Overview

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Which would NOT be included in palliative care?
1) Chemotherapy
2) Flotation mattress
3) Intravenous (IV) lines for hydration
4) Pain medication for relief of distress

____ 2. Which statement about hospice care is NOT true?
1) Hospice care has a small patient-to-worker ratio.
2) Hospice care serves the dying patient exclusively.
3) Hospice care is responsive 24 hours a day 7 days a week.
4) Hospice care encourages the involvement of the patient’s personal physician.

____ 3. An older patient who recently lost his spouse sits in the bedroom, venturing out only for brief minutes. His eyes are reddened and swollen, his appetite is decreased, and even the simplest task is too exhausting for him. In which stage of grief is this patient?
1) Denial
2) Bargaining
3) Depression
4) Acceptance

____ 4. What best defines tolerance?
1) Compassion and endurance
2) Impatience and impartiality
3) Impatience and open-mindedness
4) Closed-mindedness and impartiality

____ 5. Which behavior exemplifies empathy?
1) Crying with patients
2) Understanding patients
3) Identifying with patients
4) Making choices for patients

____ 6. Which is NOT a benchmark of a good listener?
1) Taking time
2) Not interrupting
3) Asking appropriate questions
4) Assuming what the person is going to say

____ 7. An older patient has a living will that clearly states no intubation, no IV hydration, and no feeding tube. As the end of life nears, the patient’s daughter requests a feeding tube for the patient. What should the facility do?
1) Go to court to figure out what action to take.
2) Ask the patient’s physician to make the decision.
3) Go along with the daughter and insert a feeding tube.
4) Refuse because the patient has clearly stated wishes in a legal document.

____ 8. What is the primary objective of an advance directive?
1) Prevent abuse of incompetent patients.
2) Follow the wishes of the person who wrote it.
3) Give families the right to make health-care decisions for the patient.
4) Give the state permission to make life-or-death decisions for the patient.

____ 9. What are the components of a quality hospice program?
1) Is sensitive to different cultures, has a small patient-to-worker ratio, responds Monday through Friday, 9:00 a.m. to 5:00 p.m.
2) Has community support, allows for high patient-to-caregiver ratios, responds to family and patient needs
3) Has an interdisciplinary team, is sensitive to cultural differences, responds to patient and family wants and needs
4) Has a specific religious belief structure, has small patient-to-caregiver ratios, is rigid in their ability to respond to specific needs

____ 10. Which behavior is NOT necessary when working with dying patients?
1) Flexibility
2) Immaturity
3) Sense of humor
4) Good listening skills

Answer Section

MULTIPLE CHOICE

1. ANS: 1
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family.
Chapter page reference: 204
Heading: End-of-Life Decision
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Knowledge [Remembering]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 Chemotherapy is aimed at a cure and is not palliative care.
2 Palliative care is not aimed at a cure but at symptom management and comfort. Special bedding is a comfort measure.
3 Palliative care is not aimed at a cure but at symptom management and comfort. An IV line for hydration is a comfort measure.
4 Palliative care is not aimed at a cure but at symptom management and comfort. Pain medication is a comfort measure.

PTS: 1 CON: Grief and Loss

2. ANS: 2
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 5. Use your knowledge of palliative care to provide the information to a patient and family.
Chapter page reference: 204
Heading: End-of-Life Decision
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Knowledge [Remembering]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 Hospice care has a small patient-to-worker ratio.
2 Hospice care serves not only the dying patient but also the patient’s family, finding out their needs and responding to them in a culturally sensitive way.
3 Hospice care is responsive 24 hours a day 7 days a week.
4 Hospice care encourages the involvement of the patient’s personal physician.

PTS: 1 CON: Grief and Loss

3. ANS: 3
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 2. Identify the five stages of grief as outlined by Kübler-Ross.
Chapter page reference: 201
Heading: Depression
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Analysis [Analyzing]
Concept: Grief and Loss
Difficulty: Moderate
Feedback
1 Denial is the psyche’s way of protecting itself from the harsh, bitter truth. This psychological protection is there until the person’s psyche can deal with the loss.
2 Bargaining is making a deal; planning to do something so that the pain of loss will not occur or will go away.
3 Depression is frequently manifested by crying, withdrawal, poor appetite, and low energy.
4 When the grieving person reaches acceptance, there is a sense of relief. The grief process is over and living has started again.

