Chapter-05-TB - Test banks for quizzes PDF

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Chapter Five: Hospice and Palliative Care

Multiple Choice 1.0. The term ______ was suggested by Canadian physician Balfour Mount in the 1970s and has continued to gain favor. a. hospital care b. hospice care c. pain care d. palliative care Difficulty: 1 Page-Reference: 144 Answer: d. palliative care 2.0. Approximately ______ terminally ill Americans receive hospice care at the end of their lives. a. 100,000 b. 300,000 c. 600,000 d. 1.45 million Difficulty: 1 Page-Reference: 144 Answer: d. 1.45 million 3.0. Currently, nearly ______ people choose palliative care as end of life draws near. a. 1 out of 4 b. 2 out of 4 c. 1 out of 5 d. 2 out of 5 Difficulty: 1 Page-Reference: 144 Answer: d. 2 out of 5 4.0. The earliest type of hospice facilities were well established by the ______ century. a. fifth b. ninth c. eleventh d. eighteenth Difficulty: 1 Page-Reference: 145 Answer: a. fifth 5.0. After a long absence, the renewed hospice approach to caring for the dying appeared in the ______ century. a. eighteenth b. nineteenth c. twentieth d. twenty first

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Difficulty: 1 Page-Reference: 146 Answer: b. nineteenth 6.0. ______ introduced modern hospice care when she founded St. Christopher's Hospice in London. a. Cicely Saunders b. Elizabeth Kübler-Ross c. Florence Nightingale d. Dame Myra Hess Difficulty: 1 Page-Reference: 147 Answer: a. Cicely Saunders 7.0. The International Work Group on Death and Dying was critical of the type of terminal care provided in most hospitals in the early 1970s. It was noted that: a. many people are doing the same tasks over and over. b. the "successful" death is quiet, slipping with little notice. c. the body is neglected during the caregiving process. d. all of the above Difficulty: 1 Page-Reference: 152 Answer: b. the "successful" death is quiet, slipping with little notice. 8.0. The International Work Group on Death and Dying recommended all of the following standards of care for the terminally ill EXCEPT to: a. control pain as a treatment goal. b. provide a sense of basic security and emotional safety. c. make sure that the patient is alone at the time of death. d. respect the patient's intentions as expressed in a living will. Difficulty: 1 Page-Reference: 148-149 Answer: c. make sure that the patient is alone at the time of death. 9.0. Which of the following is a family-oriented standard of care for the terminally ill? a. They should have adequate time to form and maintain personal relationships with the patient. b. They should provide opportunities for leave-takings with the people most important to the patient. c. They should have the opportunity for privacy with the dying person both while living and immediately after death. d. They should not be apprehensive about unexpected diagnostic treatment procedures. Difficulty: 3 Page-Reference: 149 Answer: c. They should have the opportunity for privacy with the dying person both while living and immediately after death. 10.0. The daughter's response to "Mother's Last Moments," a hospice vignette presented in the text, was: a. "It was the worst experience I've ever had in my life." b. "It was really right...and she was ready to go."

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c. "I never touched her that last day, and I'll always regret that!" d. "She looked like she was suffering so!" Difficulty: 2 Page-Reference: 151 Answer: b. "It was really right...and she was ready to go." 11.0. The story of Barbara, a woman who had lived an active and useful life as a Native American and university faculty member, indicated that: a. hospice was not sensitive to her ethnic heritage. b. no religious spokesperson on either side demanded a pure or exclusionary approach. c. hospice still operated from a predominantly Christian perspective. d. family was more meaningful during end-of-life care. Difficulty: 2 Page-Reference: 151-152 Answer: b. no religious spokesperson on either side demanded a pure or exclusionary approach. 12.0. Some terminal patients feel more comfortable in ______ because they are able to spend a few days with considerate and expert caregivers who are not part of their interpersonal network, thus liberating them from the investment of limited emotional energy in meeting the needs and expectations of their families and friends. a. medical care facilities b. their own homes c. respite care settings d. a & c Difficulty: 2 Page-Reference: 152 Answer: d. a & c 13.0. Seven-year-old Marie's experiences during her terminal illness demonstrated: a. the success of traditional medical care in comforting a dying child. b. a failure of hospice care to comfort the dying child. c. the comfort that can be provided by the active involvement of family. d. none of the above Difficulty: 2 Page-Reference: 153 Answer: d. none of the above 14.0. Most hospice programs: a. provide a full range of services to AIDS patients without bias. b. provide services to AIDS patients only in a limited and reluctant way. c. provide services to AIDS patients but with a lower level of quality. d. do not provide services to AIDS patients. Difficulty: 2 Page-Reference: 154-155 Answer: a. provide a full range of services to AIDS patients without bias.

