Relias ENLEC Palliative & Critical Care Module Exams 2025–2026: Expert-Curated Verified Q&A with End-of-Life Protocols, Symptom Management & Clinical Scenarios (NCLEX-RN®/NP Aligned + Instant Access)

What is one of the BEST ways that you can help patients with serious illness and their families?

Using therapeutic "presence" as a way of expressing compassion

What does data from the Sutter Health Program of Advanced Illness Management (AIM) program show about palliative care?

It decreases hospital admissions and length of stay.

Which segment of the population provides the most services for individuals with serious chronic illnesses, for older adults, or for people who have differing abilities?

Informal caregivers

All of the following questions can help patients and families prepare for the worst EXCEPT:

How successful do you feel this treatment will be?

You are orienting a new staff member in the emergency department to integrate palliative care into critical care. Which of the nurse's statements correctly reflects a principle of palliative care?

Patients may receive palliative care concurrent with curative treatment.

Mr. Rodriquez tells you that he is experiencing distress about what happens after death. What dimension of quality of life does this represent?

Spiritual

You are discussing barriers to quality palliative care with a coworker. Which of the following comments by the coworker indicates a misunderstanding of palliative care?

It's essential to know a patient has 6 months or less to live to initiate palliative care.

Which dimension of quality of life does "financial burdens resulting from a life-limiting illness" represent?

Social

All of the following statements describe the positive benefits of palliative care EXCEPT:

It is separate from life-prolonging treatment.

You are working to improve palliative care in your critical care unit. What supports this mission?

Identify the barriers that exist on the unit.

What question can BEST help the clinician with prognostication?

Would I be surprised if the patient died in the next 6 months?

Which of the following BEST describes the concerns and worries anticipated by patients with serious illness?

Worries and concerns will be unique for each person and their situation.

What is one of the possible adverse effects related to the use of NSAIDs?

Renal dysfunction

A patient with lung cancer complains of shoulder pressure and rates it at a 3 out of 10. What pain management option is BEST, considering the patient's report?

Acetaminophen 650 mg

What statement about pain is TRUE?

Pain is an individual experience.

What is the MOST appropriate breakthrough dose and dosing interval for a hydromorphone continuous infusion of 0.2 mg/hour?

0.1 to 0.2 mg every 15 minutes

What percentage of the total 24-hour oral opioid administration should be considered as breakthrough dose?

10 to 20%

A 68-year-old patient is taking two acetaminophen 325 mg tablets every 4 hours along with IV morphine for bone pain related to metastatic cancer. Their pain is a constant 8 on a 0 to 10 scale. The provider suggests increasing the acetaminophen frequency to every 3 hours around-the-clock. What should your NEXT action be?

Remind the provider that this dose exceeds the daily dose limit for acetaminophen.

An 86-year-old patient with a history of type II diabetes, CHF, renal failure, and stage III colon cancer is admitted after a fall in which she broke her right hip. She has been on opioids at home. Yesterday, she underwent surgery to pin the hip. The patient has multiple sites of pain (e.g., incisional hip pain, arthritis, back and neck pain from osteoporosis, neuropathic pain from diabetes). Her incisional pain is 8 out of 10 and her other cited pains are self-rated as 6 out of 10. She is currently receiving a continuous infusion of morphine, 1 mg IV per hour, with no breakthrough dosage. What is the NEXT best action?

Discuss adding a bolus of morphine 0.5 mg every 30 minutes.

What strategy can you use in the assessment and management of pain in persons with substance use disorder?

Use an interdisciplinary approach to assessment and management.

What type of pain is BEST managed by antidepressants or anticonvulsants?

Neuropathic pain

During your pain assessment, a patient describes their lower abdominal pain as squeezing and cramping. What type of pain does this describe?

Nociceptive pain

What opioid is commonly used in critical care settings?

Fentanyl

What is the most common adverse effect related to the use of acetaminophen?

Liver dysfunction

What is an adverse outcome for unresolved pain?

