Palliative & End-of-Life: 2026 Nursing Protocols
1. A nurse is conducting a staff educational seminar on the differences between palliative care and
hospice care. Which statement by a participant indicates a correct understanding of these healthcare
models?
A. "Palliative care is only initiated when the client has less than 24 hours to live."
B. "Hospice care allows concurrent curative treatments, whereas palliative care does not."
C. "Palliative care can be provided at any stage of a serious illness alongside curative treatments, whereas
hospice care is reserved for clients with a prognosis of 6 months or less who are no longer seeking cure."
D. "Hospice care is provided exclusively in inpatient hospital settings."
Correct Answer: C. Palliative care can be provided at any stage of a serious illness alongside curative
treatments, whereas hospice care is reserved for clients with a prognosis of 6 months or less who are no
longer seeking cure.
Rationale: Palliative care focuses on symptom relief and quality of life at any point during a serious, life-limiting
illness, and can be combined with curative therapies (e.g., chemotherapy, radiation, surgeries). Hospice care is a
specific subset of palliative care under the Medicare benefit, requiring two physicians to certify that the client has
a terminal prognosis of 6 months or less if the disease runs its normal course, and the client must agree to forego
curative treatments. Hospice is widely provided in homes, assisted living facilities, and dedicated hospice centers,
not just hospitals (D). Palliative care is not limited to active dying (A).
2. An older adult client with end-stage heart failure is evaluated for hospice eligibility under Medicare
guidelines. Which criterion is mandatory for the client to be admitted into a hospice program?
A. The client must have a primary caregiver who is a licensed nurse.
B. Two physicians must certify that the client has a life expectancy of 6 months or less if the disease runs its
natural course.
C. The client must agree to be admitted to an inpatient hospital hospice unit.
D. The client must have exhausted all financial resources and be eligible for Medicaid.
Correct Answer: B. Two physicians must certify that the client has a life expectancy of 6 months or less if
the disease runs its natural course.
Rationale: Under Medicare guidelines, hospice admission requires that the client's attending physician and the
hospice medical director (two physicians) certify a terminal illness with a prognosis of 6 months or less. The client
does not need to be low-income (D), have a licensed nurse caregiver (A), or stay in a hospital (C).
3. A gerontological nurse is collaborating with the hospice interdisciplinary team (IDT) to update a
client's care plan. Which members constitute the core interdisciplinary team required by federal
hospice regulations?
A. Physician, Registered Nurse, Social Worker, and Chaplain/Spiritual Counselor.
B. Surgeon, Physical Therapist, Pharmacist, and Dietitian.
, C. Nurse Manager, Respiratory Therapist, Occupational Therapist, and Volunteer Coordinator.
D. Cardiologist, Nephrologist, Oncologist, and Nurse Practitioner.
Correct Answer: A. Physician, Registered Nurse, Social Worker, and Chaplain/Spiritual Counselor.
Rationale: Federal regulations (CMS Conditions of Participation) dictate that the hospice core interdisciplinary
team must include a physician, registered nurse, social worker, and pastoral or other counselor (chaplain). This
core team is responsible for assessing and managing the physical, emotional, social, and spiritual needs of the
dying client and family. The other specialists (B, C, D) may collaborate but are not the legally mandated core IDT.
4. A client diagnosed with stage IV lung cancer is undergoing palliative chemotherapy. The client asks
the nurse, "Does starting palliative care mean I have to stop my chemotherapy?" What is the nurse's
best response?
A. "Yes, palliative care means we are stopping all active treatments and focus only on comfort."
B. "No, palliative care can be provided alongside your chemotherapy to help manage your symptoms and side
effects."
C. "You must choose between chemotherapy and palliative care, as insurance will not cover both."
D. "We will stop the chemotherapy only if your white blood cell count drops."
Correct Answer: B. "No, palliative care can be provided alongside your chemotherapy to help manage your
symptoms and side effects."