15.0. Which of the following is a barrier to hospice care for persons with AIDS?

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a. willingness of the community to support hospice operations through volunteer services and fundraising b. willingness of hospice staff and administrators to provide services to AIDS patients c. willingness of health care system to make whatever adjustments might be necessary in admission and management of AIDS patients d. all of the above Difficulty: 2 Page-Reference: 154 Answer: d. all of the above 16.0. Which is true of hospice care internationally? a. Most medical systems readily embrace hospice. b. Most clients choose to live in a hospice facility. c. It is used equally by men and women. d. all of the above Difficulty: 2 Page-Reference: 154 Answer: c. It is used equally by men and women. 17.0. All of the following are true of the hospice movement internationally EXCEPT that: a. hospice care is growing rapidly throughout much of the world. b. pain control is not the primary object for hospice in some countries. c. education for patients and medical care providers is a top priority. d. education for government officials and societies at large is a top priority. Difficulty: 2 Page-Reference: 155 Answer: b. pain control is not the primary object for hospice in some countries. 18.0. Pain control is important because it: a. eliminates the dying person's fear of death. b. enables the dying person to give attention to more important matters. c. reduces the dying person's concern for surviving family members. d. effectively controls life-threatening illnesses. Difficulty: 2 Page-Reference: 155 Answer: b. it enables the dying person to give attention to more important matters. 19.0. The most recent addition to the standard four vital signs is: a. temperature. b. pulse. c. pain. d. respiration. Difficulty: 1 Page-Reference: 155 Answer: c. pain. 20.0. Research finds that hospital-based nurses and physicians: a. hold negative attitudes toward hospice and are not well informed about the state of the art in pain relief. b. hold positive attitudes toward hospice and are not well informed about the state of the art in pain relief.

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c. hold negative attitudes toward hospice and are well informed about the state of the art in pain relief. d. judge themselves to lack competence in providing pain relief for terminally ill patients. Difficulty: 2 Page-Reference: 156 Answer: b. hold positive attitudes toward hospice and are not well informed about the state of the art in pain relief. 21.0. Experts suggest all of the following ways to relieve pain in terminally ill patients without surgery or drugs EXCEPT: a. promoting the moral value of pain and suffering. b. spending time with a companion animal. c. guided imagery. d. massage. Difficulty: 2 Page-Reference: 155-156 Answer: a. promoting the moral value of pain and suffering. 22.0. ______ is a symptom of terminal decline that often has not received the attention it deserves. a. Nausea b. Dypsnea c. Fatigue d. Confusion Difficulty: 2 Page-Reference: 157 Answer: c. Fatigue 23.0. ______ is a state of mind in which there is a lack of clarity and organization, along with difficulty in making accurate judgments. a. Confusion b. Delirium c. Dementia d. Dypsnea Difficulty: 2 Page-Reference: 157 Answer: a. Confusion 24.0. ______ is an agitated and incoherent state of mind that could be described as a fit of madness. a. Confusion b. Delirium c. Dementia d. Dypsnea Difficulty: 2 Page-Reference: 157 Answer: b. Delirium 25.0. When asked how they would like the last three days of their lives to be, the most frequent answer given by hospice clients was: a. "I want to be free from pain." b. "I want the last three days to be like any other days."

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c. "I want certain people to be here with me." d. "I want to be physically able to do things." Difficulty: 2 Page-Reference: 158 Answer: c. "I want certain people to be here with me." 26.0. Hospice Medicare benefits cover the costs of: a. physicians' services. b. home health aides. c. pastoral counselors. d. all of the above Difficulty: 2 Page-Reference: 159 Answer: d. all of the above 27.0. A major study found that most physicians refer patients: a. to hospice programs too early. b. to hospice programs too late. c. who are not really terminally ill to hospice programs. d. none of the above Difficulty: 2 Page-Reference: 159 Answer: b. to hospice programs too late. 28.0. Gorospe (2006) judged palliative care to be an essential public health intervention that was seldom available to: a. the impoverished. b. Native Americans. c. white Americans. d. Hispanic Americans. Difficulty: 2 Page-Reference: 160 Answer: b. Native Americans. 29.0. One of the greatest challenges facing hospice today is the: a. continuity of care. b. maintenance of high staff to patient ratios. c. medicalization of death that creates a businesslike culture. d. all of the above Difficulty: 2 Page-Reference: 160-161 Answer: d. all of the above 30.0. One reason a hospice may refuse an individual's participation as a volunteer is due to: a. a disorganized lifestyle. b. a timid personality. c. an abundance of volunteers. d. unprofessional assessments. Difficulty: 2 Page-Reference: 163 Answer: a. a disorganized lifestyle.