Increased risk for pneumonia and thromboembolism

A patient is admitted from home to the critical care setting for a pain crisis related to cancer. They were taking hydromorphone PO 6 mg every 6 hours What is the first step to converting this hydromorphone to IV morphine?

The nurse should calculate the total dose of the oral hydromorphone taken in 24 hours.

What is one non-pharmacologic technique that may help pain during procedures and can be MOST easily implemented with patients who need critical care?

Soft music

What class of medication may be used to help treat nausea and vomiting for a patient with advanced gastric cancer?

Prokinetics

You are caring for a patient with a serious illness who has a recent history of constipation. What indicator of fecal impaction should you assess for?

Sudden onset of liquid stools

How should wound care for individuals with serious illnesses be done?

After the patient has received analgesia

A patient's pain is well-managed; however, they continue to complain of feeling tired and state, "I wish it would all end." What should be your FIRST action?

Evaluate the patient for depression.

You are caring for a patient who reports frequent problems with diarrhea. Which of the following interventions would be appropriate?

Administer loperamide as ordered, not to exceed 16 mg a day.

You are caring for a 78-year-old patient dying at home. You notice a large pressure injury on their sacrum that is black and blue and butterfly-shaped. The family states it was not there earlier in the day. What is the BEST conclusion?

The patient has developed a Kennedy terminal ulcer and is close to death.

What statement from a nurse indicates a LACK of understanding about managing dyspnea end of life?

I should continue oxygen even if oxygen is not improving the patient's dyspnea.

Which of the following patients is MOST likely to experience diarrhea?

A 32-year-old female receiving radiation for ovarian and uterine cancer

What statement characterizes dyspnea at the end of life?

Dyspnea may be relieved by a cool fan circulating air in the room.

You are teaching the son of a 65-year-old man with cancer about his father's anorexia. Which of the following actions suggested by the son reassures you that he understood your education on ways to help his father?

We can offer Dad wine before dinner to try to stimulate his appetite.

True or False: When instituting calorie counts and daily weights as part of a management plan for anorexia and cachexia, the caregiver burden should be considered.

True

You are developing a plan of care for a patient nearing end of life who has a fentanyl patch and has started to take hydromorphone as a PRN medication. What goal would be essential to include in the patient's plan of care?

The patient will report a usual bowel pattern

You are caring for a patient who is in the advanced stages of heart failure. The patient is reporting fatigue. What other condition is commonly associated with fatigue in this population?

Anorexia and cachexia

You are caring for a man with nausea and vomiting after receiving chemotherapy treatments. What intervention should you implement in your plan of care?

Serve meals at room temperature with clear fluids.

True or False: The assessment and management of physical symptoms should be your primary concern.

False

What document allows the patient to choose a person to make healthcare decisions for them when they lack decision-making capacity?

Durable Power of Attorney for Healthcare

You are caring for a man hospitalized with advanced metastatic cancer. He has declined further treatment, and he is aware that his disease may progress more rapidly. The patient is considered to have good decision-making capacity. Who should make the decision to terminate treatment for this patient?

The patient

Which statement most accurately describes your role in addressing ethical issues in palliative care?

Give the patient and family the information they need about the options for care and their benefits and burdens.

While caring for a woman with advanced multiple sclerosis, you bring up a discussion of advance directives. Which statement by the patient indicates understanding of advance directives?

I can revise my choices for care in the advance directives.

You are talking with the family of a man with a serious illness. Which statement expressed by a family member best illustrates an example of the ethical principle presented?

Nonmaleficence: "Can we stop the daily weights and blood work since they cause more pain and distress?"

A 78-year-old man with diabetes and end-stage renal disease is sent to the hospital from home. He has gangrene of the left foot. The man undergoes surgery; however, the gangrene continues. Further surgery and hospitalization are recommended. He wants to return home and let nature take its course. He is alert, oriented, and determined to have decision-making capacity. His partner is extremely upset and says he may be unable to care for him unless he has surgery. As a nurse, what should you do FIRST?

Ensure the patient and family understand the treatment options and risks.

True or False: The Physician/Provider Orders for Life-Sustaining Treatment (POLST) document can replace advance healthcare directives.

