A client on the hospice unit with terminal cancer is actively dying, and the family is sad and crying. The client's sister says, "She's starving You haven't fed her since yesterday. Can I give her water or a nutritional milkshake?" How should the nurse respond? Select all that apply.

End-of-life care in hospice focuses on comfort rather than curative treatment, especially when a client is actively dying from terminal illness such as advanced cancer. Physiological changes in the dying process often include decreased appetite, reduced thirst sensation, and impaired swallowing reflex. Families may misinterpret reduced intake as starvation, requiring therapeutic communication and education. The nurse’s role is to provide reassurance while explaining normal end-of-life changes in a compassionate and factual manner. Rationale: A. Stating that it is unsafe to feed because the client cannot swallow is a factual and necessary safety statement. In the final stages of life, the risk of aspiration is extremely high. Aspiration can cause choking, respiratory distress, and pneumonia, which would cause significant suffering and detract from a peaceful death. The nurse must clearly communicate this physical limitation to protect the client from harm. B. At this stage, the body’s metabolic demands decrease significantly, and the sensation of hunger and thirst is typically diminished or absent. In terminally ill patients, the hypothalamic drive for appetite is reduced due to systemic organ failure and decreased consciousness. Providing this explanation helps normalize the dying process and reassures family members that lack of intake is not causing suffering. C. Offering to attempt feeding while warning of choking risk is unsafe and may increase family distress. In actively dying patients, impaired swallowing reflexes and decreased airway protection significantly increase aspiration risk. Attempting oral intake in this stage may lead to respiratory complications such as aspiration pneumonia, which contradicts comfort-focused hospice care goals. D. Suggesting that the family can feed the client shifts responsibility inappropriately and may encourage unsafe care practices. It undermines the nurse’s role in ensuring patient safety and may expose the client to aspiration or distress. Hospice care prioritizes comfort measures guided by clinical judgment rather than non-professional interventions initiated by family members. E. This statement is confrontational and may invalidate the family’s emotional distress. It can be perceived as dismissive or judgmental, which may damage therapeutic rapport during a highly sensitive end-of-life situation. Effective hospice communication should be supportive, empathetic, and focused on education rather than challenging beliefs.