End of Life: Easing the Final Transition

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You must score 70% or better to pass this course. Select one answer for each question by clicking the circle at the left of your choice. To change your selection, click a different circle. Do not skip any questions.

Test Question

1. Each death represents a failure of the medical system.

a. True
b. False

Test Question

2. Pioneers in improving care of the dying included:

a. Dame Cicely Saunders and Rachel Carson.
b. Elizabeth Kübler-Ross and Sister Elizabeth Kenny.
c. Dame Cicely Saunders and Elizabeth Kübler-Ross.
d. Elizabeth Kübler-Ross and Helen Keller.

Test Question

3. Which of the following statements is true about end-of-life care in the United States?

a. Hospice care is widely used in most states.
b. Hospice coverage is generally skimpy.
c. Medicaid does not actually cover hospice care.
d. Too few professionals are certified to meet growing need.

Test Question

4. When caring for veterans who are dying, health professionals should be aware that:

a. Hospice care is not included in VA benefits.
b. A veteran may be unwilling to admit being in pain.
c. Veterans usually have strong family support.
d. Veterans' needs are similar whether they enlisted or were drafted.

Test Question

5. Hospice care can be provided in the home.

a. True
b. False

Test Question

6. Palliative care:

a. Seeks to hasten death once a person has been declared terminal.
b. Seeks to improve the quality of life for dying patients.
c. Should not be used in conjunction with therapies that prolong life.
d. Is not applicable in the early stages of an illness.

Test Question

7. Any terminal patient, including a child, is eligible for hospice.

a. True
b. False

Test Question

8. People who choose hospice are more likely to die in the hospital.

a. True
b. False

Test Question

9. Assistance in dying:

a. Is acceptable if it is the unintended consequence of relieving suffering.
b. Is illegal in every state except Oregon.
c. Is unacceptable but there is no duty to intervene in a patient suicide.
d. May be an issue if a patient rejects unwanted medical treatments or procedures.

Test Question

10. Studies of death trends in American hospitals show:

a. More blacks than whites die as hospital inpatients.
b. In 2000, whites and blacks died in the hospital in equal proportions.
c. Access to pain medications is better for blacks than for whites.
d. Poor communication is not a factor when choosing end-of-life care options.

Test Question

11. Federal law requires hospitals to inform patients that they have the right to complete an advance directive.

a. True
b. False

Test Question

12. Although advance directives are helpful in certain circumstances, it is preferable to name a proxy decision maker.

a. True
b. False

Test Question

13. Do-not-attempt-resuscitation (DNAR) orders:

a. Can be written by a physician or nurse when family fails to do so.
b. Should be readily available in the event of an emergency.
c. Must be documented in the patient's charts or the orders can be ignored.
d. Are equivalent to letting someone die.

Test Question

14. Forgoing artificial nutrition and hydration (ANH) is the same as starving the patient.

a. True
b. False

Test Question

15. Which of the following is an urgent indication of the need to discuss end-of-life care?

a. Discussing the prognosis
b. Discussing treatment with low probability of success
c. Discussing hopes and fears
d. Inquiries about hospice or palliative care

Test Question

16. If a patient says he doesn't "want to be hooked up to machines," explain that:

a. Machines are not as scary as people think.
b. We don't have to talk about machines.
c. Hospice care allows people to express their needs and have them respected.
d. By the time you need machines, honestly, you really won't care.

Test Question

17. Cancer patients who believed in divine intervention were found less likely to want aggressive life-extending treatments than those who lacking similar spiritual beliefs.

a. True
b. False

Test Question

18. Which of the following statements about pain is true?

a. It should not be thought of as a vital sign.
b. Advanced cancer patients in nursing homes generally receive effective treatment for pain.
c. When pain is relieved, symptoms like depression, diminished appetite, and impaired sleep may disappear.
d. Clinicians generally manage pain effectively.

