CNA End-of-Life Care and Postmortem Care — Questions and Answers
Question 1: Which of the following is a common physical sign that death may be approaching within hours?
- Increased appetite and thirst
- Mottling (bluish-purple blotching) of the skin, especially the knees and feet (Correct answer)
- Elevated blood pressure and rapid pulse
- Increased muscle strength and activity
Correct answer: Mottling (bluish-purple blotching) of the skin, especially the knees and feet
Mottling of the extremities is caused by slowing circulation as the body's systems begin to shut down. It is a recognized sign of imminent death along with cooling of the extremities, Cheyne-Stokes breathing, and decreased responsiveness.
Question 2: A resident has a Do Not Resuscitate (DNR) order in their chart. The resident stops breathing. The nurse aide should:
- Immediately begin CPR while another aide calls the nurse
- Call 911 before notifying facility staff
- Notify the charge nurse immediately and stay with the resident (Correct answer)
- Wait to see if the resident resumes breathing on their own before calling anyone
Correct answer: Notify the charge nurse immediately and stay with the resident
A DNR order means cardiopulmonary resuscitation should not be initiated. The nurse aide's role is to notify the charge nurse immediately and remain with the resident. Initiating CPR would violate the resident's advance directive and legal order.
Question 3: When providing postmortem care, the nurse aide should:
- Begin care immediately after death is pronounced, before the family arrives, without waiting for direction
- Follow facility policy and the charge nurse's instructions, treating the body with dignity and respect (Correct answer)
- Remove all personal items and store them without documenting their location
- Avoid touching or moving the body until the funeral home arrives
Correct answer: Follow facility policy and the charge nurse's instructions, treating the body with dignity and respect
Postmortem care — cleaning and positioning the body, placing dentures, removing tubes per policy, and shrouding — must be performed according to facility protocols and nurse direction. The body must always be treated with dignity, and family and cultural wishes should be honored.
Question 4: A resident receiving hospice care is in pain and asks the nurse aide to 'make the pain stop.' The most appropriate action is to:
- Administer an extra dose of the resident's pain medication
- Tell the resident that nothing more can be done
- Notify the nurse immediately so pain management interventions can be implemented (Correct answer)
- Reposition the resident and hope the pain subsides on its own
Correct answer: Notify the nurse immediately so pain management interventions can be implemented
Pain management is a central goal of hospice and end-of-life care. The nurse aide cannot administer medication but must report pain immediately to the nurse, who can assess and act. Comfort and pain relief are priorities in palliative care.
Question 5: A resident's family member becomes very upset and tearful at the bedside of a dying resident. The nurse aide should:
- Ask the family member to leave the room until they can compose themselves
- Offer a quiet, caring presence, provide tissues, and ask if there is anything they need (Correct answer)
- Tell the family member that their loved one is not in pain and will be fine
- Leave the room to give the family complete privacy and do not return
Correct answer: Offer a quiet, caring presence, provide tissues, and ask if there is anything they need
The nurse aide's role in end-of-life situations includes emotional support for both the resident and family. Offering a compassionate presence, listening without judgment, and asking about needs are appropriate. Making false reassurances ('they will be fine') is never appropriate.
Question 6: After a resident's death is pronounced, the nurse aide notices the resident's family has placed religious items around the body. The aide should:
- Remove the items according to standard postmortem protocol
- Respect the items and inform the charge nurse so care can be coordinated with the family's wishes (Correct answer)
- Document the items as biohazardous materials
- Tell the family that personal items cannot remain in the room
Correct answer: Respect the items and inform the charge nurse so care can be coordinated with the family's wishes
Cultural and religious rituals surrounding death must be respected. The nurse aide should not remove items without direction, but should communicate with the charge nurse to ensure postmortem care is coordinated sensitively around the family's practices.
CNA End-of-Life Care and Postmortem Care
Which of the following is a common physical sign that death may be approaching within hours?