False

True or False: The National Consensus Project indicates that palliative care programs should apply ethical principles to the care of patients with serious illness, including honoring patient preferences.

True

All of the following criteria are a part of a patient's decision-making capacity EXCEPT:

Ability to apply ethical principles

You can contribute to ethical practice in serious illness care by doing all of the following EXCEPT:

Use personal values and morals to determine best courses of actions for patients and families.

What statement indicates a correct understanding of cultural assessment for patients at the end of life?

Ethnic identity varies within ethnic groups, so ask patients how strongly they identify with a particular group.

A young, female nurse is assessing a Native American male patient with amyotrophic lateral sclerosis (ALS). The nurse notices that the patient does not make eye contact. What aspect of this patient's culture is MOST likely being expressed by limited eye contact?

Respect for the nurse

What is MOST appropriate to tell a patient who has a serious illness as you are providing spiritual care for them?

We want to support you in activities you feel give your life meaning.

What is one component of cultural humility in healthcare?

Incorporating life-long learning

Following a bereavement visit with a woman whose husband died 4 months ago, the nurse is concerned that the woman is depressed because she refuses to participate in social activities. What is the role of the interdisciplinary team related to the nurse's concerns?

Offer support in cultural assessments and a plan of care.

You are frustrated because the parents of a patient have asked you not to tell their daughter about her impending death. What should be your NEXT step in providing culturally competent, ethical care to the patient?

Assess how much information the patient wants to know about her condition.

How is family defined in palliative care?

Whomever the patient says it is

You are caring for a patient from Cambodia who has terminal lung cancer. The patient is reluctant to discuss the illness. What action should you take?

Ask the family about their beliefs regarding full disclosure.

You are caring for a patient admitted to the ICU with chronic obstructive pulmonary disease (COPD). The patient speaks only Spanish, you speak only English, and some family members speak both. You want to discuss goals of care with the patient. What approach is MOST appropriate?

Request the use of a hospital interpreter when meeting with the patient and family.

What is one social determinant of health?

Education

What action BEST demonstrates culturally sensitive end-of-life care?

Ask the patient who they want to include in conversations about their illness.

How can you BEST demonstrate attentive listening?

Use nonverbal signals such as nodding your head and eye contact.

A patient with end-stage heart disease arrives at the emergency department unconscious after sustaining her third myocardial infarction. The physician has told the daughter that without major surgery, her mother could die today. You find the daughter crying by the patient's bedside. What intervention is most appropriate FIRST when communicating with the daughter?

Remain present with the daughter, using silence to impart comfort.

You are preparing for a family meeting with a patient who is alert and oriented and who was given the news that they have end stage liver failure 2 days ago. What is the BEST reason for the family meeting today?

To assist the patient with setting goals of care

What skill is fundamental to quality care for patients with serious illness?

Communicating effectively with patients and families

What is the essence of mindful presence?

Being in the moment

A 45-year-old man who was in a motorcycle accident has been in the ICU for the past week. The trauma resulted in spine injury, paralysis, and the need for ventilatory support. He asks you, "Why is this happening to me?" What is the MOST appropriate response?

I don't know. I wish I had an answer for you, but I don't.

A 31-year-old patient, whose breast cancer has progressed despite treatment, has decided to forego further treatment. The interdisciplinary team members, who have cared for the patient from diagnosis to this point, are distraught over her decision to stop treatment. What is the BEST action by the team regarding the patient's decision to stop treatment?

Ensure the patient has the necessary information to make decisions.

Which of the following is the BEST choice to communicate to a professional who is reluctant to refer their patient to palliative care?

Clearly state that palliative care supports the work of the professional.

Which action is the MOST successful for resolving conflict with a patient and family?

Identify the areas of conflict, recognizing that they may never be fully resolved.

What statement from a new team member indicates that they have a good understanding of basic communication techniques to use with patients and families?

I should acknowledge the emotions that the patient and family are expressing.

What action by a healthcare professional has the potential to cause a communication BARRIER?

