A patient receiving chemotherapy aimed at cure has severe nausea, pain and anxiety. Which type of care can be added now?
Palliative care alongside the chemotherapy
✓
Hospice care after the chemotherapy is stopped
Respite care in a skilled nursing facility
No added care until the chemotherapy ends
Correct Answer
Palliative care alongside the chemotherapy
Palliative care relieves the symptoms and stress of serious illness and can be provided alongside treatment aimed at cure, so it fits this patient now. Hospice care after the chemotherapy is stopped is for patients nearing the end of life who have chosen comfort over curative treatment. Respite care in a skilled nursing facility gives family caregivers a short break and does not address symptoms. Withholding added care until the chemotherapy ends leaves treatable suffering unrelieved.
Category: Palliative and Hospice Care
Question 2
A hospice patient's condition improves and stabilizes so that the patient no longer meets eligibility criteria. What happens next?
The patient must remain enrolled in hospice until death
The patient can be discharged and readmitted later if decline recurs
✓
The patient loses all future hospice eligibility
The patient is moved to intensive care for curative treatment
Correct Answer
The patient can be discharged and readmitted later if decline recurs
Some hospice patients improve and are discharged, which can give families more time together, and the team checks in periodically. A patient who declines again and meets the criteria can be readmitted. Remaining enrolled until death is not required. Losing all future eligibility is wrong because readmission is allowed. Moving the patient to intensive care for curative treatment does not follow from improvement and ignores the patient's goals.
Category: Palliative and Hospice Care
Question 3
What does a do-not-intubate order specify?
No CPR if the heart stops
No antibiotics for new infections
No breathing tube or ventilator if breathing fails
✓
No food or fluids by mouth
Correct Answer
No breathing tube or ventilator if breathing fails
A do-not-intubate order states that the patient does not want a breathing tube or mechanical ventilation if unable to breathe independently. Withholding CPR if the heart stops is the purpose of a do-not-resuscitate order, which is a separate order. Withholding antibiotics for new infections is a preference that can be recorded elsewhere, such as on a POLST form. Withholding food or fluids by mouth is not part of an intubation order.
Category: Advance Care Planning and Ethics
Question 4
A patient with advanced illness moves between home, the hospital and a nursing facility. Why is a POLST form useful for this patient?
It names the person who will manage the patient's finances
It applies only in the hospital where it was signed
It replaces the need to discuss wishes with the patient
Its medical orders travel with the patient across care settings
✓
Correct Answer
Its medical orders travel with the patient across care settings
A POLST or MOLST form records the patient's wishes about resuscitation, intubation, hospitalization, comfort care and antibiotics as medical orders that transfer across care settings. Naming the person who will manage the patient's finances is the role of a durable power of attorney. Applying only in the hospital where it was signed is wrong, because portability is the point of the form. Replacing the need to discuss wishes is wrong, since the form is completed through those discussions and is revisited as goals change.
Category: Advance Care Planning and Ethics
Question 5
After hearing that the cancer has spread, a patient becomes quiet and looks away. What should the nurse do?
Allow a pause and wait for the patient to respond
✓
Change the subject to something lighter
Fill the silence with more details about treatment
Tell the patient which decision to make
Correct Answer
Allow a pause and wait for the patient to respond
Pausing gives the patient time to absorb hard news and reflect before answering, and the nurse can later ask whether more time is needed. Changing the subject to something lighter signals that the patient's feelings are not welcome. Filling the silence with more details about treatment overwhelms the patient when information cannot be absorbed. Telling the patient which decision to make is giving advice, which undermines the patient's own choices.
Category: Communication
Question 6
Which question best invites a patient to share end-of-life wishes?
"Do you want CPR, yes or no?"
"What matters most to you as your illness changes?"
✓
"You don't want to suffer, do you?"
"Wouldn't you rather stay in the hospital?"
Correct Answer
"What matters most to you as your illness changes?"
An open-ended question about what matters most invites the patient to describe values and goals in their own words. Asking whether the patient wants CPR, yes or no, is a closed question that skips the values behind the choice. Asking "You don't want to suffer, do you?" leads the patient toward an expected answer. Asking whether the patient would rather stay in the hospital steers the patient toward the nurse's preference.
Category: Communication
Question 7
In palliative and hospice care, which role does the nurse commonly fill?
