PCT End-of-Life and Postmortem Care — Questions and Answers
Question 1: Which is the correct order of the Kübler-Ross stages of grief?
- Anger, denial, depression, bargaining, acceptance
- Denial, anger, bargaining, depression, acceptance (Correct answer)
- Denial, bargaining, anger, acceptance, depression
- Bargaining, denial, anger, depression, acceptance
Correct answer: Denial, anger, bargaining, depression, acceptance
Kübler-Ross described denial, anger, bargaining, depression and acceptance. Patients and families may not go through them in strict order and may return to earlier stages.
Question 2: What is Cheyne-Stokes respiration, a breathing pattern often seen as death approaches?
- Steady, deep, rapid breathing
- Cycles of increasingly deep breaths, then shallower ones, followed by periods of apnea (Correct answer)
- Loud wheezing on exhalation only
- A normal rate of 12 to 20 breaths per minute
Correct answer: Cycles of increasingly deep breaths, then shallower ones, followed by periods of apnea
Cheyne-Stokes respiration is a cycle of breaths that grow deeper and then shallower, followed by pauses with no breathing (apnea). It is a common sign that death is near and should be reported and documented.
Question 3: Which is a common sign that death is approaching?
- Warm, pink extremities
- Increased appetite and thirst
- Mottled, cool skin on the hands, feet and knees (Correct answer)
- Rising blood pressure and a strong pulse
Correct answer: Mottled, cool skin on the hands, feet and knees
As circulation slows, the extremities become cool and mottled (blotchy and purplish). Other signs include lower blood pressure, a weak pulse, less food and fluid intake, and changes in breathing.
Question 4: During postmortem care, why should the body be placed supine with the head raised slightly on a pillow?
- So the family can see the face more easily
- To keep blood from pooling in the face and discoloring it (Correct answer)
- To speed up rigor mortis
- Because it is required for the death certificate
Correct answer: To keep blood from pooling in the face and discoloring it
After death, blood settles in the lowest parts of the body (livor mortis). Raising the head slightly keeps blood from pooling in the face, so it does not discolor and the family can view the body in a more natural state.
Question 5: A patient has a valid Do Not Resuscitate (DNR) order. What does it mean?
- No care of any kind should be given
- CPR should not be started if the heart or breathing stops (Correct answer)
- The patient cannot receive pain medication
- Only family members may give care
Correct answer: CPR should not be started if the heart or breathing stops
A DNR order means no CPR if the patient's heart or breathing stops. The patient still gets all other appropriate care, including comfort measures, hygiene and pain management.
Question 6: Which sense is generally thought to be among the last to fade in a dying patient?
- Sight
- Taste
- Hearing (Correct answer)
- Smell
Correct answer: Hearing
Hearing is thought to be one of the last senses lost. Caregivers should keep talking to the patient calmly, explain care before giving it, and encourage family to speak to their loved one.
