End-Of-Life Care, Family Support
Help Questions
NCLEX-PN › End-Of-Life Care, Family Support
A 60-year-old client with metastatic breast cancer is in an inpatient hospice unit and is increasingly drowsy, taking only sips of fluid, and grimaces when repositioned. The client’s partner asks the nurse to “make her eat” and worries that decreased intake means the nurse is “giving up.” Which statement by the family indicates a need for further teaching about end-of-life care?
“If she isn’t hungry, we can offer small sips and keep her mouth moist to help her feel comfortable.”
“She needs to finish full meals so her body can fight; can you start a feeding tube today?”
“We want to keep her comfortable and let her rest, even if she sleeps most of the day.”
“We can focus on what she enjoys, like soft music and gentle touch, if she seems relaxed.”
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. The priority psychosocial concerns include addressing misconceptions about decreased oral intake at end-of-life and supporting the partner's emotional needs. The statement about needing full meals and requesting a feeding tube (B) indicates a need for further teaching because it reflects misunderstanding that forced nutrition improves outcomes or comfort at end-of-life. The other statements appropriately acknowledge decreased appetite as normal (A), prioritize comfort over alertness (C), and focus on sensory comfort measures (D), all of which demonstrate proper understanding of end-of-life care principles. Key principles include recognizing that decreased intake is a natural part of dying, forced nutrition can increase discomfort, and comfort measures should focus on what brings peace to the client. When families struggle with decreased oral intake, nurses should provide education about the dying process while offering alternative comfort measures like mouth care and presence.
A 62-year-old client with advanced ovarian cancer is in inpatient hospice. The client is tearful and says, "I’m afraid of being alone when I die," while the family appears uncomfortable and changes the subject. Which action best supports the family's needs during end-of-life care?
Redirect the client to focus on positive memories to avoid upsetting the family
Tell the client that fear is normal and the family will get over it with time
Ask the provider to order sedatives so the client will sleep and not worry
Offer to facilitate a supportive conversation, encouraging the family to share feelings and discuss ways to ensure someone is present
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include client fears of isolation, family discomfort with discussions, and emotional avoidance. Offering to facilitate a supportive conversation best supports needs by encouraging expression and planning. Option A minimizes feelings; C redirects unhelpfully; and D over-medicalizes. Key principles of end-of-life care promote open dialogue on fears. Cultural sensitivity addresses communication styles. A transferable strategy is to mediate family discussions on sensitive topics in end-of-life scenarios.
A 63-year-old client with advanced lung cancer is receiving hospice care. The client reports severe fatigue and says, "I don’t want visitors today," but the family insists that "everyone needs to say goodbye" and appears frustrated. Which action best supports the family's needs during end-of-life care?
Recommend hospital transfer so staff can manage visitors and enforce visiting hours
Support the client’s preference for rest and help the family plan brief visits at times the client chooses
Cancel all visits permanently to prevent family conflict
Tell the client that family needs come first and encourage visitors to stay as long as needed
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include client fatigue, family frustration, and respecting boundaries. Supporting rest preferences and planning brief visits best supports needs by prioritizing client wishes. Option B disregards client; C isolates; and D shifts setting unnecessarily. Key principles of end-of-life care honor client autonomy. Cultural sensitivity balances family expectations. A transferable strategy is to advocate for client preferences in visit planning during end-of-life scenarios.
A 69-year-old client with advanced liver cancer is in hospice. The family requests that many relatives visit at once as part of their tradition, but the client becomes visibly fatigued and grimaces with noise. Which action best supports the family's needs during end-of-life care?
Work with the family to schedule shorter, quieter visits in small groups to honor the tradition while protecting the client’s comfort
Ask security to remove visitors immediately to avoid conflict and maintain unit control
Tell the family that cultural practices are not permitted in hospice and restrict all visitors
Allow unlimited visitors at all times because cultural traditions must be followed without limits
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include cultural traditions, client fatigue, and balancing visits with comfort. Scheduling shorter, quieter visits best supports needs by respecting traditions while protecting energy. Option B risks exhaustion; C prohibits practices; and D escalates unnecessarily. Key principles of end-of-life care integrate culture with client needs. Cultural sensitivity requires flexible adaptations. A transferable strategy is to negotiate visit plans collaboratively in end-of-life scenarios.
A 77-year-old client with end-stage heart failure is in the hospital receiving comfort care. The client is short of breath and anxious; the family asks how they can help without making things worse. What should the nurse prioritize when providing care to a client in hospice-like comfort care in the hospital?
Encourage the family to request cardiopulmonary resuscitation so the team is prepared for any change
Explain that only the nurse should interact with the client to avoid overstimulation
Instruct the family to frequently wake the client to practice deep breathing to strengthen the lungs
Encourage the family to speak softly, stay present, and assist with positioning to ease breathing as tolerated
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include family desire to help, client anxiety, and breathlessness in comfort care. Encouraging soft speech, presence, and positioning assistance best supports needs by involving family safely without overstimulation. Option B excludes family; C may exhaust the client; and D promotes inappropriate interventions. Key principles of end-of-life care emphasize family inclusion in non-invasive comfort. Cultural sensitivity respects relational bonds. A transferable strategy is to guide families on low-stress involvement in end-of-life scenarios.