Prescriber of the patient's medications
Sole decision maker about treatment goals
Case manager and hub of team communication
✓
Manager of the patient's finances
Correct Answer
Case manager and hub of team communication
The nurse often acts as case manager, assessing how well care is working, coordinating services and keeping every team member and the plan of care up to date. Prescribing the patient's medications is the role of the provider. Acting as sole decision maker about treatment goals is wrong, because goals come from the patient and family with the team. Managing the patient's finances is not a nursing role, though a social worker can help connect the family with resources.
Category: Palliative and Hospice Care
Question 8
A dying patient in bed reports feeling short of breath. Which nonpharmacologic measure should the nurse use?
Lowering the patient to a flat position
Closing the windows and warming the room
Coaching the patient to take rapid breaths
Raising the head of the bed
✓
Correct Answer
Raising the head of the bed
Raising the head of the bed lets the lungs expand more easily and reduces the work of breathing, and opening a window or using a fan can add relief. Lowering the patient to a flat position makes breathing harder. Closing the windows and warming the room removes the cool, moving air that eases breathlessness. Coaching the patient to take rapid breaths increases the work of breathing, whereas slow pursed-lip breathing helps.
Category: Symptom Management
Question 9
The family of a dying patient urges the patient to eat full meals. What should the nurse teach the family?
Decreased appetite is expected, so favorite foods are offered without pressure
✓
Full meals are needed to slow the dying process
A feeding tube is required once appetite declines
The patient should be awakened to eat on a set schedule
Correct Answer
Decreased appetite is expected, so favorite foods are offered without pressure
Loss of appetite is an expected part of dying, so the family can offer small amounts of favorite foods or high-calorie drinks without forcing the patient to eat; going without food is not painful for the patient. Saying full meals are needed to slow the dying process is inaccurate and adds pressure. Saying a feeding tube is required once appetite declines is wrong, because tube feeding is a choice weighed against the patient's goals. Waking the patient to eat on a set schedule disrupts rest and comfort.
Category: Symptom Management
Question 10
A dying patient's breathing has become noisy and gurgling, and the family is alarmed. What should the nurse explain?
The patient is choking and emergency services are needed
The sound comes from pooled secretions and usually does not distress the patient
✓
The sound shows the patient is in severe pain
The noise means a lung infection needs antibiotics
Correct Answer
The sound comes from pooled secretions and usually does not distress the patient
Near death, the patient can no longer clear secretions from the throat, which causes noisy breathing that families often find upsetting, although the patient is typically unaware of it. Repositioning or medication can reduce the sound. Saying the patient is choking and emergency services are needed misreads an expected change. Saying the sound shows severe pain is inaccurate, since the noise reflects secretions. Saying a lung infection needs antibiotics misidentifies the cause.
Category: Signs of Approaching Death
Question 11
Which finding is an early sign that a patient is approaching death?
Cheyne-Stokes breathing
Unresponsiveness to voice and touch
Increased fatigue with less interest in surroundings
✓
Noisy, gurgling breathing
Correct Answer
Increased fatigue with less interest in surroundings
Early signs include decreased appetite, increased fatigue, changes in sleep and decreased interest in surroundings, and comfort measures such as a calm environment help. Cheyne-Stokes breathing is a late sign. Unresponsiveness to voice and touch also appears late. Noisy, gurgling breathing from secretions is another late sign.
Category: Signs of Approaching Death
Question 12
A hospice patient dies at home as expected. What should the family have been taught to do first?
Call emergency services to start CPR
Drive the patient to the nearest hospital
Wait until the next nurse visit to report it
Call the hospice agency's on-call number
✓
Correct Answer
Call the hospice agency's on-call number
When an expected death occurs at home under hospice care, the family calls the hospice on-call number, and the team guides the next steps. Calling emergency services to start CPR can lead to resuscitation the patient did not want. Driving the patient to the nearest hospital is unnecessary and distressing. Waiting until the next nurse visit to report it leaves the family without support.
Category: Signs of Approaching Death
Question 13
Which statement about the stages of grief described by Kübler-Ross is accurate?
People may move back and forth between stages in no fixed order
✓
Everyone passes through the stages in the same order
A person who skips a stage is grieving abnormally
The stages apply only to family members, not to dying patients
Correct Answer
People may move back and forth between stages in no fixed order
Everyone grieves differently and at their own pace, and people can cycle through denial, anger, bargaining, depression and acceptance repeatedly. Saying everyone passes through the stages in the same order ignores this variation. Saying a person who skips a stage is grieving abnormally is wrong, because not every person experiences every stage. Saying the stages apply only to family members is wrong, because dying patients also use them as coping mechanisms.
Category: Grief and Psychosocial Care
Question 14
Which nursing action fosters hope in a patient near the end of life?