Rationale: Unlike hospice, palliative care is not prognostic-dependent and can be integrated into the client's care
plan alongside disease-modifying, curative, or life-prolonging therapies (such as palliative chemotherapy or
radiation) to manage symptoms (e.g., pain, nausea, neuropathy) and assist with goal-of-care decision-making.
Option A describes hospice, not palliative care. Options C and D are incorrect.
5. The nurse is discussing hospice goals of care with the family of a client who has advanced
Alzheimer's disease. Which statement by a family member indicates a correct understanding of the
focus of hospice care?
A. "Hospice will perform CPR if my mother's heart stops beating."
B. "The primary goal is to keep my mother comfortable and maximize her quality of life, rather than trying to
prolong her life or cure her disease."
C. "We will use feeding tubes and ventilators to keep her alive as long as possible."
D. "Hospice will help cure her dementia through specialized exercises."
Correct Answer: B. "The primary goal is to keep my mother comfortable and maximize her quality of life,
rather than trying to prolong her life or cure her disease."
Rationale: Hospice care is comfort-oriented (palliation) rather than curative. It seeks to manage symptoms and
support the dying client and family, accepting death as a natural end. It does not seek to hasten or artificially
postpone death through invasive life-support measures like ventilators or feeding tubes (C), perform CPR (A,
hospice usually requires a DNR), or attempt curative interventions (D).
,6. A pediatric nurse is reviewing the guidelines for pediatric palliative and hospice care. How does
pediatric hospice care differ significantly from adult hospice care regarding concurrent curative
therapy?
A. Curative treatments are completely forbidden in pediatric hospice.
B. Under the Affordable Care Act, children enrolled in hospice can continue to receive concurrent curative
treatments for their terminal condition.
C. Children must be hospitalized continuously to receive hospice care.
D. Only oral medications are allowed in pediatric hospice.
Correct Answer: B. Under the Affordable Care Act, children enrolled in hospice can continue to receive
concurrent curative treatments for their terminal condition.
Rationale: The Patient Protection and Affordable Care Act (Section 2302) established the "Concurrent Care for
Children" requirement. This allows children who are eligible for Medicaid or CHIP to receive hospice care
concurrently with curative services for their terminal illness, eliminating the adult requirement of waiving curative
treatments. This supports families in seeking comfort care without having to give up hope for a cure or treatment
response. Curative treatments are not forbidden (A), continuous hospitalization is not required (C), and medication
routes are not restricted to oral (D).
7. A hospice nurse is explaining the bereavement program to the spouse of a client who recently passed
away. According to standard hospice protocols, how long must bereavement services be made available
to the family after the client's death?
A. 1 month
B. 3 months
C. 6 months
D. At least 12 months (1 year)
Correct Answer: D. At least 12 months (1 year)
Rationale: Federal Medicare guidelines require hospice programs to provide bereavement counseling and support
to surviving family members for at least 12 months (one year) following the client's death. This helps families
navigate the stages of grief and monitors for complicated grief reactions. Shorter intervals (A, B, C) do not meet
regulatory standards.
8. The oncology nurse is preparing to discuss a poor prognosis with a client. The nurse utilizes the
SPIKES protocol to structure the conversation. What do the letters in the "SPIKES" acronym
represent?
A. Sympathy, Pain, Isolation, Kinship, Empathy, Support
B. Setup/Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary
C. Shock, Panic, Intubation, Ketamine, Sedation, Solace
D. Situation, Prognosis, Intervention, Knowledge, Education, Safety
, Correct Answer: B. Setup/Setting, Perception, Invitation, Knowledge, Emotions/Empathy,
Strategy/Summary
Rationale: SPIKES is a validated six-step protocol for delivering bad news: 1) **S**etting up the interview
(privacy, seating), 2) Assessing the patient's **P**erception (what they know), 3) Obtaining the patient's
**I**nvitation (how much detail they want), 4) Giving **K**nowledge and information (clear language, small
chunks), 5) Addressing the patient's **E**motions with empathy, and 6) **S**trategy and Summary (outlining
next steps). The other options contain random clinical words that do not match this protocol.
