopramide for prokinetic effect if gastroparesis suspected

Q30. After death is pronounced, which culturally sensitive nursing action is appropriate during postmortem care?

• Remove all tubes immediately without consulting family preferences
• Invite the family to participate as desired and honor cultural/religious practices within policy
• Hurry the process to clear the room for the next patient
• Prohibit any ritual objects at the bedside

Correct Answer: Invite the family to participate as desired and honor cultural/religious practices within policy

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