Assuring the patient that a cure is still likely
Helping the patient set a realistic goal, such as writing letters to family
✓
Avoiding any talk about the future
Making decisions for the patient to reduce stress
Correct Answer
Helping the patient set a realistic goal, such as writing letters to family
At the end of life, hope shifts toward quality of life and dignity, and supporting realistic goals, meaning and control helps sustain it. Assuring the patient that a cure is still likely gives false information. Avoiding any talk about the future takes away the chance to plan meaningful goals. Making decisions for the patient removes the sense of control that supports hope.
Category: Grief and Psychosocial Care
Question 15
A dying patient says, "I need to make peace with my brother before I go." Which type of need is the patient expressing?
Physical
Financial
Spiritual
✓
Legal
Correct Answer
Spiritual
Of the needs listed, spiritual fits: spirituality is broader than religion and includes making amends, resolving unsettled issues and finding peace with loved ones. A physical need would involve symptoms or bodily comfort. A financial need would concern money or bills. A legal need would involve documents such as a will or power of attorney.
Category: Grief and Psychosocial Care
Question 16
A patient says that, in the family's tradition, an elder relative receives medical news and speaks for the patient. How should the nurse proceed?
Insist on discussing everything only with the patient
Share all findings with the family first without asking
Let the family's wishes override the patient's stated choices
Ask the patient how information and decisions should be shared
✓
Correct Answer
Ask the patient how information and decisions should be shared
Culturally competent care starts by assessing this patient's own preferences about disclosure and decision making and sharing them with the team. Insisting on discussing everything only with the patient ignores the patient's stated preference. Sharing all findings with the family first without asking the patient bypasses the patient's consent. Letting the family's wishes override the patient's stated choices fails to respect the patient's autonomy.
Category: Communication
Question 17
A child asks the hospice nurse a question about a dying parent that the nurse cannot answer. What is the best response?
Admit not knowing and offer to find out together
✓
Give a reassuring answer even if it may be untrue
Tell the child to ask again when older
Change the subject to protect the child
Correct Answer
Admit not knowing and offer to find out together
Honesty guides communication with children, and admitting uncertainty while offering to find the answer together builds trust. Giving a reassuring answer that may be untrue risks confusion and anger when the child learns the truth. Telling the child to ask again when older dismisses a real need to understand. Changing the subject to protect the child tends to leave the child feeling isolated.
Category: Supporting Families and Caregivers
Question 18
A daughter caring for her dying father at home says she is exhausted but feels she should be able to do everything herself. What should the nurse do?
Praise her for handling all of the care alone
Encourage her to accept help and suggest specific tasks others can take on
✓
Advise her to hide her fatigue from her father
Suggest that she visit her father less often
Correct Answer
Encourage her to accept help and suggest specific tasks others can take on
Primary caregivers often become physically and emotionally exhausted, so the nurse affirms that asking for and accepting help is acceptable and suggests concrete tasks such as errands, meals or sitting with the patient. Praising her for handling all of the care alone reinforces a pattern that leads to burnout. Advising her to hide her fatigue does nothing to relieve it. Suggesting that she visit less often does not address her need for support.
Category: Supporting Families and Caregivers
Question 19
After several patient deaths, a nurse notices lingering sadness. Which coping approach is healthy?
Staying busy so there is no time to think about it
Keeping the feelings private to stay strong
Talking about the feelings with the care team
✓
Avoiding assignments to dying patients from now on
Correct Answer
Talking about the feelings with the care team
Facing emotions openly and talking with the care team helps nurses process grief and prevents unresolved sadness from building up. Staying busy so there is no time to think about it is a common defense that leaves grief unresolved. Keeping the feelings private to stay strong is another defense linked to illness and burnout. Avoiding assignments to dying patients does not resolve the grief and limits the nurse's practice.
Category: Supporting Families and Caregivers
Question 20
A patient in a state where provider-assisted death is legal has received the prescribed medication. What is the nurse's role?
Administering the medication when the patient asks
Refusing to discuss the patient's choice
Reporting the patient to law enforcement
Supporting the patient and family without administering the drug
✓
Correct Answer
Supporting the patient and family without administering the drug
In provider-assisted death the patient takes the prescribed medication, and nurses are ethically prohibited from administering it, but they stay informed and support the patient and family. Administering the medication when the patient asks crosses that ethical line. Refusing to discuss the patient's choice abandons the patient's need for support. Reporting the patient to law enforcement is wrong because the practice is legal in that state.
Category: Advance Care Planning and Ethics