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| 1 | |
Which of the following statements is most accurate? |
| | A) | All depressed patients are mentally incompetent to make end of life decisions. |
| | B) | It is common for patients with terminal illnesses to have some degree of depression. |
| | C) | Dying patients under treatment for depression should have someone else make decisions for them. |
| | D) | Depression does not generally affect decisions about end of life care. |
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| 2 | |
Complete this statement with the most accurate ending. Decisional capacity. |
| | A) | is the ability to understand and appreciate the nature and consequences of health decisions and to formulate and communicate decisions concerning health care. (Nat'l Ethics Committee, pg 11) |
| | B) | is the ability for someone to make correct and wise health care decisions. |
| | C) | is only evident in patients who meet the criteria for legal competency. |
| | D) | means that persons will be able to make all decisions related to their health care or living situation. |
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| 3 | |
Physicians Maria J. Silveira, Scott Y. H. Kim and Kenneth M. Langa, believe that having advanced directives improves care for dying persons by enabling outcomes of decision-making to reflect their treatment preferences. They argue that care is improved because |
| | A) | one quarter of elderly adults need surrogate decision-making. |
| | B) | living wills have little effect on decisions to withhold or withdraw care and do little to increase consistency between care received and patients' wishes. |
| | C) | incapacitated subjects who had prepared a living will were less likely to receive all treatment possible; subjects who had assigned a durable power of attorney for health care were less likely to die in a hospital or receive all care possible. |
| | D) | when decision-making capacity is lost, data shows agreement is rare between dying patients and appointed surrogates. |
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| 4 | |
Geriatric Professor CEES M. P. M. HERTOGH from the Netherlands believes that advanced directives have failed to improve the final stages of life. These require less advance planning than sensitive day to day dialogue among physicians and patients. What does Hertogh see as their biggest weakness that challenges Silveira's claims about improved care? |
| | A) | "Prospective autonomy" called "auto-paternalism" restricts one from changing one's mind in the future. |
| | B) | There is a conflict between the prior values of the still competent person and the welfare interests of a later incompetent person. |
| | C) | A "disability paradox" shows people change their minds as their minds change to adapt to new realities. |
| | D) | Advance directives have many problems of under usage, improper interpretation, low compliance, low adherence, changing preferences, unstable health. |
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| 5 | |
Which of the following was the strongest predictor of dying without transportation to a hospital after a cardiac arrest in the study reported by Pathak, et al? |
| | A) | Persons of a minority culture. |
| | B) | Persons who lacked insurance or financial means to obtain transportation to the hospital. |
| | C) | Persons who delayed seeking medical treatment because of fear. |
| | D) | Persons who were unmarried. |
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| 6 | |
Which of the following would make it most possible to implement the respectful death model as proposed in the essay by Wasserman? |
| | A) | The patient is dying rapidly and his/her wishes are largely unknown to the nurses and physicians. |
| | B) | The patient has been frequently readmitted to the oncology unit and has frequently discussed their dying views with the health care staff. |
| | C) | The patient is unable to express their views or their wishes because of long standing psychiatric issues and dementia. |
| | D) | The patient is non English speaking and has no family advocate. |
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| 7 | |
University of California assistant professor Nancy Jo Bush identifies risk factors of empathic engagement which leads to compassion fatigue and useful coping skills. Which of the following are the most effective responses? |
| | A) | Identifying a specific plan for dying or clear goal for end of life care. |
| | B) | Problem solving mechanisms and empathic boundaries. |
| | C) | Clearly distinguishing compassion fatigue, burnout, secondary trauma stress and vicarious trauma. |
| | D) | Self-awareness and self-forgiveness. |
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| 8 | |
Florida Atlantic University's Dorothy Dunn argues that too much compassion talk focuses upon other-directed empathy rather than self-regarding sustenance. She argues for self-generating vigor as compassion energy that includes all but which of the following: |
| | A) | listening and hearing what patients experience |
| | B) | compassionate presence |
| | C) | patterned nurturance |