A 81-year-old client with end-stage heart failure is in the hospital on comfort care. The son says, "Give Dad oxygen at the highest level and do everything—he can’t die," while the client is restless and says, "Please, just let me be comfortable." Which action best supports the family's needs during end-of-life care?
Avoid discussing goals of care and redirect the son to billing and paperwork questions
Acknowledge the son’s distress, reinforce the client’s stated wishes, and offer a family meeting to discuss comfort measures
Tell the son that his feelings are unreasonable and ask him to leave so the client can rest
Focus the discussion on increasing diuretics and starting a new heart medication regimen to prolong life
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include family denial, client restlessness, and conflicting wishes about care intensity. Acknowledging distress, reinforcing client wishes, and offering a family meeting best supports needs by promoting understanding and focusing on comfort. Option A dismisses emotions; B ignores client preferences; and D avoids essential discussions. Key principles of end-of-life care include advocating for client autonomy and facilitating dialogue. Cultural sensitivity respects diverse grief expressions. A transferable strategy is to use family meetings to align on goals in end-of-life scenarios.
A 71-year-old client with metastatic cancer is in inpatient hospice. The family requests that the client’s body not be touched after death until a spiritual leader arrives; the client is actively dying and the family is anxious about staff actions. Which action best supports the family's needs during end-of-life care?
Document the request and communicate it to the team while explaining what comfort care will look like before and after death
Agree to the request but do not share it with others to avoid confusion
Tell the family to discuss rituals only after the client dies so the nurse can focus on medications
Explain that staff must follow standard postmortem care immediately and cannot adjust for family requests
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include postmortem rituals, family anxiety, and team coordination. Documenting and communicating the request while explaining care best supports needs by honoring wishes. Option B is inflexible; C delays; and D lacks collaboration. Key principles of end-of-life care respect spiritual practices. Cultural sensitivity integrates requests into protocols. A transferable strategy is to document and share cultural needs with teams in end-of-life scenarios.
A 74-year-old client with end-stage heart failure is in the hospital and has a do-not-resuscitate order. The family asks, "What will you do if his heart stops?" The client is drowsy but responsive and appears calm. The nurse should include which information when discussing palliative care options?
Assure the family that cardiopulmonary resuscitation will be performed if they request it, regardless of the order
Explain that comfort care focuses on relief of symptoms and that cardiopulmonary resuscitation will not be started, while the team will stay present and provide comfort
Tell the family that the nurse cannot discuss this and they must wait for the provider
State that a do-not-resuscitate order means the client will not receive any nursing care
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include fears about end-of-life interventions and understanding DNR implications. Explaining comfort focus and no CPR while assuring presence best supports needs by clarifying care. Option B misrepresents DNR; C defers inappropriately; and D contradicts orders. Key principles of end-of-life care include transparent discussions on orders. Cultural sensitivity addresses anxiety compassionately. A transferable strategy is to explain implications clearly when discussing options with families.
A 72-year-old client with advanced colon cancer is in an inpatient hospice unit. The family states they have specific end-of-life rituals that include quiet prayer at the bedside and washing the client's hands with scented water; the client is drowsy but calm and nods when asked if this is desired. What should the nurse prioritize when providing care to this client in hospice?
Encourage the family to focus on discussing funeral plans now to reduce stress later
Explain that scented products are not allowed and ask the family to stop the ritual to maintain unit routine
Request that the chaplain handle all family communication so nursing care can focus on medications
Coordinate care times to allow privacy for the rituals while ensuring the client’s comfort and safety
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include respecting cultural rituals, ensuring client comfort, and balancing family involvement with safety. Coordinating care to allow privacy for rituals while ensuring comfort best supports needs by honoring traditions and client preferences. Option A prohibits rituals unnecessarily; C shifts focus prematurely; and D delegates communication inappropriately. Key principles of end-of-life care include integrating cultural practices into care plans. Cultural sensitivity requires adapting routines to family beliefs without compromising care. A transferable strategy is to collaborate with families on culturally appropriate care plans in end-of-life scenarios.
A 79-year-old client with end-stage heart failure is hospitalized and has chosen comfort-focused care. The spouse asks, "If we stop aggressive treatments, are we giving up on him?" The client appears anxious, has shortness of breath at rest, and is fatigued. The nurse should include which information when discussing palliative care options?
Palliative care requires the family to make all decisions without input from the client to reduce stress
Palliative care focuses on comfort and quality of life and can include medicines to ease shortness of breath and anxiety
Palliative care is only provided during the last 24 hours of life and cannot be started in the hospital
Palliative care means the health care team will no longer monitor symptoms such as pain or breathing problems
Explanation
This question tests understanding of end-of-life care and family support within psychosocial integrity. Priority psychosocial concerns include fears of abandonment, anxiety about symptom management, and misconceptions about palliative care. Explaining that palliative care focuses on comfort and quality of life, including medicines for shortness of breath and anxiety, best supports needs by providing accurate information and addressing symptoms. Option B incorrectly limits palliative care timing; C suggests neglect of symptoms; and D excludes client input, undermining autonomy. Key principles of end-of-life care include honest education to alleviate fears. Cultural sensitivity ensures discussions respect family roles and beliefs. A transferable strategy is to use simple, reassuring explanations when discussing care options with families.