AAC End-of-Life & Palliative Care 3 — Questions and Answers
Question 1: Which of the following is a hallmark sign of the active dying phase in a person with late-stage Alzheimer's?
- Increased appetite and fluid intake
- Mottled skin and Cheyne-Stokes breathing (Correct answer)
- Return of short-term memory
- Elevated blood pressure
Correct answer: Mottled skin and Cheyne-Stokes breathing
Mottled skin (livedo reticularis) and Cheyne-Stokes irregular breathing are classic signs that death is imminent, typically within hours to days.
Question 2: In the hospice philosophy, the primary goal of care for a person with end-stage Alzheimer's is to:
- Cure the underlying disease
- Maximize comfort and quality of life (Correct answer)
- Prolong life by all available means
- Reduce healthcare costs
Correct answer: Maximize comfort and quality of life
Hospice care focuses on comfort, dignity, and quality of life rather than curative or life-prolonging treatments.
Question 3: Which team member is primarily responsible for addressing spiritual distress during the dying process?
- The attending physician
- The hospice chaplain or spiritual care provider (Correct answer)
- The certified nursing assistant
- The social worker
Correct answer: The hospice chaplain or spiritual care provider
Chaplains and spiritual care providers are trained to address existential, religious, and spiritual distress for both patients and families during end of life.
Question 4: When a person with Alzheimer's begins refusing all food and fluids, the care team should FIRST:
- Insert a nasogastric tube immediately
- Assess for reversible causes such as dental pain or medication side effects (Correct answer)
- Document the refusal and take no further action
- Contact ethics committee for forced feeding approval
Correct answer: Assess for reversible causes such as dental pain or medication side effects
Before concluding refusal is a natural end-of-life process, caregivers should rule out treatable causes like mouth pain, dysphagia, depression, or uncomfortable positioning.
Question 5: Which of the following BEST describes 'comfort-focused care' in late-stage Alzheimer's?
- Aggressive treatment of all acute infections with IV antibiotics
- Care that prioritizes symptom relief and avoids burdensome interventions (Correct answer)
- Transfer to an ICU at the first sign of decline
- Routine blood draws and vital sign monitoring every four hours
Correct answer: Care that prioritizes symptom relief and avoids burdensome interventions
Comfort-focused care minimizes painful or burdensome procedures and maximizes symptom management, emotional support, and dignity.
Question 6: Bereavement support in the hospice model is typically provided to families for how long after the patient's death?
- One week
- One month
- At least 13 months (Correct answer)
- Until the family requests it to stop
Correct answer: At least 13 months
Medicare hospice regulations require hospices to offer bereavement services to surviving family members for at least 13 months following the patient's death.
Question 7: Which non-pharmacological intervention is MOST effective for reducing agitation in a person with Alzheimer's near the end of life?
- Stimulating cognitive exercises
- Soft music, gentle touch, and a calm environment (Correct answer)
- Frequent repositioning and bright lighting
- Engaging the person in group activities
Correct answer: Soft music, gentle touch, and a calm environment
Sensory comfort measures such as familiar music, gentle touch, and a quiet calm environment are evidence-based approaches to reducing agitation in advanced dementia.
AAC End-of-Life & Palliative Care 3
Which of the following is a hallmark sign of the active dying phase in a person with late-stage Alzheimer's?