| | D) | intentionally knowing the nursed and self as whole |
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| 9 | |
Attorney Kathryn Tucker, the Director of Legal Affairs for the Compassion and Choices in Seattle argues that treating physicians, hospital and nursing homes for an end-stage cancer patient |
| | A) | should be held accountable for inadequate pain management because they did not pay enough attention to the patient's pain or family requests. |
| | B) | reached a confidential settlement that acknowledged responsibility among caregivers including mandatory retraining and regulatory-sanctions that serve as correctives for inadequate pain treatment. |
| | C) | were shown to be legally negligent after his death because they neither assessed pain adequately, nor initiated pain management, nor prescribed adequate pain relief thereby causing unnecessary suffering. |
| | D) | were successfully sued by the family in California under laws of elder abuse that showed "recklessness" in failure to due a duty in treating obvious pain. |
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| 10 | |
University of Florida Professor of Pharmacy David Brushwood argues that holding physicians accountable "sets up" doctors to fail in their provision of adequate pain relief to their patients. Which of the following hurts the effort to distinguish criminal misconduct outside medicine from malpractice within medicine? |
| | A) | Pain management training is inadequate or unproductive in medical schools, residency ("start low and go slow") and Continuing Medical Education ("Telling-Showing" but no "Doing"). |
| | B) | Under-resourced: Agency rules don't financial support needed staffing for good pain support. |
| | C) | Patient fears of addiction cause under-compliance with prescriptions. |
| | D) | Over-regulation is not addressed by "safe harbors of legitimate use" in the face of legal surveillance and adversarial expert witnesses paid to find mistaken prescriptions. |
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| 11 | |
Intractable pain is: |
| | A) | Pain that takes longer to respond to medications. |
| | B) | Pain that is relieved by higher doses of medications |
| | C) | Pain that affects the internal organs and psyche. |
| | D) | Pain that is unrelieved even with the highest doses of pain medication. |
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| 12 | |
Mrs. S. who has very severe cancer pain is being treated at home on hospice at the end of life. The family is reluctant to give pain medications because they are afraid they will "kill" the patient. Which of the following would be the best response to their concerns? |
| | A) | "If she dies after you give a pain medication, just don't tell anyone you gave it." |
| | B) | "Your intent with the pain medication is to relieve pain; it is the cancer that is "killing" her." |
| | C) | The rule of double effect means that you probably will kill her with a pain medication when you give it. |
| | D) | "Just try to have her avoid pain medications as much as possible". |
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| 13 | |
Bloomberg News Executive Editor Amanda Bennett argues |
| | A) | most end stage cancer treatments cause needless pain for patients and their families. |
| | B) | she and her husband Terrence agreed that extra costs for his care were worth the extra months of life with his family. |
| | C) | her corporate health coverage in several jobs completely covered all expenses, which were themselves only a fraction of bills charged. |
| | D) | highly-motivated patients and families who seek aggressive and experimental treatments should be able to use resources of insurance coverage to prolong life, or dying. |
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| 14 | |
According to Medical Journalist Shannon Brownlee, by correcting irregular heartbeats, implanted cardiac defibrillators |
| | A) | have given extra years to frail elderly at risk of death from cardiac conditions. |
| | B) | have not led to improved education for patients and families about appropriate end of life goals |
| | C) | are expensive but improve blood flow to the brain that improves cognitive ability and cures dementia |
| | D) | should only be given after screening—and not be given to patients with dementia. |
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| 15 | |
According to Orentlicher & Callahan (2004), what did decision-makers report as the primary goal of initiating PEG tube feeding in patients with dementia? |
| | A) | Improve nutrition (pg 395). |
| | B) | Help overcome acute illness. |
| | C) | Prevent aspiration pneumonia. |
| | D) | Control fluid intake. |
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| 16 | |
According to Orentlicher & Callahan (2004), which of the following is true about PEG tube insertion in patients with dementia? |
| | A) | PEG tube placement has been shown to significantly improve nutrition and prevent aspiration pneumonia. |
| | B) | PEG tube placement does not significantly improve nutrition or length of life and may increase the risk of aspiration pneumonia (pg 396). |
