NUR3500 Practice of Palliative and End-of-Life Care
The Complete Exam Bible · Sem 1 AY2026/27NUR3500 Overview
- Semester 1, AY2026/27
- National University of Singapore
- Nursing
- Fifty question final paper
- Group presentation in week 13
This guide covers the practice of palliative and end-of-life care as it is taught and assessed in Semester 1 of AY2026/27, from the philosophy of the approach through to the conversations held in a patient's last days at home.
- Need triggers the referral Palliative involvement follows unmet need rather than a prognosis estimate or an exhausted treatment plan.
- The paper rewards discrimination Most questions turn on one contrast: the action that is right in an acutely unwell patient and wrong in a dying one.
- Learn each tool with its patient Frailty scales, symptom scales and observational scores are correct only for the population they were built for.
- Communication is graded Silence, open questions and the absence of false reassurance have to appear in the script your group submits.
How NUR3500 is assessed
| Component | Weight | Format |
|---|---|---|
| Class active participation | 10% | Consistency of attendance and contribution across the tutorial weeks and on the group presentation day |
| Group work | 30% | Groups of five to six: a symptom report, a clinical scenario and a conversation script submitted in advance, then a live presentation assessed by the tutor |
| Final exam | 60% | Fifty multiple-choice questions set on the course learning materials and on the face to face tutorial discussions |
Weights are those published for this offering and add to 100. Any minimum mark required in an individual component is something to confirm on the course site, along with the exam venue.
Current NUR3500 dates
| Date | Item | Control |
|---|---|---|
| 02 November 2026 | Group supporting documents due | Uploaded to the group folder by 11.59pm, one submission per group |
| 10 to 12 November 2026 | Group presentations | One evening for each group across the three days |
| 14 to 20 November 2026 | Reading week | No scheduled teaching |
| 25 November 2026 | Final examination | One hour from 1pm; venue announced later |
Dates are as published in the current course assessment details and timetable. Confirm exact deadlines and submission settings in the live LMS.
What NUR3500 covers
Ten chapters move from the philosophy of palliative care to the conversations held in a patient's last days, following the order the course teaches them.
Principles and Philosophy of Palliative Care
Read the definition as an instruction to assess four domains, not as a descriptionWhy this chapter comes first
Palliative care is defined by what it attends to rather than by where it happens or how close death is.
- Definition and philosophy
- The four domains of suffering
- The family as part of the unit of care
- Principles and what each one rules out
- Hospice, palliative and end of life care compared
Models of Care and Illness Trajectories
Timing of entry, and how much warning each illness gives before it endsA model of care is a claim about timing
The three models contrasted in this course disagree about one thing only: at what point palliative input begins relative to treatment aimed at the disease.
- Traditional, integrated and bow tie models
- The characteristic failure of each model
- Cancer, organ failure and frailty trajectories
- Choosing the moment for the conversation
- Referral prompts and settings of care
Advance Care Planning in Singapore
A facilitated conversation, three stages, and four instruments that are not interchangeableWhat planning actually is
Advance care planning is a structured conversation in which a person explores what matters to them, what they would and would not want if they became seriously unwell, and who should speak for them if they could not speak for themselves.
- What the conversation involves
- General, disease specific and preferred plan stages
- Planning compared with the legal instruments
- What the trial evidence supports
- Barriers reported by clinicians
Identifying Who Needs Palliative Care
General deterioration, condition specific signals, and the tools used to score themThe problem this chapter solves
The hardest practical problem in palliative care is not what to do; it is noticing in time.
- General indicators of deteriorating health
- The surprise question and its purpose
- Condition specific signals of advanced disease
- The review the tool then directs
- Frailty grading compared with symptom scoring
Palliative Care in End Stage Organ Disease
One trajectory shared by heart, lung and kidney failure, three dominant symptomsWhat the three failures share
Heart, lung and kidney failure sit on the organ failure trajectory: long term limitation punctuated by acute episodes, each of which could be the last, with a baseline that never quite returns.
