Nursing Acceleration Challenge Exam I PN Hospice, Palliative Care, and End-of-Life Nursing — Questions and Answers
Question 1: A patient with terminal cancer is enrolled in hospice. Which statement BEST describes the goal of hospice care?
- Cure the underlying disease through aggressive treatment
- Prolong life as long as possible using all available interventions
- Provide comfort and quality of life when curative treatment is no longer the goal (Correct answer)
- Transfer the patient to a skilled nursing facility for 24-hour monitoring
Correct answer: Provide comfort and quality of life when curative treatment is no longer the goal
Hospice care focuses on comfort, dignity, and quality of life for patients with a terminal prognosis (typically ≤6 months). It is palliative—not curative—and supports both the patient and family through the dying process. Aggressive curative interventions are withdrawn.
Question 2: According to KĂĽbler-Ross's five stages of grief, a patient who has just been told she has a terminal diagnosis says, 'The lab must have mixed up my results. I'm going to get a second opinion.' This patient is in which stage?
- Anger
- Bargaining
- Denial (Correct answer)
- Acceptance
Correct answer: Denial
Denial is the first stage in KĂĽbler-Ross's model and is characterized by disbelief, shock, and rejection of the diagnosis. The patient's statement that results were mixed up and her plan to seek a second opinion are classic denial behaviors. This is a normal protective psychological response.
Question 3: A terminally ill patient is experiencing Cheyne-Stokes respirations. The family asks what this means. The nurse's BEST response is:
- 'This means the patient needs supplemental oxygen immediately.'
- 'This pattern—cycles of rapid breathing followed by pauses—is a normal sign that death is approaching.' (Correct answer)
- 'We should call the physician to start mechanical ventilation.'
- 'This breathing pattern means the patient is in pain and needs more medication.'
Correct answer: 'This pattern—cycles of rapid breathing followed by pauses—is a normal sign that death is approaching.'
Cheyne-Stokes respirations (irregular cycles of apnea and hyperpnea) are a normal physiological sign of imminent death caused by decreased cerebral perfusion. Educating the family that this is expected and not distressing to the patient provides comfort and reduces panic. It does not indicate a need for aggressive intervention.
Question 4: A patient with a valid advance directive (living will) stating 'no resuscitation' suffers cardiac arrest. A family member demands the nurse perform CPR. The nurse should:
- Begin CPR because family consent overrides the advance directive
- Contact the physician to obtain a verbal order before deciding
- Honor the advance directive and do not perform CPR (Correct answer)
- Perform CPR until the ethics committee can be convened
Correct answer: Honor the advance directive and do not perform CPR
A legally valid advance directive reflects the patient's autonomous wishes and takes precedence over family requests when the patient lacks decision-making capacity. The nurse is legally and ethically obligated to honor it. Family members cannot override a competently executed advance directive.
Question 5: Which comfort measure is the priority nursing intervention for a patient in the active dying phase experiencing air hunger?
- Initiate mechanical ventilation to normalize oxygen saturation
- Administer prescribed low-dose opioids and position the patient upright or on their side (Correct answer)
- Apply a non-rebreather mask at 15 L/min to maximize oxygenation
- Perform chest physiotherapy to clear secretions
Correct answer: Administer prescribed low-dose opioids and position the patient upright or on their side
Low-dose opioids (such as morphine) are the most effective palliative intervention for dyspnea/air hunger at end of life. Positioning (HOB elevated or lateral) reduces the sensation of breathlessness. Aggressive interventions like mechanical ventilation or high-flow oxygen may add burden without comfort in the dying phase.
Question 6: A nurse is caring for a patient who recently died. The patient's spouse is crying and says, 'I should have been here—I wasn't with him when he died.' Which response by the nurse is most therapeutic?
- 'Try not to feel guilty—many patients die when family steps out of the room.'
- 'At least he is no longer suffering. That's what matters most.'
- 'It sounds like you're feeling guilty. Being with someone you love through this is incredibly hard.' (Correct answer)
- 'You can discuss these feelings with the hospital chaplain when you're ready.'
Correct answer: 'It sounds like you're feeling guilty. Being with someone you love through this is incredibly hard.'
Reflecting the spouse's emotional experience ('It sounds like you're feeling guilty') validates their grief without minimizing it or immediately offering solutions. Clichés like 'at least he's not suffering' or deflecting to a chaplain can shut down emotional expression. Presence and acknowledgment are the most therapeutic tools at this moment.
Nursing Acceleration Challenge Exam I PN Hospice, Palliative Care, and End-of-Life Nursing
A patient with terminal cancer is enrolled in hospice.
Which statement BEST describes the goal of hospice care?