CHPN Care at the Time of Death

Question 1

Which physiological change is most indicative that death is imminent within hours?

Accepted Answer

Mottling extending to the knees and thighs

Answer

Elevated blood pressure above baseline

Answer

Increased urine output

Answer

Hyperactive bowel sounds

Question 2

The 'death rattle' heard in actively dying patients is primarily caused by:

Accepted Answer

Accumulation of secretions in the oropharynx that the patient can no longer clear

Answer

Aspiration of food or liquid

Answer

Bronchospasm from terminal asthma

Answer

Pleural effusion compressing the lungs

Question 3

Cheyne-Stokes respirations, commonly seen in the final days of life, are characterized by:

Accepted Answer

Alternating periods of apnea and hyperpnea in a crescendo-decrescendo pattern

Answer

Rapid, shallow breaths at a consistent rate

Answer

Deep, slow respirations with prolonged exhalation

Answer

Labored breathing with audible stridor

Question 4

A hospice patient's extremities are cool and cyanotic, with mottling, and respirations are irregular. The family asks how long the patient has to live. The most accurate response is:

Accepted Answer

These signs suggest death may occur within hours to a few days

Answer

It is impossible to estimate timing of death in any patient

Answer

The patient likely has weeks remaining

Answer

The patient is not yet in the active dying phase

Question 5

Which of the following is considered a late sign of approaching death?

Accepted Answer

Mandibular breathing (jaw breathing)

Answer

Decreased appetite and oral intake

Answer

Withdrawal from social interaction

Answer

Increased sleep duration

Question 6

A dying patient's blood pressure is unobtainable, pulse is weak and irregular, and extremities are mottled to the hips. Which term best describes this patient's status?

Accepted Answer

Actively dying

Answer

Palliative care patient

Answer

Terminally ill but stable

Answer

Comfort care only

Question 7

Which change in urinary output is expected and normal in an actively dying hospice patient?

Accepted Answer

Oliguria or anuria as perfusion to the kidneys decreases

Answer

Polyuria due to loss of ADH secretion

Answer

Hematuria from coagulation failure

Answer

Normal urinary output maintained until the moment of death