- The shared organ failure trajectory
- Assessment structure and management principles
- Advanced heart failure and functional grading
- Breathlessness in advanced lung disease
- Dialysis decisions and uraemic itch
Advanced Cancer: Symptoms and Emergencies
Site specific complications, matched antiemetics, and events you prepare for in advanceReading the intake
Advanced cancer arrives with a paper trail, and the first skill is reading it for what will change the plan.
- Reading the referral and setting a visit priority
- Complications by primary tumour site
- Choosing an antiemetic by mechanism
- Four emergencies and their advance preparation
- Psychological, spiritual and family dimensions
Advanced Frailty and Dementia in Older Adults
Defining frailty, staging dementia, and assessing symptoms a person cannot reportFrailty as a clinical state
Frailty is a recognisable clinical state in which an older person's ability to withstand everyday or acute stressors is reduced, because reserve and function have declined across several organ systems with age.
- Phenotype, index and screening definitions of frailty
- The symptom and psychological burden of frailty
- Why no terminal phase makes planning hard
- Functional staging in advanced dementia
- Observational scoring of pain and breathlessness
Total Pain and Opioid Management
Structured assessment, mechanism, the analgesic ladder and the arithmetic of titrationWhat pain is, and what control aims at
Pain is an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.
- Definition and the goal of pain control
- Structured history plus sleep, mood and meaning
- Nociceptive and neuropathic mechanisms
- The four dimensions of total pain
- The ladder, prescribing principles and titration
Last Days of Life and Compassionate Discharge
Recognising the dying phase, controlling five symptoms, and getting someone home in timeRecognising that someone is dying
Nothing else in this chapter works if the dying phase is not recognised, and the signs are individually unremarkable and collectively unmistakable.
- Signs of the actively dying patient
- Acute-care readings that mislead in this phase
- Pain, breathlessness, delirium, seizures and secretions
- The three conditions for compassionate discharge
- Preparation at home and bereavement support
Communication in Serious Illness
Nine assessed behaviours, a four move structure, and the artefact your group submitsCommunication is graded here
In this course communication is not a soft addition to the clinical content; it is part of a graded component.
- The nine assessed communication behaviours
- Why silence and false reassurance matter most
- Acknowledge, explore, explain, align
- Four sentences that end a conversation
- What the group task asks you to produce
It is built around clinical decisions rather than topic headings, because that is the form a fifty question single best answer paper takes.
Principles and Philosophy of Palliative Care
The definition is read as an instruction: four domains of suffering, two people in the unit of care, and an expectation that involvement begins early rather than after treatment is exhausted.
The chapter separates palliative care, end of life care and hospice care, which are not synonyms and are regularly tested on the difference.
Models of Care and Illness Trajectories
Traditional, integrated and bow tie models disagree about one thing only, which is when palliative input begins.
Set against them are the three trajectories of function over time in cancer, organ failure and frailty, each of which gives a different amount of warning and therefore demands its conversation at a different moment.
Advance Care Planning in Singapore
A facilitated conversation, staged from general planning through disease specific planning to a preferred plan of care, sits alongside three legal instruments that are frequently confused with it.
The chapter also sets out what the trial evidence does and does not support, and why clinician time is the largest reported barrier.
Identifying Who Needs Palliative Care
Identification rests on general indicators of deterioration rather than on a diagnosis, with two or more as the working threshold, supported by condition specific signals and by the surprise question.
Frailty grading and symptom scoring answer different questions and are not interchangeable.
Palliative Care in End Stage Organ Disease
Heart, lung and kidney failure share one trajectory and one assessment structure while differing in the symptom that dominates and the scale used to stage them.
The chapter covers functional classification in heart failure, the fear driven breathlessness cycle in lung disease, and the two very different timescales that follow a dialysis decision.
Advanced Cancer: Symptoms and Emergencies
Complications differ by primary site, from airway and bleeding risk in head and neck disease to obstruction in gastrointestinal disease.
The chapter matches antiemetics to the pathway driving the nausea and treats palliative emergencies as events whose outcome depends on what was arranged in advance.
Advanced Frailty and Dementia in Older Adults
Frailty is defined by a physical phenotype or by an accumulated deficit index, which is why prevalence estimates vary so widely.
In advanced dementia the chapter covers functional staging and the observational tools used to score pain and breathlessness in someone who cannot report either.
Total Pain and Opioid Management
Structured pain assessment is extended with sleep, mood and meaning, then mechanism decides the drug.
The chapter works through the analgesic ladder, the five prescribing principles, the arithmetic of titration and the breakthrough dose, and the side effects that are prevented rather than discovered.
Last Days of Life and Compassionate Discharge
Recognising the dying phase converts a list of abnormal observations into a plan, because each sign has an acute-care reading that would be correct in a different patient.
Five symptoms account for most distress, and compassionate discharge succeeds only when patient, community and family conditions all hold.
Communication in Serious Illness
Nine communication behaviours are named in the assessment criteria and have to be visible in a written script.
The chapter gives a four move structure for answering a frightened question and lists the sentences that reliably end a conversation.
Worked example · free
Reading a single best answer stem
- 2Establish what the stem is asking for, assessment or action.
- 2Eliminate the options that assume a capability she does not have.
- 2Eliminate the option that belongs to a different phase of illness.
Key terms
- Palliative care
- An approach improving quality of life for people with a life threatening illness and their families by relieving suffering across four domains.
- Unit of care
- The patient and family together, both assessed and both supported, including after the death.
- Illness trajectory
- The shape function takes over time in an advanced illness, used to judge how much warning there will be.
- Advance care planning
- A facilitated conversation recording values, goals and a nominated spokesperson, which guides the team without binding it.
- General indicator
- A sign of deteriorating health independent of diagnosis, two or more of which should prompt a palliative review.
- Total pain
- Suffering understood as physical, psychological, social and spiritual at once, converging on one reported experience.
- Breakthrough dose
- A rescue analgesic dose calculated orally as one sixth of the total daily regular dose.
- Compassionate discharge
- A rapid transfer arranged so a dying person can spend their final days and die at home.
- Terminal delirium
- Delirium in the dying phase, often without a reversible cause, appearing as agitation or as quiet withdrawal.
- Anticipatory medicines
- Drugs left in the home in advance so that pain, breathlessness, agitation and secretions can be treated without delay.
NUR3500 FAQ
How is this course assessed and what carries the most weight?
Three components. Participation across the tutorial weeks carries a tenth of the mark, the group work carries just under a third, and a one hour written paper of fifty multiple-choice questions carries the remaining three fifths. Because that paper is set across the whole semester, breadth matters more than depth in any single topic.
What kind of questions does the written paper ask?
Applied ones. A typical item gives a patient, a symptom and a setting and asks which action comes first, so the distractors are usually actions that would be correct at a different point in the illness or for a patient with a different capability. Recognition of a definition is rarely enough.
Which topics are most heavily represented across the semester?
Symptom management in advanced cancer, in end stage organ disease and in frailty and dementia, together with pain and the last days of life. Identification, planning and communication run underneath all of them and reappear inside the clinical scenarios.
Do I need to memorise drug doses for this course?
The examinable arithmetic is limited and structural rather than encyclopaedic: how a breakthrough dose relates to the total daily dose, and by how much a regular dose is increased when pain is uncontrolled. Knowing which class of drug matches which mechanism matters far more than memorising individual doses.
How should I prepare for the group presentation?
Choose one distressing symptom and learn it in depth across causes, presentation, assessment tools, drug and non-drug management, safety concerns and follow up. Then write a scenario and a script in which a nurse visibly demonstrates the communication behaviours named in the criteria, including silence and the absence of false reassurance.
What is the single most common mistake students make in this material?
Choosing the action that would be correct for an acutely unwell patient when the person described is dying. Fluids for a low blood pressure, investigation for restlessness and a feeding tube for poor intake are all defensible earlier in an illness and all wrong in the last days.
