Psychosocial and Spiritual Aspects of Palliative Care Quiz Answers

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Week 01: Psychosocial and Spiritual Aspects of Palliative Care Quiz Answers

Introduction to Common Concerns Assessment

When someone has cancer and is anxious about the outcome of the next healthcare appointment, they are experiencing:

  • Spiritual concern
  • Psychological concern
  • Social concern
  • None of the above

Why do we often talk about psychological, social and spiritual suffering together (i.e., psycho-social-spiritual suffering)?

  • These terms all mean the same thing
  • These terms are grouped together because each one is a minor source of suffering on its own
  • Causes and symptoms of these types of suffering often overlap
  • Healthcare providers don’t understand these sources of suffering

Which of the following statements describes a way palliative care providers can help ease relationship concerns for people who have serious illnesses?

  • Ask patients if they have any relationship concerns
  • Tell family members to set aside their differences while the patient is ill
  • Set communications ground rules with family members so you can control interactions more effectively
  • Palliative care providers should not get involved in relationship concerns

A “family system” is:

  • A theory of how families can cope effectively with serious illness
  • All people related to the patient by blood
  • A set of behavioral rules followed by all members of an extended family
  • Every person who is considered “family,” whether they are blood-relations or just have close ties to the patient

Utilizing Maslow’s Hierarchy of Needs to understand financial distress, which of the following statements are correct? Choose all that apply

  • Financial distress associated with serious illness can impact the most basic needs, like food and shelter
  • Health Insurance and access to health care is an example of meeting the Safety Needs of patients and families
  • With palliative care support, all patients will be able to achieve the highest levels of functioning, which includes personal growth and self-fulfillment

Even when patients have health insurance, some common healthcare services that are needed for care in the home may not be covered. Which of the following are health care services that are needed but insurance m? Choose all that apply

  • Home health aides
  • Rent
  • Hospital bed
  • Medications
  • Oxygen tanks
  • Utilities (e.g., electricity and phone)

Martha, who lives in Denver, Colorado USA, has health insurance through her employer. Martha has been hospitalized for a new diagnosis of lung cancer that has already spread to bone. She is not able to continue to work due to this serious illness. True or False: It is likely that Martha will become uninsured in the next few months because she will have difficulty paying her premium.

  • True
  • False

Select the intervention that may worsen the severity of a body image problem.

  • Encourage discussion of concerns
  • Use active listening skills
  • Highlight the temporary nature of side effects
  • Educate the person and family caregiver(s) about body image changes associated with treatment
  • Encourage the person to go back to work before talking about how coworkers may respond to new hair loss

How can you help people accept a body image change?

  • Set a time frame for feeling bad about changes and then encourage the person to quickly move on
  • Encourage the person to express negative emotions, especially anger
  • Teach family caregivers about body image changes
  • Suggest reconstructive surgery or scar revision

Which of the following complementary therapies may not be beneficial to persons adjusting to body image changes? Choose all that apply

  • Art therapy
  • Exercise
  • Music therapy
  • Strength training
  • Plastic surgery
  • Mindfulness

Week 02: Psychosocial and Spiritual Aspects of Palliative Care Quiz Answers

How Sad is Too Sad Assessment

Priya has multiple sclerosis. When you see her for the first time in 2 weeks, you notice that she is now using a cane to help with balance when she walks. You ask about the cane and Priya tells you she is angry because the disease is taking away her ability to get out of the house every day. Priya’s loss of walking freely is an example of:

  • Real loss
  • Threatened loss
  • Chronic loss
  • Symbolic loss

Jeff wants to cry when he learns his grandmother died from heart failure, but he knows his family expects him to be strong and not show his emotions. Jeff’s situation is an example of:

  • Anticipatory grief
  • Disenfranchised grief
  • Chronic grief
  • Normal grief

Omo has stage IV lung cancer. She believes she will die before her daughter gives birth to her first grandchild. Whenever Omo’s daughter talks about her pregnancy, Omo starts a fight with her daughter over something insignificant. Omo shows signs of:

  • Anticipatory grief
  • Disenfranchised grief
  • Chronic grief
  • Normal grief

