CHPN Care at the Time of Death 2

Question 1

The most appropriate nursing intervention for a hospice patient experiencing the death rattle is to:

Accepted Answer

Reposition the patient to facilitate postural drainage and administer anticholinergic medication as ordered

Answer

Perform vigorous oral suctioning to clear secretions

Answer

Increase IV fluid rate to thin secretions

Answer

Place the patient in a supine position with the head flat

Question 2

When a patient is actively dying and can no longer swallow oral medications, the preferred alternative route of administration in hospice care is:

Accepted Answer

Subcutaneous or sublingual administration

Answer

Intravenous (IV) bolus injection

Answer

Rectal suppositories only

Answer

Intramuscular injection in the deltoid

Question 3

A family member of an actively dying patient asks: 'Can my mother still hear us?' The best hospice nurse response is:

Accepted Answer

'We don't know for certain, but hearing is believed to be one of the last senses to fade—continue speaking to her.'

Answer

'No, hearing is the first sense to be lost as death approaches.'

Answer

'She may only respond to her name; avoid other conversation to prevent overstimulation.'

Answer

'She cannot hear you, but touching her may provide comfort.'

Question 4

Mouth care for an actively dying patient who can no longer swallow should be performed:

Accepted Answer

Every 15 to 30 minutes with moistened swabs to maintain comfort

Answer

Only once daily to minimize disruption

Answer

Only when the patient requests it

Answer

With toothbrush and toothpaste as per standard oral hygiene

Question 5

A hospice nurse is repositioning an actively dying patient. Which principle should guide repositioning decisions?

Accepted Answer

Limit repositioning to what the patient tolerates comfortably; pressure injury prevention is secondary to comfort

Answer

Reposition every 2 hours strictly to prevent pressure injuries

Answer

Turn to both sides alternately regardless of patient response

Answer

Avoid all repositioning to prevent pain

Question 6

Which medication is most commonly used to manage terminal secretions (death rattle) in hospice patients?

Accepted Answer

Glycopyrrolate

Answer

Lorazepam

Answer

Haloperidol

Answer

Methadone

Question 7

A hospice nurse notices a dying patient is showing signs of terminal agitation (restlessness, moaning, picking at bedclothes). The first-line pharmacological intervention is typically:

Accepted Answer

Lorazepam or midazolam (benzodiazepine)

Answer

High-dose morphine

Answer

Haloperidol alone in all cases

Answer

Diphenhydramine