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True/False 1.0. Early Greeks had temples for healing which were very holistic in nature, but were not designed to care for the dying. a. true b. false Difficulty: 1 Page-Reference: 145 Answer: a. true 2.0. The earliest documented infirmaries designed for people dying from epidemics were established in the Greek-speaking areas of Christian lands in the fourth century. a. true b. false Difficulty: 2 Page-Reference: 145 Answer: a. true 3.0. One of the most well-known hospice facility in the sixth century was the Monte Cassino monastery. a. true b. false Difficulty: 2 Page-Reference: 146 Answer: a. true 4.0. One family-oriented standard for hospice care suggests that it is not acceptable for the staff to disregard requests for information or expressions of the need to share feelings. a. true b. false Difficulty: 2 Page-Reference: 149 Answer: a. true 5.0. Throughout the world the largest number of hospice patients fall within the 60-79 age group. a. true b. false Difficulty: 2 Page-Reference: 154 Answer: a. true 6.0. Inpatient care is the type of service most often received by hospice clients in every world region. a. true b. false

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Difficulty: 2 Page-Reference: 154 Answer: b. false 7.0. The primary goal of palliative care is to reduce anxiety. a. true b. false Difficulty: 2 Page-Reference: 155 Answer: b. false 8.0. Pain control, relief, and suffering are difficult to manage because they represent a qualitative and subjective experience. a. true b. false Difficulty: 2 Page-Reference: 155-156 Answer: a. true 9.0. The typical hospital-based physician and nurse have a level of confidence about their ability to provide technically competent care to terminally ill patients that is not supported by their actual knowledge of the effects of specific pain medication regimes. a. true b. false Difficulty: 2 Page-Reference: 156 Answer: a. true 10.0. The personality and mental state of patients and the interpersonal setting in which they are located do not affect sensitivity to pain. a. true b. false Difficulty: 2 Page-Reference: 156 Answer: b. false 11.0. The Waddell observational signs are effective in making distinctions between organic and psychological pain. a. true b. false Difficulty: 2 Page-Reference: 156 Answer: b. false 12.0. Other problems that can beset a dying person include nausea, dypsnea, incontinence, and weakness. a. true b. false Difficulty: 1 Page-Reference: 157 Answer: a. true

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13.0. In a national survey of wishes for the last three days of life, very few people chose being "mentally alert" as a top priority. a. true b. false Difficulty: 2 Page-Reference: 158 Answer: a. true 14.0. In a national survey of wishes for the last three days of life, very few people chose to "live until a certain time or event." a. true b. false Difficulty: 2 Page-Reference: 158 Answer: a. true 15.0. The homeless, migrants, and other impoverished individuals still have equal access and utilization of palliative care. a. true b. false Difficulty: 2 Page-Reference: 160 Answer: b. false 16.0. Members of racial and ethnic minorities less frequently choose hospice care. a. true b. false Difficulty: 2 Page-Reference: 160 Answer: a. true 17.0. An aging prison population has led to an increase in hospice care services for the inmates or "done-bads." a. true b. false Difficulty: 2 Page-Reference: 160 Answer: b. false 18.0. When a patient such as "Mr. A" physically assaults staff members with his motorized wheelchair, then standard operating procedures should be enforced to manage or ensure patient compliance to hospice regulations. a. true b. false Difficulty: 3 Page-Reference: 161 Answer: b. false 19.0. Hospice can also be understood as a place to hasten death. a. true b. false

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Difficulty: 2 Page-Reference: 161 Answer: b. false 20.0. In the interview with Dame Cicely Saunders, Kastenbaum found that she greatly admired Dr. Kevorkian. a. true b. false Difficulty: 2 Page-Reference: 163 Answer: b. false