Due to growing fatigue as her illness progresses, Bella can no longer join her family on hikes in the hills near their home. This is an activity the family has enjoyed together for many years. Bella encourages her family to continue to hike on Saturday mornings, but over time they notice that she has no appetite for the rest of the weekend. Bella’s appetite loss is a sign of:

  • Anticipatory grief
  • Disenfranchised grief
  • Chronic grief
  • Normal grief

Dell’s 60-year-old mother dies unexpectedly in a car accident. Dell and his two adult sisters create a meaningful memorial service for their mother, and many friends and relatives attend. Dell laughs and cries during the service as people share stories about his mother’s life. Dell shows signs of:

  • Normal grief
  • Anticipatory grief
  • Disenfranchised grief
  • Chronic grief

Thi provides constant care for her mother, who has pancreatic cancer. Thi is no longer able to pursue her education and dreams for the future. She feels guilty about resenting the demands her mother’s care places on her time. Thi is likely experiencing:

  • Normal grief
  • Anticipatory grief
  • Depression
  • Caregiver burden

Luis is a 65-year-old retired auto mechanic with advanced colon cancer. This is your first visit with him and his wife, Angela. Luis says he is in pain and “can’t do anything anymore.” Angela reports that she has been worried about Luis for the past 3 weeks because he has been a “sad lump” ever since he became too weak to work on his cars at home. He can no longer climb the stairs to their second-floor bedroom, and he is unable to use the bathroom by himself. Angela says Luis sleeps more each week and does not eat well because of nausea. As Angela talks, Luis sits slumped in his chair, looking his hands. When you ask if he has anything to add to Angela’s report, he just shakes his head to indicate “no.” You believe Luis may be experiencing:

  • Normal grief because of his advanced cancer
  • Demoralization
  • Desire for hastened death
  • Caregiver burden

You ask Luis what concerns him most about his illness right now. He says “It’s too much for Angela to take care of me anymore. I want her to have the life she deserves.” How concerned should you be that Luis may have a desire for hastened death?

  • Not at all concerned
  • Somewhat concerned
  • Very concerned
  • I would not ask this question

You want to know if Luis’ desire for hastened death is just a passing thought, or if he’s seriously thinking about ending his life. Your next step should be:

  • Ask Luis how he feels about suicide
  • Ask Angela is she thinks Luis is planning to end his life
  • Ask Luis if he is planning to end his life
  • Ask Luis if he feels like he is a burden on Angela

After Luis tells you he is not thinking of killing himself, the three of you discuss ways to help improve his quality of life. Then, you turn your attention to Angela. You ask how she has been coping with Luis’ illness the past 3 weeks. Angela sighs and says “I wish I could do more for my Luis. I am causing him more pain because I can’t manage the house as well as he did.” When you ask if they have family who can help, Angela tells you “Yes, but when they call these days, we tell them not to visit. It’s too hard for everyone.” You believe Angela may be experiencing:

  • Normal grief as a caregiver for someone with a serious illness
  • Depression
  • Desire for hastened death
  • Caregiver burden

Week 03: Psychosocial and Spiritual Aspects of Palliative Care Quiz Answers

Anxiety and Coping Assessment

People indicate they are anxious by:

  • Complaining of vague aches and pains
  • Saying they feel “tense,” “not quite right,” or “worried”
  • Calling their healthcare provider constantly for more information
  • All of the above

Which of the following statements is true?

  • People with anxiety related to serious illness may think the worst will happen
  • When patients feel better physically, anxiety related to serious illness disappears
  • People with a past history of anxiety are less likely to have anxiety related to serious illness
  • Anxiety is always a negative response to serious illness

Death anxiety can be described as:

  • Fear of being around people who are dying
  • Complicated grief about a person who has recently died
  • Feelings of dread, apprehension, and fear when thinking about death and dying
  • Fear of dying alone

Which of the following statements is true?