Expressing personal ethical concerns

The daughter of a patient who died 2 months ago states, "It's just so typical, them leaving me to fend for myself. They were always so selfish." Which task of grief is the daughter MOST likely working through?

Working through the pain of the loss

When you discuss your feelings about the death of a patient with a co-worker, what system of support are you accessing?

Informal support system

What statement from a nurse to the family of someone who just died of injuries from a tragic accident would be MOST helpful?

It must be hard to accept that this has happened.

True or False: The first grief task is sharing the acknowle

True

You are caring for a patient who has just died. What family member is MOST at risk for disenfranchised grief?

The ex-partner who is estranged from their children

A grieving spouse, whose wife died 5 months ago, states, "I still can't get through a week without crying sometimes. I know I should be at least starting to move on a bit." What statement is the BEST response to support them?

Grief is unpredictable and you may experience it in waves.

You are caring for several patients and family members who are facing loss or death. What can you convey to them about grief?

Grief begins before a loss or death, as people consider an impending loss.

The daughter of a female patient who died 3 months ago reports she is experiencing fatigue, loss of appetite, and difficulty concentrating. What type of grief reaction is the daughter MOST likely experiencing?

Normal grief

After the death of his son by suicide, a parent expresses that they are terrified that their surviving son will also die by suicide and even reports nightmares in which this happens. What type of complicated grief is this parent likely experiencing?

Exaggerated grief

You are caring for a 55-year-old female patient who has heart and respiratory failure. You notice the patient's 22-year-old daughter weeping in the waiting room. The daughter explains that she just realized that her mother will not be alive when she gets married or has children of her own. Recognizing anticipatory grief in the young woman, what is the BEST intervention?

Provide therapeutic presence and practice active listening.

True or False: Grief work is never finished, as there will always be times when a memory, object, anniversary of the death, or feelings of loss occur.

True

A family asks what costs they will need to pay for donating the organs of their deceased loved one. What is your BEST response?

Donors' families neither pay for nor receive payment for organ and tissue donation.

You enter the room of a 19-year-old woman who just died. You find the mother in bed holding her daughter. What should you do?

Support the mother as she says goodbye to her daughter.

A family member is asking you if it is possible to hasten their loved one's death. What should be your FIRST action in response to this request?

Offer your nonjudgmental commitment to care for the patient until they die.

Why should an opioid or benzodiazepine never abruptly be discontinued?

It can cause severe withdrawal symptoms.

You are caring for a patient who is imminently dying. During morning care, the patient asks you if they are dying. Which of the following would be the BEST response?

What makes you ask this question now?

Opioid medications have been successful for managing a patient's pain for the last 2 months. The patient is now imminently dying. What is the MOST appropriate action?

Maintain analgesic therapy and assess for comfort.

You are caring for a patient who has just died. What is your FIRST priority in providing postmortem care?

Provide a clean, peaceful impression of the deceased for the family.

Which statement BEST describes an essential role of the nurse during the dying process?

Proactively anticipate and prevent symptoms.

An adult patient dying from end-stage heart failure confides in you that she has stopped eating and drinking to hasten her death. She states, "I've made my peace and I'm ready to go." What should be your FIRST response?

Explore her suffering and motivation for hastening her death.

You are caring for an 85-year-old man who is dying. He has been comatose for several days. His respirations are now shallow, and he is exhibiting terminal secretions. His adult children at the bedside state, "We don't want our father to suffocate." Which of the following actions should be your FIRST response?

Reassure the family that the terminal secretions are expected and do not cause physical discomfort.

Which of the following is MOST often affected by a family's culture?

Reactions to decreased food intake

Which statement is TRUE about controlled, or palliative, sedation?

Controlled sedation is considered after all other symptom management options have failed.

You are caring for a patient who is imminently dying and has been unconscious for days. Her 10-year-old daughter tells you that she hopes her mother will open her eyes one last time before dying. Knowing that this is unlikely, what is your BEST response?

Even if she doesn't open her eyes, you can talk to your mom, and she can hear you and feel your touch.