Vocabulary 1.0. amyotrophic lateral sclerosis (ALS) Difficulty: 2 Answer: A neuromuscular disorder in which there is a progression of weakness and paralysis until vital functions are inoperative. Also known as "Lou Gehrig's disease" after the New York Yankee Hall of Fame first baseman, and in Europe as "motor neuron disease." 2.0. cachement area Difficulty: 2 Answer: The geographical region served by a health care agency. 3.0. hospice Difficulty: 2 Answer: (1) A program of care devoted to providing comfort to terminally ill people through a team approach with participation by family members. (2) A facility in which such care is provided. 4.0. Medicare hospice benefit Difficulty: 2 Answer: A federal reimbursement program that enables eligible people to select hospice care as an alternative to traditional medical management during their terminal illness. 5.0. National Hospice Study Difficulty: 2 Answer: A major project (1982-1983) that compared traditional and hospice care for terminally ill people in the United States. The Medicare hospice benefit was established as a result of this study. 6.0. palliative care Difficulty: 2 Page-Reference: 167 Answer: Health services intended to reduce pain and other symptoms to protect the patient's quality of life. 7.0. physician-assisted suicide (PAS)

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Difficulty: 2 Answer: Termination of a person's life by a physician through lethal injection or other means, at that person's request (illegal except in Oregon when in compliance with the state's Death with Dignity Act). 8.0. remission Difficulty: 2 Answer: The disappearance or relief of symptoms. 9.0. symptom Difficulty: 2 Answer: An observable sign of dysfunction and/or distress (e.g., pain, fever). 10.0. terminal illness Difficulty: 2 Answer: Defined in the Medicare hospice benefit as an illness that is expected to end in death within six months or less. In other contexts, the specific definition is open to discussion and controversy. 11.0. vital signs Difficulty: 2 Answer: Body functions that are routinely assessed by physicians and nurses. Traditionally included temperature, pulse, respiration, and blood pressure. Now also includes patient's experience of pain.

Essay Questions 1.0. List Kastenbaum's four observations about the spirit of the modern hospice movement. Difficulty: 2 Answer: 1. Promoters of hospice have been mostly women 2. Unique personal interactions and relationships have been emphasized 3. Attitude that the patients know better than physicians what they need when dying 4. Attitude that all are free to make their own meaning regarding death (hospice does not promote religion) 2.0. List the four patient-oriented standards developed by the International Work Group on Death and Dying. Difficulty: 2 Answer: 1. Remission of symptoms is a treatment goal. 2. The patient's intentions will be respected as one of the main determinants of the total pattern of care. 3. Patients should feel safe. 4. Opportunities should be provided for leave-takings with the people most important to the patient, and for experiencing the final moments in a way that is meaningful to the patient.

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3.0. Describe any three of the five reasons given as to why pain must be controlled. Difficulty: 2 Page-Reference: 154-156 Answer: • Pain is, by definition, a stressful experience. • Pain reduces the ability to give attention to other matters, thereby isolating the sufferer and reducing opportunities to reflect, interact, and accomplish. • Pain can intensify other symptoms, such as weight loss, insomnia, pressure sores, and nausea. • Fear and anticipation of pain can be demoralizing. • Pain contributes much to anxiety about the dying process. 4.0. List five specific suggestions for relieving pain without surgery or drugs. Difficulty: 2 Answer: • Reduced mental distress that is associated with illness, dependency, loss of function, and concern about the future • Supportive social and familial relationships • Company of companion animals • Massage • Application of heat, cold, menthol, or electrical nerve stimulation to the skin • Careful positioning and exercising • Hypnosis • Guided imagery • Aroma therapy 5.0. List in order of frequency the five most common responses given by hospice clients as to how they wanted their last three days to be. Difficulty: 2 Answer: 1. I want certain people to be here with me. 2. I want to be physically able to do things. 3. I want to feel at peace. 4. I want to be free from pain. 5. I want the last three days of my life to be like any other days. 6.0. List in order of frequency the five sources of strength cited by hospice patients in a national survey. Difficulty: 2 Answer: 1. Supportive family or friends 2. Religion 3. Being needed 4. Confidence in self 5. Satisfied with the help received 7.0. Describe the key turning points in the development of hospice care from the early Christian movement to the founding of St. Christopher's Hospice in London. Difficulty: 2 Answer:

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Fourth Century - Public infirmaries were established in Greek-speaking areas of Chris...