  • People who are very religious are not afraid of death because they will go to heaven when they die
  • There is no proven relationship between being religious and experiences of death anxiety
  • Atheists are protected from death anxiety because they do not believe in an afterlife
  • Patients who do not talk about death will not be anxious about it

Ivan is a new palliative care patient. He tells you he is worried about many things. Your best response would be:

  • Let me teach you how to tense and relax your muscles
  • Tell me what worries you today
  • You’re using chest breathing. If you take more deep breaths, you’ll feel better
  • You may need antidepressants to help you cope with your anxiety

Which of the following patients is most likely to use spirituality to cope with their serious illness?

  • Bea is a 74-year-old widow living on a fixed income. She emigrated from the Philippines to Germany as a young adult and worked as a housekeeper until chronic pain recently forced her to see a healthcare provider. She was diagnosed with end-stage liver cancer. She lives with her adult daughter and 6 grandchildren in a small apartment.
  • Kacey is 28 years old, engaged to be married, and is working as a legal assistant in a midwestern town in the United States, where she was born. She was recently diagnosed with breast cancer, but she currently looks healthy and feels good physically.
  • Ricardo is a 45-year-old Latino auto mechanic who lives in Bolivia. He has been married for 23 years, and he has no living children. Ricardo and his wife have been careful with their money; they have no debt and have saved as much as they could over the years. A prolonged cough led to a lung cancer diagnosis. Ricardo recently had to stop work because of fatigue and other symptoms.

Which of the following best describes “collaborative spiritual coping”?

  • The patient manages the stress of the illness experience on her own
  • The patient gives control of his illness experience to God, saying “God knows what is best for me.”
  • The patient actively does what she can, and she gives control of everything else to a higher power.

How does “normalizing” anxiety help patients cope with anxious feelings about the illness experience?

  • Telling patients their anxiety is normal helps them breathe more deeply, reducing the physical feelings of anxiety
  • Telling people that anxiety is not a serious mental health problem helps them realize they can cope with it on their own
  • Telling patients that anxiety is normal with serious illness reduces shame the person may feel about not being able to cope well with the illness.
  • Telling patients that anxiety will make their illness experience worse will prompt them to get help

Which of the following is true about the diagnostic phase of serious illness?

  • Patients can feel like they’re on an emotional roller coaster
  • Patients are ready to say goodbye to loved ones
  • Patients can create a “new normal” life that includes serious illness
  • Patients may experience spiritual renewal and peace

MaryLou was diagnosed with brain cancer 6 months ago. She has adapted well to treatments and medications, and she has a large, dependable support system. She tells you her prognosis is good, she is free of pain, and she has the energy to make peace with people from her past. Which phase of serious illness is MaryLou likely in?

  • Diagnostic phase
  • Chronic phase
  • Recovery phase
  • Terminal phase

Which of the following routes for medications are best for people who are in the last days and hours of life? Choose all that apply.

  • IV Injections
  • Pills
  • Drops under the tongue
  • Liquids
  • Suppositories

The phase of death referred to as “Rigor Mortis” involves stiffening of the joints and muscles of the body occurring a few hours after death and usually lasts from one to four days.

  • True
  • False

What could you do to provide a comforting environment for a family to view their newly deceased loved one? Please select all that apply.

  • Provide enough chairs around the bed for family members and loved ones
  • Provide soft lighting if possible
  • Cleanse the body, remove all drains and tubes, dress the deceased in clothing selected by the family, and position the bed sheets appropriately
  • If desired, play soft music in the background

Which of the following statements regarding identifying people who are nearing the end of life are correct? Choose all that apply

  • Patients in the last days or weeks of life are usually eating all their meals and are able to get out of bed easily
  • The Surprise Question can be used to identify patients that are in the last 6 months –to year of life that would benefit from symptom assessment and goals of care conversations
  • Frequent hospitalizations and inability to swallow pills are common signs that time may be short
  • The Surprise Question can be used to identify many patients that are likely to die in the hospital or nursing home and will need benefit from a comfort focused care plan
  • The Surprise Question can predict sudden and unexpected deaths

Which of the following are statements are true regarding medication for symptoms in the last days of life? Choose all that apply

  • It is important to continue to take medications like multivitamins or cholesterol lowering medications even on the last day of life
  • Lower doses of opioid medications given every 1-2 hours for pain allows families and providers to better control pain without causing over sedation
  • Converting medications to liquid/elixir formulations allows patients and families to manage symptoms when pills are hard to swallow
  • IV injection of pain medication is always more effective that oral pain medication

Week 04: Psychosocial and Spiritual Aspects of Palliative Care Quiz Answers

Easing Spiritual Distress Assessment

Which of the following is one of the two key elements of spiritual orienting systems?