Test Question

19. The JCAHO requires that hospitals and other healthcare facilities regularly assess, monitor, and manage pain in all patients.

a. True
b. False

Test Question

20. The patient's preferences should not define the goal of pain management.

a. True
b. False

Test Question

21. Drowsiness frequently occurs at the beginning of opioid therapy, not only from drug action on the brain but also because the patient has been sleep-deprived due to unrelieved pain.

a. True
b. False

Test Question

22. Shortness of breath is common among dying patients. Which of the following are used to treat this symptom?

a. Inhaled corticosteroids, antibiotics, and yoga
b. Guided imagery, glucosamine, and sponge baths
c. Nonsteroidal anti-inflammatory drugs, meditation, and acupuncture
d. Oxygen, opioids, and anti-anxiety medications

Test Question

23. A patient who has trouble swallowing should be given mineral oil.

a. True
b. False

Test Question

24. One of the most common fears expressed by a person with a terminal illness is:

a. Fear of starvation.
b. Fear of disfigurement.
c. Fear of pain.
d. Fear of dying in the presence of family members.

Test Question

25. Although depression is highly treatable in most people, it cannot be treated effectively at the end of life.

a. True
b. False

Test Question

26. Grief:

a. Is a private process that cannot be shared.
b. Has stages that must be experienced in the proper sequence.
c. Is universal, individual, and unpredictable.
d. Is independent of our cultural values and norms.

Test Question

27. Bereavement is:

a. The period of time, approximately 6 months, before a loved one's death.
b. Being deprived of someone through death and the feeling of desolation that follows.
c. The process by which an individual is able to move through the stages of grief and emerge from the grieving process.
d. An exaggeration of the normal process of grieving, often resulting from multiple losses.

Test Question

28. Risk factors for delirium include sleep deprivation and visual/hearing impairment.

a. True
b. False

Test Question

29. Hospice benefits include services for the caregiver.

a. True
b. False

Test Question

30. Which statement is true about cancer and end-of-life?

a. Chemotherapy and radiation are always stopped when the patient appears terminal.
b. Treatment of cancer patients near death becomes gradually less aggressive.
c. Patients are being admitted to hospice care only in the final days, to manage the death rather than palliate the disease.
d. Cancer patients are usually admitted to hospice several months before death.

Test Question

31. Depending on therapeutic goals, a cogent patient may make an early decision not to treat hypercalcemia or other metabolic abnormalities in order to avoid a more prolonged death from advancing metastasis.

a. True
b. False

Test Question

32. Patients with Alzheimer's disease are eligible for hospice care and account for more 30 percent of the annual hospice census.

a. True
b. False

Test Question

33. If patients with dementia are maintaining a constant body weight, there is no medical indication for inserting a feeding tube.

a. True
b. False

Test Question

34. The availability of HAART for the treatment of HIV/AIDS has eliminated the need to provide end-of-life care to HIV-positive patients.

a. True
b. False

Test Question

35. For someone living with advanced AIDS, which of the following is true?

a. Support systems are now in place to meet all of the patient's needs.
b. The issues are no different from anyone else who has a terminal illness.
c. Bereavement issues are often intensified because of multiple losses with little time for resolution.
d. When treated with HAART, the course of HIV/AIDS is predictable.

Test Question

36. Which of the following is true about dying children?

a. Most children with cancer receive palliative care.
b. It is difficult to predict whether a life-threatening illness will end in cure or death.
c. Children do not fear death as much as adults.
d. Children are prone to addiction from pain medications.

Test Question

37. Parents of infants with a terminal diagnosis need one nurse or one physician who will provide daily updates and answer their questions.

a. True
b. False

Test Question

38. Dying children need to talk with family members about death, especially about fear of pain and fear of dying alone.

a. True
b. False

Test Question

39. Signs of imminent death include:

a. A sudden spurt of awareness.
b. Ease of controlling pain.
c. Breath sounds becoming quiet and regular.
d. Decreased socialization and withdrawal.

Test Question

40. Postmortem care:

a. Always removes all tubes before allowing the family to enter the room.
b. Avoids facial discoloration by elevating the legs with pillows.
c. Avoids upsetting the family by allowing only a brief visit with the body.
d. Attaches identification tags to the ankle and wrist.

Test Question

41. Autopsies disfigure the body and interfere with having an open-casket service.

a. True
b. False

Test Question

42. Questions about organ donation are best discussed with the patient in the context of advance directives.

a. True
b. False

Test Question

43. It is best not to form new relationships while grieving.

a. True
b. False

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