PTS: 1 CON: Grief and Loss

4. ANS: 1
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care.
Chapter page reference: 202
Heading: Tolerance and Empathy
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Knowledge [Remembering]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 Tolerance is compassion and endurance.
2 Tolerance is patience and impartiality.
3 Tolerance is patience and open-mindedness.
4 Tolerance is open-mindedness and patience.

PTS: 1 CON: Grief and Loss

5. ANS: 2
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care.
Chapter page reference: 202
Heading: Tolerance and Empathy
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Knowledge [Remembering]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 Empathy is not assuming the patient’s emotions.
2 The definition of empathy is the ability to identify with the patient by being sympathetic and understanding.
3 Empathy is not identifying with patients.
4 Empathy is not a decision-making process.

PTS: 1 CON: Grief and Loss

6. ANS: 4
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care.
Chapter page reference: 202
Heading: Box 11.1 Qualities to Develop Before Working with Dying People
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Knowledge [Remembering]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 A good listener takes time.
2 A good listener does not interrupt.
3 A good listener asks appropriate questions.
4 A good listener does not assume what the speaker will say.

PTS: 1 CON: Grief and Loss

7. ANS: 4
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney.
Chapter page reference: 205
Heading: Advance Directives
Integrated Processes: Nursing Process: Implementation
Client Need: Safe and Effective Care Environment: Coordinated Care
Cognitive level: Application [Applying]
Concept: Legal
Difficulty: Moderate
Feedback
1 A court does not need to be consulted to make this decision.
2 The physician is not responsible for making this decision.
3 Inserting a feeding tube would be in violation of the patient’s living will.
4 Family members and facilities must abide by the patient’s wishes when those wishes are stated in a living will. Not even family members can make decisions for an incompetent patient with clear and convincing evidence of the patient’s wishes. In this case, the clear and convincing evidence exists as a living will.

PTS: 1 CON: Legal

8. ANS: 2
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 6. Differentiate between a living will and a durable power of attorney.
Chapter page reference: 205
Heading: Advance Directives
Integrated Processes: Nursing Process: Assessment
Client Need: Safe and Effective Care Environment: Coordinated Care
Cognitive level: Knowledge [Remembering]
Concept: Legal
Difficulty: Easy
Feedback
1 A secondary benefit is to prevent others from being able to abuse the individual if he or she should become incompetent.
2 The primary purpose of the advance directive is to follow the wishes of the person who wrote it.
3 Advance directives are not written by family to make decisions for other family members.
4 The state has the right to assign independent individuals to make health-care decisions for incompetent individuals, however, an advance directive would prevent state intervention.

PTS: 1 CON: Legal

9. ANS: 3
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 1. Define the essential characteristics of a hospice organization.
Chapter page reference: 204
Heading: Box 11.2 Essential Components of Hospice Programs
Integrated Processes: Nursing Process: Assessment
Client Need: Psychosocial Integrity
Cognitive level: Knowledge [Remembering]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 A quality hospice program is available 24/7 and not just 9:00 a.m. to 5:00 p.m.
2 A quality hospice program has a small patient-to-caregiver ratio.
3 A quality hospice program is sensitive to all cultures, values, and beliefs and has an interdisciplinary team of experts in state-of-the-art care of dying persons with small patient-to-caregiver ratios.
4 A quality hospice program does not have a specific belief structure and is not rigid in responding to specific needs.

PTS: 1 CON: Grief and Loss

10. ANS: 2
Chapter number and title: Chapter 11: End-of-Life Issues in Older Adults
Chapter/learning objective: 3. List the qualities necessary for a nurse to give end-of-life care.
Chapter page reference: 202
Heading: Box 11.1 Qualities to Develop Before Working with Dying People
Integrated Processes: Nursing Process: Planning
Client Need: Psychosocial Integrity
Cognitive level: Comprehension [Understanding]
Concept: Grief and Loss
Difficulty: Easy
Feedback
1 All personnel working with dying individuals need a high level of flexibility.
2 All personnel working with dying individuals need a high level of maturity.
3 All personnel working with dying individuals need a sense of humor.
4 All personnel working with dying individuals need good listening skills.

PTS: 1 CON: Grief and Loss