NSG 4067: CARING FOR OLDER ADULTS AT THE END OF LIFE
1. A nurse on a geriatric medical care unit consults hospice for a client. Which of the following
nursing interventions should the nurse anticipate after the client begins hospice care?
A) Administering chemotherapy to a client with a diagnosis of pancreatic cancer
B) Assessing the deep tendon reflexes of a client with neurologic impairment
C) Infusing total parenteral nutrition to a client with dysphagia
D) Providing an opioid analgesic to a client with bone metastases
Ans: D
Feedback:
The focus of hospice care is on the relief of suffering rather than cure of disease. Relief of
suffering often encompasses providing pain relief to clients. Active curative treatments, such as
chemotherapy, and parenteral feeding often are forgone. Health assessments that do not assess
the client's comfort, such as the assessment of deep tendon reflexes, are not the priority of
palliative/hospice care.
2. A nurse cares for an 87-year-old client from India who has noted Hinduism as religious
preference on admission records. This client is transferred to the hospice unit. Which of the
following actions by the nurse best shows caring?
A) Ask the family to tell you about Hinduism.
B) Assess the client's spiritual needs.
C) Notify the family's pastor.
D) Pray with the client and family.
Ans: B
Feedback:
Spiritual assessment should take place on admission and throughout the client's time in palliative
care. Spiritual care is within the scope of nursing, and prayer would be appropriate if it were
chosen based on a sound assessment of the client's needs and belief system. Nurses should be
prepared to refer to whatever spiritual leader the client expresses a desire to speak with. Now is
not the time to query, it is the time to listen.
3. A nurse explores resources available to assist a client. Which of the following older adults
meets the eligibility requirements for hospice care?
A) A client who is immobilized and unable to afford specialized nursing care
B) A client who has experienced a stroke and been given 3 months to live
C) A client with cancer who is living with uncontrolled persistent pain
, D) A client with acquired immunodeficiency syndrome who lacks family support to provide
needed care
Ans: B
Feedback:
The eligibility requirements for hospice care include physician referral and a life expectancy of
less than 6 months. Financial need, high pain levels, and lack of family support are not explicit
qualifiers for hospice care.
4. A nurse cares for an older adult who is nonresponsive and surrounded by family. Which of the
following statements by the nurse is most appropriate?
A) "I am here for you, how can I be helpful?"
B) "I know just how you feel, my mother died last month."
C) "I'll leave you alone so that you can grieve in private."
D) "She was a really nice lady; she did a good job raising you."
Ans: A
Feedback:
Nurses can help people who are dying and their caregivers express their needs by using open,
honest, direct, and empathetic communication. Nurses use ongoing assessment to meet the needs
of their clients. The statements by the nurse should center on the client and not the nurse.
Presence is an appropriate intervention; the nurse should not assume that they desire to be alone.
5. An older adult client on a palliative care unit divulges to his nurse that he fears being in pain
during the dying process. How can the nurse best respond to the client's admission?
A) "It sounds like you're understandably anxious about this. How can I help you to relax?"
B) "A lot of clients do have pain at the end, and we will do all we can to control it for you."
C) "We will do all we can to address it, and you'll be able to have a peaceful passing."
D) "Pain during the dying process actually is not nearly as common as many people believe."
Ans: B
Feedback:
Acknowledging that a lot of clients do have pain at the end and that staff will do all they can to
control it both acknowledges the client's specific concern and provides a realistic response that
the pain will be treated as effectively as possible, but does not guarantee a pain-free dying
process. Acknowledging the anxiety and offering relaxation assistance do not address the
specific concern about pain. Stating that the client will have a peaceful passing makes a promise
that is not possible to guarantee. Pain is a common accompaniment to the dying process.
1. A nurse on a geriatric medical care unit consults hospice for a client. Which of the following
nursing interventions should the nurse anticipate after the client begins hospice care?
A) Administering chemotherapy to a client with a diagnosis of pancreatic cancer
B) Assessing the deep tendon reflexes of a client with neurologic impairment
C) Infusing total parenteral nutrition to a client with dysphagia
D) Providing an opioid analgesic to a client with bone metastases
Ans: D
Feedback:
The focus of hospice care is on the relief of suffering rather than cure of disease. Relief of
suffering often encompasses providing pain relief to clients. Active curative treatments, such as
chemotherapy, and parenteral feeding often are forgone. Health assessments that do not assess
the client's comfort, such as the assessment of deep tendon reflexes, are not the priority of
palliative/hospice care.
2. A nurse cares for an 87-year-old client from India who has noted Hinduism as religious
preference on admission records. This client is transferred to the hospice unit. Which of the
following actions by the nurse best shows caring?
A) Ask the family to tell you about Hinduism.
B) Assess the client's spiritual needs.
C) Notify the family's pastor.
D) Pray with the client and family.
Ans: B
Feedback:
Spiritual assessment should take place on admission and throughout the client's time in palliative
care. Spiritual care is within the scope of nursing, and prayer would be appropriate if it were
chosen based on a sound assessment of the client's needs and belief system. Nurses should be
prepared to refer to whatever spiritual leader the client expresses a desire to speak with. Now is
not the time to query, it is the time to listen.
3. A nurse explores resources available to assist a client. Which of the following older adults
meets the eligibility requirements for hospice care?
A) A client who is immobilized and unable to afford specialized nursing care
B) A client who has experienced a stroke and been given 3 months to live
C) A client with cancer who is living with uncontrolled persistent pain
, D) A client with acquired immunodeficiency syndrome who lacks family support to provide
needed care
Ans: B
Feedback:
The eligibility requirements for hospice care include physician referral and a life expectancy of
less than 6 months. Financial need, high pain levels, and lack of family support are not explicit
qualifiers for hospice care.
4. A nurse cares for an older adult who is nonresponsive and surrounded by family. Which of the
following statements by the nurse is most appropriate?
A) "I am here for you, how can I be helpful?"
B) "I know just how you feel, my mother died last month."
C) "I'll leave you alone so that you can grieve in private."
D) "She was a really nice lady; she did a good job raising you."
Ans: A
Feedback:
Nurses can help people who are dying and their caregivers express their needs by using open,
honest, direct, and empathetic communication. Nurses use ongoing assessment to meet the needs
of their clients. The statements by the nurse should center on the client and not the nurse.
Presence is an appropriate intervention; the nurse should not assume that they desire to be alone.
5. An older adult client on a palliative care unit divulges to his nurse that he fears being in pain
during the dying process. How can the nurse best respond to the client's admission?
A) "It sounds like you're understandably anxious about this. How can I help you to relax?"
B) "A lot of clients do have pain at the end, and we will do all we can to control it for you."
C) "We will do all we can to address it, and you'll be able to have a peaceful passing."
D) "Pain during the dying process actually is not nearly as common as many people believe."
Ans: B
Feedback:
Acknowledging that a lot of clients do have pain at the end and that staff will do all they can to
control it both acknowledges the client's specific concern and provides a realistic response that
the pain will be treated as effectively as possible, but does not guarantee a pain-free dying
process. Acknowledging the anxiety and offering relaxation assistance do not address the
specific concern about pain. Stating that the client will have a peaceful passing makes a promise
that is not possible to guarantee. Pain is a common accompaniment to the dying process.
