1. In the United States, end-of-life care programs:

• a. Are widely used in most states.
• b. Are used for far more than the 60 days considered necessary to gain maximum benefit.
• c. Are available in the vast majority of hospitals.
• d. Have too few nurses or physicians certified in palliative care.

2. West Virginia:

• a. Has the lowest percentage of people over the age of 65 in the United States.
• b. Has more than half of its population living in rural areas.
• c. Has the lowest median age of all states.
• d. Has low rates of cancer compared to other states.

3. Palliative care:

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

4. Which of the following statements about hospice care is true?

• a. It is a specific place or facility.
• b. It is only for people with cancer.
• c. Anyone diagnosed with terminal illness is eligible.
• d. It is only for older people.

5. 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 deciding on end-of-life care options.

6. West Virginia law recognizes two types of written advance directives for health care decision-making:

• a. The codicil and the declaration of dependence.
• b. The do-not-resuscitate order and the will.
• c. The living will and the medical power of attorney.
• d. The end-of-life agreement and the attorney's directive.

7. Which statement about do-not-attempt-resuscitation (DNAR) orders is false?

• a. It was formerly known as do-not-resuscitate orders.
• b. They are found in over 90% of medical charts.
• c. They should be readily available in the event of an emergency.
• d. Withholding CPR does not equate with letting someone die.

8. Which statement about artificial nutrition and hydration (ANH) is false?

• a. Many older clients choose to end their lives by refusing food and liquids.
• b. Forgoing ANH is the same as killing or starving the client.
• c. Nasogastric tube feedings can lead to such complications as pain, aspiration pneumonia, and epistaxis.
• d. People who choose not to have ANH do not suffer from hunger or thirst.

9. An urgent indication of the need to discuss end-of-life care might be evidenced by:

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

10. Discussing death explicitly helps the client express fears and concerns about the dying process and allows the clinician to address them directly.

• a. True
• b. False

11. Which statement about pain is true?

• a. It should not be considered as a vital sign.
• b. Most people in nursing homes with advanced cancer receive effective treatment for pain.
• c. When pain is relieved symptoms such as depression, diminished appetite, and impaired sleep may disappear.
• d. Its symptoms are generally effectively managed by clinicians.

12. Which statement about pain is false?

• a. Pain perception varies from person to person.
• b. Older adults may have a higher pain threshold than younger people or children.
• c. A person's perception of pain may be affected by cultural considerations.
• d. The client's preferences should not define the goal of pain management.

13. Methods such as massage, physical therapy, acupuncture, and psychotherapy can be effective in the treatment of pain.

• a. True
• b. False

14. 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.

15. Which statement about dying children is true?

• a. The majority of children with cancer receive palliative care.
• b. It is sometimes 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.

16. The possibility of dying raises issues for both the child and the family. These include:

• a. Fear of a painful death.
• b. Fear of dying alone.
• c. Fear of not being present when the child dies.
• d. All of the above.

17. Signs of imminent death include:

• a. Drowsiness and extremities becoming cool to the touch.
• b. Breath sounds suddenly decrease or disappear.
• c. Pain decreases significantly.
• d. Client is hyperresponsive to touch or speech.

18. Which statement about bereavement is false?

• a. A family's bereavement begins when their loved one is diagnosed with terminal illness.
• b. Grief can cause somatic distress, guilt, and hostile reactions.
• c. Grief can cause overwhelming fatigue.
• d. It is best not to form new relationships while grieving.