| | C) | PEG tube placement improves quality of life but has no effect on nutrition or prevention of aspiration pneumonia. |
| | D) | PEG tube placement significantly decreases the risk of aspiration pneumonia and significantly improves quality of life, but does not significantly affect nutrition. |
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| 17 | |
According to Goldstein et al. (2008), reasons physicians cited for not engaging in conversations about deactivating ICDs in patients with advanced illness included, |
| | A) | such conversations are regarded as futile. |
| | B) | such conversations are uncomfortable for family members and therefore avoided. |
| | C) | deactivation of ICDs is already known based on patient's POLST form. |
| | D) | it is challenging for physicians to think of ICDs in the same context as end-of-life management. (Goldstein, pg. 2) |
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| 18 | |
The "bridge" that Goldstein et al. (2008) refers to is |
| | A) | the bridge between life and death. |
| | B) | the bridge as an metaphor for the life cycle. |
| | C) | the bridge towards accepting end-of-life care. |
| | D) | the finality and no return implications of a decision like deactivating an ICD (Goldstein, pg. 4). |
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| 19 | |
Oregon State Epidemiologist Katrina Hedberg and colleagues argue that legal self-administration of lethal medication is |
| | A) | a good way to die. |
| | B) | used by only a small number of terminally ill Oregonians. |
| | C) | part of decreasing usage trends in DWDA participation in Oregon. |
| | D) | the best way to die in Oregon. |
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| 20 | |
According to McKnight Presidential Professor of Law, Medicine & Public Policy at the University of Minnesota Susan M. Wolf, the hardest yet most memorable aspect of her time with her dying father was |
| | A) | withholding and withdrawing futile treatment. |
| | B) | refusing his request for accelerating death that he thought necessary for humane dying. |
| | C) | helping him transfer among hospitals for specialized care. |
| | D) | keeping vigil in an ICU for his comfortable death. |
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| 21 | |
Based on evidence from Oregon's Death with Dignity Act (DWDA), Ronald Lindsay, a lawyer and CEO of the Center for Inquiry argues that, |
| | A) | Oregon has become a suicide mill. |
| | B) | DWDA has no abuses. |
| | C) | participants in DWDA have a better death than those who die from natural causes in Oregon. |
| | D) | risks are outweighed by benefits and palliative care has improved. |
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| 22 | |
President Emeritus and Cofounder of the Hastings Research Center, Daniel Callahan argues that |
| | A) | state regulations in Oregon don't collect or disclose needed data. |
| | B) | the shift from suicide to "physician aid in dying" correctly puts spatients in control. |
| | C) | control of pain helpfully medicalizes autonomy by controlling death events. |
| | D) | advocates of physician assisted suicide have proven it can be safely regulated. |
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| 23 | |
What distinguishes palliative sedation from euthanasia? In 2007, the National Ethic Committee of the Veterans Health Administration (VHA) stated palliative sedation is distinct from euthanasia because palliative sedation |
| | A) | is a therapy of last resort. |
| | B) | aims to relieve the patient's suffering and not cause death by using a risky procedure that carries a proportionate benefit. |
| | C) | can only be used by those willing to forgo life-sustaining treatment. |
| | D) | appropriately treats those with existential suffering (affliction without physical symptoms). |
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| 24 | |
University of Utah philosopher and ethicist Margaret Battin argues sedation unto death called terminal sedation |
| | A) | already has legal safeguards similar to assisted death. |
| | B) | includes patient-elected cessation of eating and drinking. |
| | C) | allows competent administration of correct dosages for physician assisted death. |
| | D) | should be one but not the only nor perhaps the best among many last resort options. |
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| 25 | |
What is pluralism as discussed in this chapter? |
| | A) | Having numerous points of view on a single topic. |
| | B) | Having more than one definition or criteria for death. |
| | C) | Refers to the numerous different manners in which one can die. |
| | D) | Refers to the numerous ways different states determine death. |
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| 26 | |
The determination of death has changed since the 1950's because |
| | A) | we have access to more technology. |
| | B) | physicians are now required to attend seminars regarding appropriate death determination. |
| | C) | the practice of organ transplantation has provided an incentive to determine death while organs are still viable. |
| | D) | we have access to increased ICU availability. |
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| 27 | |