  • Belonging to a faith community
  • Belief in God
  • Connection to the sacred
  • Prayer and meditation

In spiritual conversations, why is it important to use the other person’s words?

  • It shows respect for the other person as the expert on her or his spiritual world
  • We want to show curiosity about the person’s beliefs
  • It shows we are listening carefully
  • It will show that we know more than other person about spirituality

The 4 steps of SNAP are:

  • See, Note, Ask, Pause
  • Self-awareness, Now, Ask, Person guides
  • Self-awareness, Now, Ask, Pause
  • See, Now, Align values, Person guides

Palliative care providers should be aware of how patients and families make meaning of serious illness because:

  • The way people understand the cause of a serious illness can affect their willingness to follow healthcare treatment plans
  • Meaning making is an interesting topic to discuss
  • Palliative care providers should educate patients and families on meaning making models
  • The inability to make meaning can be a sign of depression

Which statement best describes the moral model understanding of serious illness?

  • Illness may be caused by spirits, gods, or demons
  • Illness is a defect or a problem to be fixed in the body
  • Illness is a normal experience for humans
  • Illness is the result of life energy that is slow, out of balance, weak, or blocked

Which statement best describes the biomedical model understanding of serious illness?

  • Illness may be caused by spirits, gods, or demons
  • Illness is a defect or a problem to be fixed in the body
  • Illness is a normal experience for humans
  • Illness is the result of life energy that is slow, out of balance, weak, or blocked

Which statement best describes the energy body understanding of serious illness?

  • Illness may be caused by spirits, gods, or demons
  • Illness is a defect or a problem to be fixed in the body
  • Illness is a normal experience for humans
  • Illness is the result of life energy that is slow, out of balance, weak, or blocked

Which statement best describes the social model understanding of serious illness?

  • Illness may be caused by spirits, gods, or demons
  • Illness is a defect or a problem to be fixed in the body
  • Illness is a normal experience for humans
  • Illness is the result of life energy that is slow, out of balance, weak, or blocked

Which statement is true?

  • Spiritual distress is the opposite of spiritual well-being
  • Spiritual distress is the same experience as spiritual crisis
  • Most people with a serious or life-limiting illness will experience a spiritual crisis
  • Patients who can stay at home during serious illness have less spiritual distress than patients who are hospitalized or in other care facilities

When patients who are near death tell you they hope for a miracle cure, you should:

  • Tell them miracles don’t happen in a world where science explains the healing process
  • Tell them how your religion defines miracle
  • Say you hope for that as well and ask questions to help them consider realistic hopes for the coming days
  • Tell them you know they don’t really expect a literal miracle

Week 05: Psychosocial and Spiritual Aspects of Palliative Care Quiz Answers

Advocating Advance Care Planning, Shared Decision Making, Goals of Care, and Family Meetings Assessment

Charlie and Joy have been married for 45 years. Charlie is a controlling, dominating personality who makes all the decisions in the home. Joy has gone along with these decisions over the years but doesn’t necessarily agree with all of them. They have two children, Tom and Amanda, who live in other states and see their parents once every 4-5 years. Joy has a best friend named Sophie. Until Joy was diagnosed with Alzheimer’s, she and Sophie had spent many many days together talking about everything in their lives. Joy’s disease has progressed to the point where she is no longer able to make her own decisions. Who do you think would make the best healthcare decision maker for Joy?

  • Amanda
  • Sophie
  • Tom
  • Charlie

According to studies, how many people have put their end-of-life wishes into writing?

  • 86%
  • 73%
  • 23%
  • 18%

Hillary has been cared for by her Primary Care Provider (PCP) for over 25 years. Her PCP knows her well and has seen her through numerous illnesses as well as healthy visits. Hillary has a great relationship with her PCP and feels she understands Hillary’s values and preferences for treatments. Last month, Hillary was diagnosed with Stage 4 lung cancer and her prognosis to live longer than 6 months is not likely. She is getting her End-of-life wishes together however she has no family and no close friends. Can she choose her PCP to be her Healthcare decision maker?