Questions students ask in each NUR3500 chapter
- Can palliative care run at the same time as chemotherapy or dialysis?
- Yes. One of the published principles is that this approach applies early in an illness and alongside therapies intended to prolong life, including the investigations needed to understand a distressing complication. A patient still receiving disease directed treatment is not, for that reason alone, too early for a referral. Chapter 01 · Principles and Philosophy of Palliative Care
- How do I know when to start the goals of care conversation?
- Use the trajectory. In organ failure an acute exacerbation is the natural trigger, because instability and engagement coincide. In frailty and dementia nothing dramatic marks the change, so the discussion must be scheduled. In cancer the steep late fall means planning should happen while function still looks preserved. Chapter 02 · Models of Care and Illness Trajectories
- Is an advance care plan legally binding on the team?
- No. It is a record of values, goals and a nominated spokesperson, and it guides decisions rather than dictating them. The legally operative instruments are the lasting power of attorney, which appoints a decision maker once capacity is lost, and the advance medical directive, which is narrow and applies only in terminal illness. Chapter 03 · Advance Care Planning in Singapore
- How many indicators are needed before I should raise a review?
- Two or more general indicators of deteriorating health is the working threshold, and the condition specific rows strengthen the case rather than replacing it. The point of a threshold is that it removes the need to make a prognosis estimate before acting. Chapter 04 · Identifying Who Needs Palliative Care
- Are opioids safe for breathlessness in advanced lung disease?
- Yes, when carefully titrated, and they are used for exactly that indication. The safeguard is the titration: small doses reviewed against the effect on the sensation rather than on a saturation reading. Ruling them out for fear of respiratory depression is a common and costly error. Chapter 05 · Palliative Care in End Stage Organ Disease
- Why does the same nausea need different drugs in different patients?
- Because the pathway differs. Nausea driven by circulating drugs or metabolic upset responds to a dopamine antagonist, nausea from chemotherapy or radiation to a serotonin antagonist, and nausea from gastric stasis to a pro-motility agent that must be avoided once obstruction is complete. Chapter 06 · Advanced Cancer: Symptoms and Emergencies
- How do I assess pain in someone who cannot speak?
- Use an observational scale rather than a guess. Score breathing, negative vocalisation, facial expression, body language and consolability, observe for several minutes, and repeat the observation during movement or personal care when pain is most likely to be visible. Chapter 07 · Advanced Frailty and Dementia in Older Adults
- How is a breakthrough dose calculated?
- Orally it is one sixth of the total daily regular dose, given no more often than the prescription allows. A patient should never be without one, and frequent use is the signal to review the regular dose rather than to keep giving rescue doses. Chapter 08 · Total Pain and Opioid Management
- What happens to oral medication when someone can no longer swallow?
- Essential drugs are converted to a route that still works, usually subcutaneous, at an equivalent dose, and anything that no longer contributes to comfort is stopped. Stopping analgesia because tablets cannot be swallowed is the omission that produces uncontrolled pain in the last hours. Chapter 09 · Last Days of Life and Compassionate Discharge
- What do I say when a family asks whether we are giving up?
- Acknowledge the worry before answering it, then explore what concerns them most and stop talking. Only then explain that a change of focus does not mean no care, describing concretely what is being assessed and treated, and finish by proposing that you plan the next steps together. Chapter 10 · Communication in Serious Illness
How to study for the exam
Work in four passes. First, read each chapter once and write the one decision it settles, so you know where a question lives. Second, load the named tools and attach each to the population it belongs to, because most mis-answered items are the right tool on the wrong patient.
Third, compare across chapters: take one symptom, such as breathlessness, and write how the first action differs in advanced lung disease, in dementia with pneumonia and in the last hours of life. Fourth, answer practice questions from memory against a clock and mark yourself on the reasoning rather than on the keyword. Revisit the tutorial case discussions as well as the written materials, because the paper is set on both.
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