NUR 426 Exam UPDATED ACTUAL
QUESTIONS AND CORRECT ANSWERS
•Requires frequent assessment
•Not always present at end of life
•May not be able to rate pain & must rely on behavior cues
•Rule out / think about other causes of distress
•Use of oral/transdermal medications - CORRECT ANSWER Pain at end of life
•Adult sudden death (i.e. accidents, heart attacks)
•Advanced illnesses, six months to live (i.e.
cancer)
•Chronic illness (i.e. diabetes, heart disease, COPD, etc),
•Childhood accidents, acute or chronic illnesses, Neonatal/infant deaths (i.e. congenital defects, SIDS,
etc) - CORRECT ANSWER Nurse Exposures to Death
• Provide support to patients, families and each other
• Interpersonal competence: Empathy, Unconditional Positive Regard, Genuineness,
Attention to Detail
• Being present
• Interdisciplinary team - CORRECT ANSWER Healthcare Provider Role in death
-Appreciate unique roles of patient and family
-Avoid giving specific times
-Some patients want family present, some prefer to be alone
-Assess their understanding
-Echo their language
-Assess their willingness and ability to provide care
-Use simple terms, explain care being provided, provide reassurance
-Provide guidance / "what to expect" at/after death - CORRECT ANSWER Communication
with Patient/Family in death
,-Death Rattle: 56%
- Pain: 51%
- Agitation: 42%
- Urinary Incontinence: 32%
- Dyspnea: 22%
- N/V: 14%
- Myoclonus: 12% (brief, involuntary twitching of a muscle or group of muscles) - CORRECT
ANSWER Frequency of Sxs Last 48 hrs prior to death
• Requires frequent assessment
• Not always present at end of life
• May not be able to rate pain & must rely on behavior cues
• Rule out / think about other causes of distress
• Use of oral/transdermal medications - CORRECT ANSWER Pain in dying
-Is a distressing symptom for patients and families
• Be proactive
• Oxygen
• Positioning
• Fan/cool environment
• Calming environment/provide reassurance
• Use of opioids
• Benzodiazepines - CORRECT ANSWER Dyspnea in dying
-pain
-dyspnea
-respiratory secretions
-restlessness
-delerium
-Cardiovascular - cold extremities/mottling, change is vital signs
,-Respiratory - change in breathing pattern (apnea, panting, cheyne-stokes, mandibular breathing),
audible secretions
-Metabolic - fatigue, surge of energy, temperature changes/diaphoresis
-Gastrointestinal- decreased intake, nausea, vomiting, diarrhea, constipation, incontinence
-Urinary - decreased urine output
-Communication - decrease interaction with others (i.e. withdrawn, using metaphors, expressing
emotional and/or fears) - CORRECT ANSWER symptoms of near death
-Be proactive
-Oxygen
-Positioning-(head elevated or side lying)
-Fan/cool environment-
-Calming environment/provide reassurance
-Use of opioids
-Benzodiazepines - CORRECT ANSWER management of Dyspnea in death
death rattle - CORRECT ANSWER -noisy wet-sounding respirations caused by mouth
breathing and accumulation of mucus in the airways
-distressing and frightening symptom for those involved in the patient's terminal care.
-For patients who are alert, their noisy respirations can cause them to become agitated and fearful of
suffocating
-primary lung cancer
-cerebral metastases
-pneumonia
-dysphagia
-those in the last days of life. - CORRECT ANSWER Those with increased risk for death rattle
-Pulmonary embolism or myocardial infarction if the death rattle occurs suddenly
-Fluid overload as is found in congestive heart failure may benefit from a trial of diuretic therapy
-Pneumonia may benefit from antibiotic therapy - CORRECT ANSWER Potential causes for
the death rattle may include:
, *Begin anticholinergic drugs to dry secretions such as:
-Scopolamine patch, starting with one (1.5 mg) and increasing by one patch daily. If at three patches
the patient is without relief, begin an infusion of 50 mg/hr and titrate hourly to a maximum of 200
mg/hr.
-Atropine (0.4 mg), either IV or SQ can be used, but this may cause excitation.
-Other agents include glycopyrrolate, oxybutynin, or hyoscine.
-Finally, reduce (to <500ml/24 hrs) or withhold parenteral fluids or enteral feeding, as the fluids may
be contributing to the rattling secretions. (Harlos, 2010). - CORRECT ANSWER drugs for
death rattle
-Attempt to reposition the patient
-Keep head of bed elevated.
-Suctioning is generally not recommended, as it can increase agitation and distress in the patient. -
CORRECT ANSWER nonpharm for death rattle
-Using the term "death rattle" can be a frightening term to hear. Some have suggested using the term
"respiratory congestion" or "terminal secretions" to describe this phenomena to patients/family.