Which of the following statements is most accurate? |
| | A) | Persons are eligible for hospice at any time after being diagnosed with cancer. |
| | B) | Only persons with cancer can be eligible for hospice. |
| | C) | Persons with any terminal disease, with a 6 month life expectancy are eligible for hospice. |
| | D) | Two physicians have to declare a person terminal before they can be referred to hospice. |
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| 28 | |
Complete this statement with the most accurate ending. Hospice care |
| | A) | is the provision of comfort care at the end of life for anyone who meets criteria of being terminally ill. |
| | B) | is an indication that the patient is giving up. |
| | C) | is only for elderly patients who need 24 hour around the clock care. |
| | D) | does not include care or support for the family members or caregivers. |
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| 29 | |
According to Marshall, Skinner and McGarry (2010), out of pocket costs for elderly are |
| | A) | significant for end of life care even with Medicare as insurance. |
| | B) | completely covered by Medicare. |
| | C) | not a problem for the majority of older adults because of their wealth. |
| | D) | only a problem if Medicare patients aren't referred for hospice. |
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| 30 | |
Marshal Skinner and McGarry indicate that older patients incur the greatest costs at the end of life because |
| | A) | home health care and nursing home care don't participate in hospice. |
| | B) | home health care and nursing home care for basic health changes must be paid out of pocket. |
| | C) | older persons tend to request expensive hospital treatments that are not covered by insurance. |
| | D) | hospice care is not covered by Medicare. |
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| 31 | |
Carolyn Pevey and her colleagues at Auburn University Montgomery argue that religion comforts the dying. Which is NOT one of their reasons? |
| | A) | Prayer is the best medicine. |
| | B) | Relationships with dying. |
| | C) | Hope in an afterlife. |
| | D) | Trust in cosmic order (control by a perceived other). |
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| 32 | |
Lamont Satterly, Master of Divinity and Founder of the SEARCH foundation argues that religious pain afflicts the spiritual well-being of dying persons because |
| | A) | even believers in heaven don't want to die to get there. |
| | B) | religions teaching love for others cause people to hate themselves. |
| | C) | unresolved issues of pain rooted in religious guilt and spirituality cause shame because of breaking moral codes. |
| | D) | actual suffering creates anxiety that a good God neither rewards virtuous nor punishes wicked. |
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| 33 | |
Considering the essays in this chapter and identify which one of the following statements that both of the essay writers would likely agree to be accurate: |
| | A) | Persons of a minority cultures will always want aggressive care at the end of life. |
| | B) | A better understanding of cultural experiences may improve end of life care. |
| | C) | There aren't very many differences in end of life preferences based on culture. |
| | D) | Cultural experiences influence how families approach funerals but not end of life care requests. |
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| 34 | |
According to research studies, which of the following was NOT given as a possible explanation for aggressive care requests at the end of life by Hispanic and black populations? |
| | A) | The lower health literacy of minority cultural groups limits understanding of the treatment benefits and burdens that physicians are describing to them. |
| | B) | Fear of dying in minority groups is more common. |
| | C) | Deep rooted cultural and religious background of the minority patients influence end of life decisions. |
| | D) | Longstanding discriminatory health care practices may influence the decision of patients to request more aggressive care at the end of life. |
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| 35 | |
Consider the essays in this chapter and identify which one of the following statements that both of the essay writers would likely agree to be accurate. |
| | A) | Death rituals are similar across all cultural groups. |
| | B) | A better understanding of grieving and death rituals may help health care professionals better address the needs of grieving families. |
| | C) | Deep intensive counseling which reviews the dying process of the patient is very helpful to those who grieve. |
| | D) | Cultural norms dictate grieving, so everyone from a specific culture grieves in the same way. |
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| 36 | |
In the Kohler article, the author identifies the work of George Bonnano which suggests that grieving |
| | A) | occurs in fixed stages. |
| | B) | varies widely and is unique to each individual. |
| | C) | follows a specific time pattern. |
| | D) | occurs more rapidly if in depth psychotherapy occurs. |
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