Caring for a Resident Near the End of Life: What the CNA Exam Expects

What the CNA exam expects about end-of-life care

The federal nurse aide curriculum lists "caring for residents when death is imminent" among basic nursing skills (42 CFR 483.152(b)(2)(v)), and the competency evaluation must address every subject in that curriculum (483.154(b)(1)(ii)). On the 2024 NNAAP written outline, end-of-life questions can fall under several areas, including Emotional and Mental Health Needs and Spiritual and Cultural Needs. One of the six sample questions in Credentia's handbooks is about caring for a dying resident.

The questions test the same values as the rest of the exam, applied to a hard moment: comfort, dignity, the resident's own wishes, and telling the nurse about changes. The clinical background in this guide comes from the National Cancer Institute's Last Days of Life (PDQ®), Patient Version (updated October 15, 2024), which describes common changes near death. It was written for people with cancer and their families, so treat it as background. Your training program, the resident's care plan, and the nurse decide what you do for a specific resident.

Comfort care within the nurse aide role

Most end-of-life care a nurse aide gives is ordinary personal care done with extra attention. The table separates what the aide does from what goes to the nurse.

Changes near death to report to the nurse

NCI lists physical changes that are common near death, while noting that not everyone has them. A resident may:

• feel tired or weak, sleep more, and respond slowly or not at all
• pass less urine, which may be dark
• have hands and feet that become blotchy, cold, or blue
• have a heart rate that speeds up, slows down, or becomes irregular
• breathe irregularly, with very shallow breaths, short pauses, or deep, rapid breathing

Your role is to notice and report these changes, not to interpret them. If a family member asks whether the resident is dying, or how long it will be, do not guess. Acknowledge the question kindly and get the nurse. Recognizing abnormal changes and reporting them to a supervisor is part of the nurse aide curriculum (483.152(b)(2)(iv)).

The resident's wishes: advance directives and refusals

Residents have the right to request, refuse, or discontinue treatment and to formulate an advance directive (42 CFR 483.10(c)(6)). Facilities must follow federal advance directive requirements and inform adult residents of their right to accept or refuse treatment (483.10(g)(12)). A resident may also choose hospice care.

For a nurse aide, that means:

• The resident's documented wishes and care plan guide care, even when a family member wants something else. If a family member asks you to change care, tell the nurse.
• If a resident becomes unresponsive or stops breathing normally, activate the emergency response immediately and provide basic life support within your training. Follow valid, applicable resuscitation orders; without an applicable order limiting CPR or recognized signs of irreversible death, do not delay required CPR while waiting for the nurse to arrive. Report the event and make the documented care plan available to the responding team.
• If a resident tells you something about his or her wishes, such as not wanting to go back to the hospital, pass it to the nurse.

Spiritual and cultural wishes, without assumptions

Spiritual and Cultural Needs is only 2% of the NNAAP written outline, but end-of-life care is where it matters most. Residents have the right to participate in religious activities (483.10(f)(8)) and to privacy during visits (483.10(h)(1)). NCI notes that cultural or religious customs may be important at the time of death and after it, and that the care team should know which ones matter to the person and family.

Ask the resident or family, or check the care plan, rather than assuming what someone's faith or background requires. Make room for visits from clergy or a spiritual leader, give privacy for prayer, and tell the nurse about any custom that affects care, such as how the body should be handled after death.

Families at the bedside

Families often stay close in the last days. Give them privacy, a chair, and room to be with the resident. NCI notes that most people can still hear after they can no longer speak, and that touch and talk from family may comfort them. Keep speaking to the resident yourself, too: say your name and explain what you are doing before you give care, even if the resident does not answer.

Questions about the resident's condition, medications, or what will happen next go to the nurse. The communication guide explains how privacy rules apply to families.

Original scenarios in CNA exam style

The people below are fictional.

The untouched tray. Mrs. Greene is receiving hospice care and has eaten almost nothing for two days. Her daughter asks you to "just get a few bites into her." You do not force food. You offer a small amount if the care plan allows, give mouth care, record her intake as your facility requires, and tell the nurse about both the intake and the daughter's worry.

Cold hands. Mr. Hale's hands feel cold and look mottled. You cover him with an extra blanket, not a heating pad, and tell the nurse about the change.

A prayer in a shared room. Mr. Silva's family wants to pray and sing at his bedside, and his roommate is resting. You close the curtain, ask the family what they need, and tell the nurse so the team can arrange a private space if one is available.

After a resident dies

Care after death, sometimes called postmortem care, follows your facility's policy and the nurse's direction, and the steps differ between facilities. The constants are dignity and the family's wishes. NCI notes that family members may want to stay with the person for a while, and that customs for handling the body can matter. Treat the person's body and belongings with the same respect you gave in life, and pass any family requests to the nurse.

The federal resident-rights rule covers privacy and choice in more depth, and the guide to the nurse aide's role explains what to do when a request falls outside your training.