9. An older adult client with metastatic colon cancer asks the hospice nurse, "How long do I have left
to live?" Which response by the nurse is the most therapeutic and clinically appropriate?
A. "You have exactly 34 days left; you should start packing."
B. "No one can know for sure. Let's not focus on death; let's talk about the weather."
C. "While it is impossible to predict an exact day, based on how your body is changing, it may be a matter of
weeks. What are you hoping for or worrying about most right now?"
D. "You still have many years left; don't lose hope."
Correct Answer: C. "While it is impossible to predict an exact day, based on how your body is changing, it
may be a matter of weeks. What are you hoping for or worrying about most right now?"
Rationale: Answering prognostic questions requires honesty, compassion, and avoiding false reassurance.
Providing a realistic frame (e.g., weeks, days, hours) based on physiological indicators, followed by an open-
ended inquiry into the client's hopes and fears, invites therapeutic expression. Giving a precise number (A) is
inaccurate and unprofessional. Deflecting (B) or giving false hope (D) blocks communication and invalidates the
client's reality.
10. The nurse is discussing palliative care with the daughter of a client who has advanced Parkinson's
disease. The daughter states, "I don't want palliative care because it means we are giving up hope."
What is the nurse's best response to reframe the concept of hope?
A. "Palliative care does mean giving up on chemotherapy, but we can hope for a good funeral."
B. "Palliative care does not mean giving up hope. It shifts the focus of hope from curing the disease to hoping
for comfort, peace, quality time with family, and control over symptoms."
C. "You must accept reality; there is no hope left for your father."
D. "We can hope that a miracle cure will be discovered next week."
Correct Answer: B. "Palliative care does not mean giving up hope. It shifts the focus of hope from curing
the disease to hoping for comfort, peace, quality time with family, and control over symptoms."
Rationale: Reframing hope is a critical communication skill in palliative care. Rather than extinguishing hope, the
nurse helps the family redefine it. Hope changes from "cure" to "comfort, pain-free days, achieving personal
goals, and peaceful closure." Option A and C are insensitive and dismissive. Option D offers false reassurance.
1. A nurse is conducting a staff educational seminar on the differences between palliative care and
hospice care. Which statement by a participant indicates a correct understanding of these healthcare
models?
A. "Palliative care is only initiated when the client has less than 24 hours to live."
B. "Hospice care allows concurrent curative treatments, whereas palliative care does not."
C. "Palliative care can be provided at any stage of a serious illness alongside curative treatments, whereas
hospice care is reserved for clients with a prognosis of 6 months or less who are no longer seeking cure."
D. "Hospice care is provided exclusively in inpatient hospital settings."
Correct Answer: C. Palliative care can be provided at any stage of a serious illness alongside curative
treatments, whereas hospice care is reserved for clients with a prognosis of 6 months or less who are no
longer seeking cure.
Rationale: Palliative care focuses on symptom relief and quality of life at any point during a serious, life-limiting
illness, and can be combined with curative therapies (e.g., chemotherapy, radiation, surgeries). Hospice care is a
specific subset of palliative care under the Medicare benefit, requiring two physicians to certify that the client has
a terminal prognosis of 6 months or less if the disease runs its normal course, and the client must agree to forego
curative treatments. Hospice is widely provided in homes, assisted living facilities, and dedicated hospice centers,
not just hospitals (D). Palliative care is not limited to active dying (A).
2. An older adult client with end-stage heart failure is evaluated for hospice eligibility under Medicare
guidelines. Which criterion is mandatory for the client to be admitted into a hospice program?
A. The client must have a primary caregiver who is a licensed nurse.
B. Two physicians must certify that the client has a life expectancy of 6 months or less if the disease runs its
natural course.
C. The client must agree to be admitted to an inpatient hospital hospice unit.
D. The client must have exhausted all financial resources and be eligible for Medicaid.
Correct Answer: B. Two physicians must certify that the client has a life expectancy of 6 months or less if
the disease runs its natural course.
Rationale: Under Medicare guidelines, hospice admission requires that the client's attending physician and the
hospice medical director (two physicians) certify a terminal illness with a prognosis of 6 months or less. The client
does not need to be low-income (D), have a licensed nurse caregiver (A), or stay in a hospital (C).