  • Yes. Her PCP knows her well and would be a good person to choose to speak for her in the event she is unable to speak for herself
  • Yes. As a healthcare professional, this would be a great person to select to speak for her in the event she is unable to speak for herself
  • No. She is on the healthcare team caring for Hillary and thus not eligible to serve as healthcare decision maker

No. She is too busy as a healthcare provider to also serve as Hillary’s healthcare decision maker

When someone decides to change their healthcare decision maker legally, the next best step is to?

  • Start a new living will document but there is no need to complete the MDPOA portion
  • Complete a new MDPOA form and shred the old one
  • Tell your new proxy you have appointed him/her
  • Tell your healthcare team

It is best not to bring up the topic of end-of-life wishes to a parent who has a serious illness because he/she might get mad

  • True
  • False

Which of the following statements are false?

  • A medical durable power of attorney document lists your health care agent or medical decision maker – someone who will make decisions for you if you cannot make them for yourself
  • An advance directive is the same thing as a MDPOA
  • A living will is a document that describes the health care you want
  • An advance directive is a form you complete that BOTH lists your health care agent and tells your family and healthcare providers the kind of care you would want if you were sick and unable to speak for yourself

Who should have an advance directive? (Please check all that apply)

  • Persons with dementia
  • Persons with advanced medical illness
  • Everyone over age 18
  • Those who are 65 years of age and older
  • Children under the age of 18

Once you have completed an advance directive, it is difficult to make any changes

  • True
  • False

Which of the following statements are true about advance directive completion? Choose all that apply

  • You should share a copy with your healthcare agent
  • You should share a copy with your healthcare provider
  • You only need to have one witness watch you sign the advance directive
  • You should keep a copy for yourself
  • You need two witnesses to see you sign the advance directive
  • You must always have your AD notarized
  • You should keep it a secret and not tell anyone you have one

Which is the best example of Shared Decision making?

  • A mother making the decision to give her son an antibiotic for his respiratory infection
  • A physician explaining the risks, benefits and burdens of a surgery with a patient and together a decision is made to move ahead with the surgery
  • A physician explaining the risks, benefits and burdens of a treatment to a patient then selecting the treatment that seems to be the best option
  • An adult daughter and her Mom’s social worker talk about the housing available for the Mom. Together the daughter and the social worker select the best option and proceed with moving the Mom into this housing

What are some examples of goals of care? Choose all that apply

  • Not being a burden to my family
  • Living to see my daughter’s wedding
  • Surgery
  • Being awake to see my family at dinner
  • Radiation

PERSON is a way to use letters to represent the steps that are helpful to keep in mind when talking with people about their Goals of Care. The P can represent two different words. These words are?

  • Perception and Preparation
  • Persuasion and preparation
  • Preparation and production
  • Present and preparedness

Joe, a 75-year-old gentleman who is living with advanced cancer of his stomach, has come to the palliative care clinic to talk about his next treatment decisions. His oncologist has suggested a round of chemotherapy. The chemotherapy has a 80% chance of successfully stopping the growth of his stomach tumor. Joe needs to come to the oncology office once a week for this treatment. His insurance will cover 75% of this medication but Joe will need to pay an estimated $1500 out of pocket. There is a significant chance this medication will cause Joe to become susceptible to illness and possibly causing hospitalizations. It will be unlikely that he will be able to continue going for his daily walks while he is undergoing treatment. What is the burden Joe is facing with this treatment plan?

  • The 20% chance of the chemotherapy not working
  • The estimated $1500 out of pocket cost for the medication
  • The possibility of hospitalization
  • The 80% chance of successfully stopping the tumor growth

When would be a good time to hold a family conference? Select all that apply

  • When there is uncertainty about what the patient wants from his or her treatment
  • When the healthcare providers need to talk the patient into treatments that they feel are best for the patient
  • When the family caregiver wants to meet with the healthcare team to decide the course of treatment
  • When there are questions about the what is going on with the patient’s disease process

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