CDP End-of-Life Care Planning 3 — Questions and Answers
Question 1: A POLST form differs from a standard advance directive primarily because it:
- Applies only to patients aged 65 and older
- Is a physician-signed medical order immediately actionable across care settings (Correct answer)
- Must be updated annually to remain valid
- Is only valid within hospital settings
Correct answer: Is a physician-signed medical order immediately actionable across care settings
A POLST (Physician Orders for Life-Sustaining Treatment) is a portable medical order signed by a clinician that is immediately actionable by emergency responders and providers across all care settings.
Question 2: When a person with moderate dementia expresses fear about dying alone, the most therapeutically appropriate response from the dementia practitioner is to:
- Redirect conversation to a pleasant activity to reduce distress
- Acknowledge the fear, provide reassurance of presence, and document the conversation for care planning (Correct answer)
- Administer an anxiolytic and notify the physician
- Explain that dementia will limit awareness at end of life
Correct answer: Acknowledge the fear, provide reassurance of presence, and document the conversation for care planning
Validating emotional expression, offering reassurance, and documenting the disclosure supports both therapeutic relationship and person-centered end-of-life planning.
Question 3: Which of the following is a hallmark sign of the active dying phase in a person with advanced dementia?
- Increased appetite and fluid intake
- Mottled skin, Cheyne-Stokes breathing, and peripheral cooling (Correct answer)
- Heightened social responsiveness
- Bradypnea with normal oxygen saturation
Correct answer: Mottled skin, Cheyne-Stokes breathing, and peripheral cooling
Mottled skin (livedo reticularis), Cheyne-Stokes (irregular) breathing, and cooling of the extremities are classic physical signs indicating the body is actively shutting down.
Question 4: In the context of dementia end-of-life care, 'terminal secretions' (death rattle) are best managed by:
- Suctioning the oropharynx every 30 minutes
- Repositioning to the lateral position and family education (Correct answer)
- Increasing IV fluid rate to thin secretions
- Administering nebulized saline every 2 hours
Correct answer: Repositioning to the lateral position and family education
Repositioning to a side-lying position uses gravity to reduce pooling of secretions, and family education about the benign nature of the sound prevents unnecessary distress.
Question 5: A surrogate decision-maker is applying the 'substituted judgment' standard. This means they are asking:
- What is medically best for this patient given current evidence?
- What decision would this person have made based on their known values and wishes? (Correct answer)
- What do most people in similar situations choose?
- What intervention will cause the least financial burden to the family?
Correct answer: What decision would this person have made based on their known values and wishes?
Substituted judgment requires the surrogate to set aside their own preferences and decide as the patient would have decided, based on prior expressed values, beliefs, and wishes.
Question 6: Which cultural consideration is MOST important when planning end-of-life care for a person with dementia from a collectivist cultural background?
- Insisting on one-on-one family meetings to respect privacy
- Recognizing that family group consensus may be the preferred decision-making model (Correct answer)
- Discouraging family involvement to preserve patient autonomy
- Requiring written consent from each family member separately
Correct answer: Recognizing that family group consensus may be the preferred decision-making model
Many collectivist cultures prioritize group family decision-making over individual autonomy; culturally competent care acknowledges and accommodates this approach.
Question 7: A hospice nurse asks the CDP to help explain anticipatory grief to a family. The BEST description is:
- Grief experienced only after the person has died
- Grief and mourning that occurs before and in anticipation of an expected death (Correct answer)
- A pathological response requiring psychiatric referral
- The brief sadness felt when visiting a person with dementia
Correct answer: Grief and mourning that occurs before and in anticipation of an expected death
Anticipatory grief is a normal, healthy process in which family members begin mourning losses—cognitive, functional, and relational—before the person with dementia dies.
CDP End-of-Life Care Planning 3
A POLST form differs from a standard advance directive primarily because it: