CPEN End of Life Flashcards: 10 Practice Questions & Answers

The nurse's priority is the mandatory notification of the local Organ Procurement Organization (OPO). Per CMS and the Uniform Anatomical Gift Act (UAGA), the OPO must be notified of all imminent deaths. The Decoupled Approach is vital: the clinical team provides the death notification, while a trained OPO representative (Designated Requestor) discusses donation. This prevents a conflict of interest and increases consent rates. Exam Tip: Do not approach the family about donation yourself; the OPO determines eligibility and handles the request.

For infants and children (30 days to 18 years), two independent clinical examinations separated by an observation period of at least 12 hours are required. For term newborns (37 weeks gestation to 30 days), the interval is 24 hours. The exams must be performed by two different attending physicians. Apnea testing is performed with the second exam. Exam Strategy: Distinguish between these timelines; BCEN often tests the 12-hour vs. 24-hour distinction. Supplemental tests (EEG, blood flow) are only required if the clinical exam/apnea test cannot be completed.

In a forensic case (homicide, suicide, suspicious or unexplained death), all lines (IVs, ETTs), tubes (OG/NG, foley), and medical devices must remain in place and be secured to the body. Do not wash the body or clip fingernails. Cover the child’s hands with paper bags to preserve evidence. Documentation must be meticulous. Exam Tip: BCEN focuses on the nurse's role in evidence preservation. While family presence is encouraged, they must be supervised to ensure evidence is not tampered with or removed.

An Allow Natural Death (AND) order is often preferred in pediatrics as it focuses on what *will* be done (comfort, pain control, dignity) rather than what will be *withheld* (resuscitation). While legally similar to a DNR, the AND terminology facilitates a more positive, palliative-focused discussion with families. It emphasizes that the goal of care has shifted to comfort-directed measures only. Exam Tip: Recognize that an AND/DNR does not mean do nothing; it requires active management of symptoms like dyspnea, pain, and anxiety.

The primary responsibility is to facilitate Family-Presence During Resuscitation (FPDR) by assigning a dedicated staff member (nurse, chaplain, or social worker) to stand with the family. This family facilitator explains the procedures, provides emotional support, and assesses the family's coping. Clinical Pearl: Evidence shows FPDR helps with the grieving process and does not negatively impact resuscitation outcomes. Distractor: The nurse performing compressions or giving meds should NOT be the one supporting the family.