Module 16

Question 1

What are the five stages of grief?

Answer 1

denial, anger, bargaining, depression, and acceptance

Question 2

Which stage of grief is associated with feelings of shock, disbelief, or numbness?

Answer 2

Denial

Question 3

Which stage of grief is associated with feelings of sadness, emptiness, and/or loneliness?

Answer 3

Depression

Question 4

Which stage of grief is associated with questioning why this has happened and believing it is unfair?

Answer 4

anger

Question 5

Which stage of grief is associated with an individual learning to live with the loss and realizing that this is their “new normal”?

Answer 5

Acceptance

Question 6

Which stage of grief is associated with feelings of guilt and a series of “what if” and “if only” thoughts?

Answer 6

Bargaining

Question 7

If a resident who is terminally ill is feeling distressed, they may benefit from speaking with a _____ _____ or a _____ _____ professional.

Answer 7

social worker; mental health

Question 8

True or False: If the patient’s/resident’s family is struggling emotionally, you must be supportive, but it is not necessary to report this to the nurse, as they are not the actual patients.

Answer 8

False, if the family is struggling, you must ALSO report this to the nurse.

Question 9

What is the difference between Palliative Care and Hospice Care?

Answer 9

Palliative Care involves symptom management for serious life-threatening illnesses and can include curative treatments.

Hospice Care does not include curative care, it only involves symptom management to improve quality of life for terminal patients who are expected to die within the next six months.

Question 10

While providing Hospice Care, the care team may recommend that the patient/resident work with the _____ or receive _____ therapy in order to increase quality of life.

Answer 10

chaplain (for spiritual care); recreational

Question 11

True or False: Hospice Services are offered to the whole family, they are seen as a unit.

Answer 11

True

Question 12

Hospice Serices are offered to the family up to _____ months after the passing of the loved one to help with the grieving process.

Answer 12

13 months

Question 13

In which type of settings is Hospice Care offered?

Answer 13

resident/patient home, hospital, or any other care facility including long-term care facilities.

Question 14

What is an advance directive?

Answer 14

also known as a living will, are instructions for medical care and only go into effect if the resident/patient becomes unable to communicate their own wishes.

Question 15

Physical changes in a dying patient/resident occur and can last from ___ to _____.

Answer 15

days to weeks

Question 16

__________ is a pattern of fast, shallow breathing, followed by slow, deep breathing, with periods of apnea.

Answer 16

Cheyne-Stokes breathing

Question 17

As death becomes imminent, the resident/patient may transition from nose breathing to _____ breathing.

Answer 17

mouth

Question 18

The sound of saliva collecting in the back of the throat that appears as a gurgling or rattling noise is called the _____ _____.

Answer 18

death rattle

Question 19

True or False: When you hear the sound of the death rattle, this is indicative that the patient/resident is choking.

Answer 19

False

Question 20

What should you do if you hear the death rattle in a patient/resident?

Answer 20

reposition or slightly raise or lower the head of the bed

Question 21

What is mottling?

Answer 21

the result of poor blood flow to the extremities appearing as a purplish marbling on the skin.

Question 22

As the cardiovascular system slows down, blood is shunted/pulled towards the _____ of the body, and blood flow becomes poor in the __________, causing mottling.

Answer 22

core, extremities (hands and feet)

Question 23

True or False: Once mottling sets in, it permanently stays on the skin.

Answer 23

False, mottling comes and goes

Question 24

What should you do if you spot mottling on the patient/resident’s skin? Will this make the mottling go away?

Answer 24

You can reposition the patient/resident, the mottling might go away for a bit but it will return later

Question 25

True or False: Mottling occurs only in extremities such as the hands and feet.

Answer 25

False, mottling can occur on legs, thighs, buttocks, back or on the side on which the resident is lying.

Question 26

What happens to the blood pressure and pulse of a terminal patient/resident and how does this effect body temperature?

Answer 26

They can become irregular; mostly the bp is low, as the pulse increases the resident/patient may sweat, followed by periods of low pulse and chills.

Question 27

Which sense is the last to fade before dying?

Answer 27

hearing

Question 28

True or False: As the resident/patient approaches death, urine production may stop.

Answer 28

True

Question 29

How often should you reposition a dying resident/patient?

Answer 29

hourly

Question 30

How often should you be performing oral care on a dying resident/patient and how?

Answer 30

hourly, with every time you reposition them; you provide oral care by using as many oral swabs as necessary to remove slough accumulated in and around the mouth.

Question 31

What can you use to decrease the risk of nosebleeds in a dying resident/patient who’s nares have become dry and cracked from being on oxygen?

Answer 31

small amounts of water-based lubricant in the nares

Question 32

Always abide by _____ laws, only offer health information to those who have been approved by the resident, direct all other people’s inquiries to the _____.

Answer 32

confidentiality/HIPPA; nurse

Question 33

True or False: It is the nurse and not the CNA, who listens for a heartbeat and pronounces the resident/patient dead.

Answer 33

False, the nurse does listen for the heartbeat, but the doctor is the one that pronounces the resident/patient dead.

Question 34

True or False: It is the CNA’s responsibility to speak to the family present or notify the family by phone that the resident/patient has passed, and then call the funeral home.

Answer 34

False, all this needs to be done by the nurse.

Question 35

How many CNA’s should be in the room to perform post-mortem care and why?

Answer 35

at least two; for emotional support and help rolling the body

Question 36

In a brief summary, what does post-mortem care consist of?

Answer 36

partial bed bathing of the body, oral care, dressing and positioning the body for viewing, tiding the room before family is let back in for viewing.

Question 37

What physiological signs may you encounter as you roll the dead body of the resident/patient as you bathe them?

Answer 37

a sigh indicating the expulsion of the last bit of air in the lungs; there may also be vomiting or stooling.

Question 38

Where should a bed protector be placed when bed-bathing a dead body and why?

Answer 38

A bed protector should be used at the head of the bed and underneath the body from waist to hips to protect the bed against vomit and stool.

Question 39

Briefly describe how the dead body is positioned during post-mortem care for the family to view.

Answer 39

body is positioned on it’s back, head sightly raised, sheet up to the abdomen/chest area, eyes closed, hands over the abdomen/chest.

Question 40

What can you do if the eyes of the body do not stay closed?

Answer 40

you can place moist cotton balls on the lids or raise the head of the bed a bit more.

Question 41

When performing post-mortem care and preparing the body for the family to view how must the body look or be dressed?

Answer 41

you should try to make the body look as normal and peaceful as possible; clean hospital gown, glasses and dentures if usually worn, religious object in hands if they had one.

Question 42

True or False: Helping the funeral home representative move the body from the bed into the bag on the stretcher is within the CNAs scope of practice.

Answer 42

True

Question 43

True or False: After the body is removed from the room, their personal care items such as the resident/patient’s washbasin, bedpan, toothbrush, soap, and toothpaste are given to the family.

Answer 43

False, these personal care items are disposed of immediately. The family may take personal effect items such as pictures, clothing, or furniture belonging to the resident/patient.

Question 44

After the resident/patient’s body is removed from the room, the CNA strips the bed and _______ proceeds to clean the room and the mattress.

Answer 44

housekeeping

Question 45

What should you do if the patient/resident’s mouth will not stay closed while preparing the body for final viewing?

Answer 45

attempt to elevate the head with an additional pillow