# Stage 6 — Evaluate outcomes. Review the day-shift trajectory and answer the three questions about symptom relief, escalation, and care after death.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372809&lang=en  
> language: en  
> subject: Personal Hygiene  
> category: BCC

## Question

Stage 6 — Evaluate outcomes. Review the day-shift trajectory and answer the three questions about symptom relief, escalation, and care after death.

| Time | Data |
| --- | --- |
| 0700 — Initial assessment | RR 28 and labored with intermittent Cheyne-Stokes breathing; BP 96/58; mottled knees; arousable only to firm voice; coughing and pocketing a sip; grimacing and reaching into the air; pooled upper-airway secretions audible. Family asks whether he is suffering. |
| 0720 — Goal-concordant care | The nurse explains the changes, positions Mr. K with the head elevated and supported side-lying, provides mouth and lip care, continues oxygen for comfort, and administers prescribed subcutaneous morphine for observed dyspnea. The secretion medication is used only for its documented target and response is monitored. |
| 0800 — Reassessment | Breathing remains irregular but is less labored; brow and jaw are relaxed; restless reaching has stopped; secretions are softer. Mottling and reduced responsiveness continue. The wife accurately explains that the care is relieving distress rather than reversing the dying process. |
| 1430 — Death with family present | Breathing gradually slows and stops. Required notification and pronouncement procedures begin. The nurse checks medical-examiner, donation, facility, and family requirements before device removal or postmortem care. |

Q1. Which evaluation best describes the response by 0800?

The plan failed because mottling and reduced responsiveness continued
Observable distress improved while the underlying dying process continued
The opioid reversed the terminal process and restored physiologic stability

Q2. Which finding would require prompt hospice-prescriber or specialist reassessment?

The family asks to remain at the bedside
Mottling progresses despite a relaxed face and easier breathing
Labored breathing, grimacing, and agitation persist after the ordered intervention

Q3. Which action cluster is appropriate after death?

Follow notification and pronouncement rules, check medical-examiner and donation requirements before removing devices, honor preferences, document, and arrange hospice bereavement follow-up for up to one year
Remove every line immediately and transfer the body before discussing family or cultural preferences
Reverse the opioid to prove that symptom treatment did not contribute to death

## Explanation

Outcome interpretation
Less respiratory effort, relaxed facial muscles, resolution of restless reaching, and family understanding support effective symptom relief and goal-concordant care. Continued mottling and decreasing responsiveness reflect the underlying dying process and do not by themselves mean the comfort plan failed. Persistent distress after the ordered interventions would require prompt hospice-prescriber or specialist reassessment.

After death
Follow legal and facility requirements for notification and pronouncement, determine whether medical-examiner or donation procedures require lines to remain, honor cultural and religious preferences, secure belongings, document, and connect the family to hospice bereavement services. Medicare hospice bereavement counseling may continue for up to one year after death, not 13 months.

## In-depth explanation

Measure comfort, not the time of death
The desired outcome is reduced observable distress with care consistent with the person's goals. Progression of the dying process can continue even when symptom treatment works.

Know the escalation trigger
Ongoing labored breathing, grimacing, or agitation after the ordered dose is not simply expected dying; reassess causes and obtain hospice specialist or prescriber input.

Postmortem care has gates
Do not remove devices automatically. Pronouncement authority, medical-examiner referral, donation requirements, facility policy, and family preferences may change the sequence. Bereavement follow-up is part of the hospice plan and is available for up to one year under Medicare guidance.

## Clinical scenario

Scenario (Stage 6 — Evaluate outcomes)
The nurse compares observable comfort before and after intervention and then applies required care after death.

Clinical judgment target
Distinguish symptom relief from disease reversal and complete lawful, preference-sensitive postmortem and bereavement care.

## Key concepts

- **Goal-concordant outcome** — Relief of observable distress, avoidance of unwanted burden, informed family participation, and prompt reassessment in accordance with the documented care plan.
- **Postmortem procedural gate** — Before removing lines or preparing the body, follow law and policy for pronouncement, notification, medical-examiner review, and organ or tissue donation requirements.
- **Hospice bereavement counseling** — Emotional, psychosocial, and spiritual support offered before and after death; Medicare hospice guidance provides it for up to one year after the patient's death.

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