-Be honest with families and let them know that this can occur before death, so that families caring for
their loved one at home will know what may be available to relieve this symptom - CORRECT
ANSWER family support for death rattle
-Elevate head of bed
-Begin anticholinergic drug(s)
-Reduce or stop IV fluids/enteral feedings
-Provide reassurance and education
-Provide peaceful, calming environment
-Role model comforting - CORRECT ANSWER Interventions/Management for respiratory
secretions/death rattle
HYPERactive -restlessness, calling out, agitated, disoriented, crawling out of bed, delusions
HYPOactive -lethargic, somnolent, appear to be in a stupor
-Can have both - hypo and hyper active delirium - CORRECT ANSWER Delirium and death
QUESTIONS AND CORRECT ANSWERS
•Requires frequent assessment
•Not always present at end of life
•May not be able to rate pain & must rely on behavior cues
•Rule out / think about other causes of distress
•Use of oral/transdermal medications - CORRECT ANSWER Pain at end of life
•Adult sudden death (i.e. accidents, heart attacks)
•Advanced illnesses, six months to live (i.e.
cancer)
•Chronic illness (i.e. diabetes, heart disease, COPD, etc),
•Childhood accidents, acute or chronic illnesses, Neonatal/infant deaths (i.e. congenital defects, SIDS,
etc) - CORRECT ANSWER Nurse Exposures to Death
• Provide support to patients, families and each other
• Interpersonal competence: Empathy, Unconditional Positive Regard, Genuineness,
Attention to Detail
• Being present
• Interdisciplinary team - CORRECT ANSWER Healthcare Provider Role in death
-Appreciate unique roles of patient and family
-Avoid giving specific times
-Some patients want family present, some prefer to be alone
-Assess their understanding
-Echo their language
-Assess their willingness and ability to provide care
-Use simple terms, explain care being provided, provide reassurance
-Provide guidance / "what to expect" at/after death - CORRECT ANSWER Communication
with Patient/Family in death
,-Death Rattle: 56%
- Pain: 51%
- Agitation: 42%
- Urinary Incontinence: 32%
- Dyspnea: 22%
- N/V: 14%
- Myoclonus: 12% (brief, involuntary twitching of a muscle or group of muscles) - CORRECT
ANSWER Frequency of Sxs Last 48 hrs prior to death
• Requires frequent assessment
• Not always present at end of life
• May not be able to rate pain & must rely on behavior cues
• Rule out / think about other causes of distress
• Use of oral/transdermal medications - CORRECT ANSWER Pain in dying
-Is a distressing symptom for patients and families
• Be proactive
• Oxygen
• Positioning
• Fan/cool environment
• Calming environment/provide reassurance
• Use of opioids
• Benzodiazepines - CORRECT ANSWER Dyspnea in dying
-pain
-dyspnea
-respiratory secretions
-restlessness
-delerium
-Cardiovascular - cold extremities/mottling, change is vital signs
,-Respiratory - change in breathing pattern (apnea, panting, cheyne-stokes, mandibular breathing),
audible secretions
-Metabolic - fatigue, surge of energy, temperature changes/diaphoresis
-Gastrointestinal- decreased intake, nausea, vomiting, diarrhea, constipation, incontinence
-Urinary - decreased urine output
-Communication - decrease interaction with others (i.e. withdrawn, using metaphors, expressing
emotional and/or fears) - CORRECT ANSWER symptoms of near death
-Be proactive
-Oxygen
-Positioning-(head elevated or side lying)
-Fan/cool environment-
-Calming environment/provide reassurance
-Use of opioids
-Benzodiazepines - CORRECT ANSWER management of Dyspnea in death
death rattle - CORRECT ANSWER -noisy wet-sounding respirations caused by mouth
breathing and accumulation of mucus in the airways
-distressing and frightening symptom for those involved in the patient's terminal care.
-For patients who are alert, their noisy respirations can cause them to become agitated and fearful of
suffocating
-primary lung cancer
-cerebral metastases
-pneumonia
-dysphagia
-those in the last days of life. - CORRECT ANSWER Those with increased risk for death rattle
-Pulmonary embolism or myocardial infarction if the death rattle occurs suddenly
-Fluid overload as is found in congestive heart failure may benefit from a trial of diuretic therapy
-Pneumonia may benefit from antibiotic therapy - CORRECT ANSWER Potential causes for
the death rattle may include:
, *Begin anticholinergic drugs to dry secretions such as:
-Scopolamine patch, starting with one (1.5 mg) and increasing by one patch daily. If at three patches
the patient is without relief, begin an infusion of 50 mg/hr and titrate hourly to a maximum of 200
mg/hr.
-Atropine (0.4 mg), either IV or SQ can be used, but this may cause excitation.
-Other agents include glycopyrrolate, oxybutynin, or hyoscine.
-Finally, reduce (to <500ml/24 hrs) or withhold parenteral fluids or enteral feeding, as the fluids may
be contributing to the rattling secretions. (Harlos, 2010). - CORRECT ANSWER drugs for
death rattle
-Attempt to reposition the patient
-Keep head of bed elevated.
-Suctioning is generally not recommended, as it can increase agitation and distress in the patient. -
CORRECT ANSWER nonpharm for death rattle
-Using the term "death rattle" can be a frightening term to hear. Some have suggested using the term
"respiratory congestion" or "terminal secretions" to describe this phenomena to patients/family.
-Be honest with families and let them know that this can occur before death, so that families caring for
their loved one at home will know what may be available to relieve this symptom - CORRECT
ANSWER family support for death rattle
-Elevate head of bed
-Begin anticholinergic drug(s)
-Reduce or stop IV fluids/enteral feedings
-Provide reassurance and education
-Provide peaceful, calming environment
-Role model comforting - CORRECT ANSWER Interventions/Management for respiratory
secretions/death rattle
HYPERactive -restlessness, calling out, agitated, disoriented, crawling out of bed, delusions
HYPOactive -lethargic, somnolent, appear to be in a stupor
-Can have both - hypo and hyper active delirium - CORRECT ANSWER Delirium and death