3. A gerontological nurse is collaborating with the hospice interdisciplinary team (IDT) to update a
client's care plan. Which members constitute the core interdisciplinary team required by federal
hospice regulations?
A. Physician, Registered Nurse, Social Worker, and Chaplain/Spiritual Counselor.
B. Surgeon, Physical Therapist, Pharmacist, and Dietitian.
, C. Nurse Manager, Respiratory Therapist, Occupational Therapist, and Volunteer Coordinator.
D. Cardiologist, Nephrologist, Oncologist, and Nurse Practitioner.
Correct Answer: A. Physician, Registered Nurse, Social Worker, and Chaplain/Spiritual Counselor.
Rationale: Federal regulations (CMS Conditions of Participation) dictate that the hospice core interdisciplinary
team must include a physician, registered nurse, social worker, and pastoral or other counselor (chaplain). This
core team is responsible for assessing and managing the physical, emotional, social, and spiritual needs of the
dying client and family. The other specialists (B, C, D) may collaborate but are not the legally mandated core IDT.
4. A client diagnosed with stage IV lung cancer is undergoing palliative chemotherapy. The client asks
the nurse, "Does starting palliative care mean I have to stop my chemotherapy?" What is the nurse's
best response?
A. "Yes, palliative care means we are stopping all active treatments and focus only on comfort."
B. "No, palliative care can be provided alongside your chemotherapy to help manage your symptoms and side
effects."
C. "You must choose between chemotherapy and palliative care, as insurance will not cover both."
D. "We will stop the chemotherapy only if your white blood cell count drops."
Correct Answer: B. "No, palliative care can be provided alongside your chemotherapy to help manage your
symptoms and side effects."
Rationale: Unlike hospice, palliative care is not prognostic-dependent and can be integrated into the client's care
plan alongside disease-modifying, curative, or life-prolonging therapies (such as palliative chemotherapy or
radiation) to manage symptoms (e.g., pain, nausea, neuropathy) and assist with goal-of-care decision-making.
Option A describes hospice, not palliative care. Options C and D are incorrect.
5. The nurse is discussing hospice goals of care with the family of a client who has advanced
Alzheimer's disease. Which statement by a family member indicates a correct understanding of the
focus of hospice care?
A. "Hospice will perform CPR if my mother's heart stops beating."
B. "The primary goal is to keep my mother comfortable and maximize her quality of life, rather than trying to
prolong her life or cure her disease."
C. "We will use feeding tubes and ventilators to keep her alive as long as possible."
D. "Hospice will help cure her dementia through specialized exercises."
Correct Answer: B. "The primary goal is to keep my mother comfortable and maximize her quality of life,
rather than trying to prolong her life or cure her disease."
Rationale: Hospice care is comfort-oriented (palliation) rather than curative. It seeks to manage symptoms and
support the dying client and family, accepting death as a natural end. It does not seek to hasten or artificially
postpone death through invasive life-support measures like ventilators or feeding tubes (C), perform CPR (A,
hospice usually requires a DNR), or attempt curative interventions (D).
,6. A pediatric nurse is reviewing the guidelines for pediatric palliative and hospice care. How does
pediatric hospice care differ significantly from adult hospice care regarding concurrent curative
therapy?
A. Curative treatments are completely forbidden in pediatric hospice.
B. Under the Affordable Care Act, children enrolled in hospice can continue to receive concurrent curative
treatments for their terminal condition.
C. Children must be hospitalized continuously to receive hospice care.
D. Only oral medications are allowed in pediatric hospice.
Correct Answer: B. Under the Affordable Care Act, children enrolled in hospice can continue to receive
concurrent curative treatments for their terminal condition.
Rationale: The Patient Protection and Affordable Care Act (Section 2302) established the "Concurrent Care for
Children" requirement. This allows children who are eligible for Medicaid or CHIP to receive hospice care
concurrently with curative services for their terminal illness, eliminating the adult requirement of waiving curative
treatments. This supports families in seeking comfort care without having to give up hope for a cure or treatment
response. Curative treatments are not forbidden (A), continuous hospitalization is not required (C), and medication
routes are not restricted to oral (D).
