End-of-Life Care
http://www.criticalcareceu.com/courses/103/index_ccare.html
1.
More than 2.4 million people die each year in the United States. Of those:
a. Ninety percent die at home.
b. Less that 25% die at home.
c. Twenty percent die in hospitals.
d. Most die suddenly in an accident.

2.
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 few nurses or physicians certified in palliative care.

3.
All of the following statements about hospice care are true except:
a. Drugs for symptom control and pain relief are not covered by the Medicare hospice benefit program.
b. Most Americans do not know that hospice care can be provided in the home.
c. The Medicare hospice benefit guarantees comprehensive high-quality care at little or no cost.
d. To access the hospice benefit, the client’s doctor must certify that the client likely has six months or less of life remaining.

4.
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.

5.
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.

6.
The principle of double effect states:
a. The healthcare provider has a duty to protect life and to provide the means to end life.
b. Hastening death is acceptable if it is an unintended consequence of relieving suffering.
c. A healthcare worker is not required to intervene if a client attempts to take his or her own life. d. A client can refuse medical treatments but cannot refuse artificial nutrition or hydration.

7.
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.

8.
Federal law requires hospitals to inform clients that they have the right to complete an advance directive.
a. True
b. False

9.
All of the following statements about do-not-attempt-resuscitation (DNAR) orders are true except:
a. It was formerly known as do-not-resuscitate orders.
b. DNAR orders are found in over 90% of medical charts.
c. The DNAR order should be readily available in the event of an emergency.
d. Withholding CPR does not equate with letting someone die.

10.
All of the following statements about artificial nutrition and hydration (ANH) are true except:
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.

11.
Which of the following is an urgent indication of the need to discuss end-of-life care?
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.

12.
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

13.
Which of the following statements 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.

14.
The Joint Committee on Accreditation of Healthcare Organizations (JCAHO) requires that hospitals and other healthcare facilities regularly assess, monitor and manage pain in all clients.
a. True
b. False

15.
Which of the following statements 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.

16.
Drowsiness frequently occurs at the beginning of opioid therapy, not only from drug action on the brain but also because the client has been sleep-deprived due to unrelieved pain.
a. True
b. False

17.
Shortness of breath is common among dying clients. All of the following approaches are used to treat this symptom except:
a. Inhaled corticosteroids.
b. Supplemental oxygen.
c. Anti-anxiety medications.
d. Low doses of morphine.

18.
Methods such as massage, physical therapy, acupuncture, and psychotherapy can be effective in the treatment of pain.
a. True
b. False

19.
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.

20.
Depression during end-of-life care may be due to all of the following factors except:
a. A weak support system.
b. Persistent negative thinking regarding the diagnosis.
c. The need to spend time alone.
d. Increased dysfunction related to the illness.

21.
Although depression is highly treatable in most people, it cannot be treated effectively during end-of-life.
a. True
b. False

22.
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.

23.
All of the following caregiver problems are common except:
a. Families may face severe economic consequences.
b. Physical exhaustion, economic worries, and disrupted routines may lead to anxiety and depression.
c. Care for the loved one often takes priority over the caregiver’s own healthcare needs.
d. Hospice benefits provide mental health services for the caregiver.

24.
Which statement about end-of-life and cancer is true?
a. Chemotherapy and radiation treatments are usually stopped several months before death.
b. Treatment of cancer clients near death becomes gradually less aggressive.
c. Hospice is often being used to manage the death rather than palliate the disease.
d. Cancer clients are usually admitted to hospice care several months before death.

25.
Clients with Alzheimer’s disease are eligible for hospice care and account for more 30% of the annual hospice census.
a. True
b. False

26.
In people with severe cognitive impairment, artificial nutrition and hydration:
a. Can be withheld if the client’s wishes have been made clear in an advance directive.
b. Is given via feeding tube to more than 18% of those with severe cognitive impairment.
c. Is sometimes given because the nursing home receives special reimbursement.
d. All of the above

27.
The availability of HAART for the treatment of HIV/AIDS has eliminated the need to provide end-of-life care to HIV positive clients.
a. True
b. False

28.
A person living with advanced AIDS may have unique issues related to the disease including:
a. Stigmatization because of HIV/AIDS.
b. Lack of traditional support systems.
c. Bereavement from multiple losses.
d. All of the above

29.
Which of the following statements 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.

30.
The dying child and family members need to talk with one another about death.
a. True
b. False

31.
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

32.
Signs of imminent death include all of the following except:
a. Drowsiness.
b. Extremities becoming cool to the touch.
c. Rattling or gurgling breath sounds.
d. Increased ease in controlling pain.

33.
Post-mortem care should include all of the following except:
a. Remove all equipment and soiled linen from the bedside.
b. Avoid facial discoloration by placing the body in a supine position with a pillow under the head and shoulders.
c. Avoid upsetting the family by allowing only a short viewing of the body.
d. Attach identification tags to the ankle and wrist.

34.
All of the following statements about autopsies are true except:
a. Nationally, only about 5% of deaths undergo autopsy.
b. Clinical diagnoses, whether obtained from death certificates or hospital discharge data, contain major inaccuracies compared with autopsy diagnoses.
c. The healthcare system as a whole can benefit enormously from autopsy data.
d. Autopsies disfigure the body.

35.
Questions about organ donation are best discussed with the client in the context of advance directives.
a. True
b. False

36.
Which of the following statements 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.