7. A hospice nurse is explaining the bereavement program to the spouse of a client who recently passed
away. According to standard hospice protocols, how long must bereavement services be made available
to the family after the client's death?
A. 1 month
B. 3 months
C. 6 months
D. At least 12 months (1 year)
Correct Answer: D. At least 12 months (1 year)
Rationale: Federal Medicare guidelines require hospice programs to provide bereavement counseling and support
to surviving family members for at least 12 months (one year) following the client's death. This helps families
navigate the stages of grief and monitors for complicated grief reactions. Shorter intervals (A, B, C) do not meet
regulatory standards.
8. The oncology nurse is preparing to discuss a poor prognosis with a client. The nurse utilizes the
SPIKES protocol to structure the conversation. What do the letters in the "SPIKES" acronym
represent?
A. Sympathy, Pain, Isolation, Kinship, Empathy, Support
B. Setup/Setting, Perception, Invitation, Knowledge, Emotions/Empathy, Strategy/Summary
C. Shock, Panic, Intubation, Ketamine, Sedation, Solace
D. Situation, Prognosis, Intervention, Knowledge, Education, Safety
, Correct Answer: B. Setup/Setting, Perception, Invitation, Knowledge, Emotions/Empathy,
Strategy/Summary
Rationale: SPIKES is a validated six-step protocol for delivering bad news: 1) **S**etting up the interview
(privacy, seating), 2) Assessing the patient's **P**erception (what they know), 3) Obtaining the patient's
**I**nvitation (how much detail they want), 4) Giving **K**nowledge and information (clear language, small
chunks), 5) Addressing the patient's **E**motions with empathy, and 6) **S**trategy and Summary (outlining
next steps). The other options contain random clinical words that do not match this protocol.
9. An older adult client with metastatic colon cancer asks the hospice nurse, "How long do I have left
to live?" Which response by the nurse is the most therapeutic and clinically appropriate?
A. "You have exactly 34 days left; you should start packing."
B. "No one can know for sure. Let's not focus on death; let's talk about the weather."
C. "While it is impossible to predict an exact day, based on how your body is changing, it may be a matter of
weeks. What are you hoping for or worrying about most right now?"
D. "You still have many years left; don't lose hope."
Correct Answer: C. "While it is impossible to predict an exact day, based on how your body is changing, it
may be a matter of weeks. What are you hoping for or worrying about most right now?"
Rationale: Answering prognostic questions requires honesty, compassion, and avoiding false reassurance.
Providing a realistic frame (e.g., weeks, days, hours) based on physiological indicators, followed by an open-
ended inquiry into the client's hopes and fears, invites therapeutic expression. Giving a precise number (A) is
inaccurate and unprofessional. Deflecting (B) or giving false hope (D) blocks communication and invalidates the
client's reality.
10. The nurse is discussing palliative care with the daughter of a client who has advanced Parkinson's
disease. The daughter states, "I don't want palliative care because it means we are giving up hope."
What is the nurse's best response to reframe the concept of hope?
A. "Palliative care does mean giving up on chemotherapy, but we can hope for a good funeral."
B. "Palliative care does not mean giving up hope. It shifts the focus of hope from curing the disease to hoping
for comfort, peace, quality time with family, and control over symptoms."
C. "You must accept reality; there is no hope left for your father."
D. "We can hope that a miracle cure will be discovered next week."
Correct Answer: B. "Palliative care does not mean giving up hope. It shifts the focus of hope from curing
the disease to hoping for comfort, peace, quality time with family, and control over symptoms."
Rationale: Reframing hope is a critical communication skill in palliative care. Rather than extinguishing hope, the
nurse helps the family redefine it. Hope changes from "cure" to "comfort, pain-free days, achieving personal
goals, and peaceful closure." Option A and C are insensitive and dismissive. Option D offers false reassurance.
