Deck 12: Psychological Issues in Advancing and Terminal Illness

Question 1

For children _ devil. __, death is personified into a shadowy figure, such as a ghost or the

A) 11 to 12 years old
B) nine to ten years old
C) five to nine years old
D) five to six years old
E) 13 to 14 years old

Answer 1

five to nine years old

Question 2

The infant mortality rate in Canada

A) is higher relative to some Western European countries.
B) is higher for First Nations infants than for white infants.
C) is higher relative to some Western European countries, is higher for First Nations infants, but is unrelated to socio-economic status.
D) is higher relative to some Western European countries, is higher for First Nations infants, and is related to socio-economic status.
E) is unrelated to socio-economic status.

Answer 2

is higher relative to some Western European countries, is higher for First Nations infants, but is unrelated to socio-economic status.

Question 3

Sudden death

A) has the advantage of not allowing people to prepare their exit.
B) does not facilitate a more graceful departure.
C) is preferred by most people compared to slow and painful death.
D) is unkind to family members.
E) is brought about by physical deterioration and loss of mental faculties.

Answer 3

is preferred by most people compared to slow and painful death.

Question 4

As reproductive technology has improved over the past decade, the infant mortality rate for First Nations infants has declined.

Question 5

Death in the elderly is

A) less likely to be caused by degenerative diseases.
B) more likely to be prolonged.
C) usually accompanied by a shorter terminal phase.
D) more likely to be sudden.
E) usually protracted because there is often more than one biological competitor for death.

Question 6

Attaining the ideal of the good death is always possible, regardless of the health condition.

Question 7

In the first year of life, the main causes of death are

A) acute illness.
B) external factors.
C) congenital abnormalities and SIDS.
D) cancer, especially leukemia, and SIDS.
E) accidents and congenital abnormalities.

Question 8

Which of the following is one of the factors that have been found to predict mortality in the elderly age group?

A) depression
B) the neighbourhood they live in
C) satisfactory work-life balance
D) hardiness
E) distant family relationships

Question 9

Canadian right-to-die advocate Sue Rodriguez suffered from terminal multiple sclerosis.

Question 10

Currently, physician aid-in-dying is legal in

A) the Netherlands, Switzerland, Oregon (US), Washington (US), and Montana (US).
B) only the Netherlands.
C) California (US).
D) Oregon (US), Washington (US), and Montana (US).
E) the Netherlands and Switzerland.

Question 11

In Canada, ________ have a longer lifespan than _.

A) men; women
B) older adults; younger adults
C) older female adults; middle-aged female adults
D) women; men
E) older male adults; middle-aged male adults

Question 12

After infancy, the main cause of death among children younger than age 15 is

A) congenital abnormalities.
B) cancer, especially leukemia.
C) acute illness.
D) SIDS.
E) external causes.

Question 13

A living will outlines

A) a patient's wishes to undergo euthanasia.
B) a patient's request that extraordinary life-sustaining procedures not be used.
C) how children will be taken care of after one's death.
D) the disposition of one's belongings after death.
E) the conditions under which a patient requests to remain alive.

Question 14

The major cause of death in youths aged 15 to 24 is unintentional injury.

Question 15

Which of the following is NOT one of the factors that have been identified as contributing to a "good death"?

A) Preparation for death
B) Pain and symptom management
C) Clear decision making
D) Completion
E) Seeking forgiveness

Question 16

The main cause of premature death in adulthood is sudden death due to

A) stroke or heart attack.
B) accidents.
C) homicide.
D) AIDS.
E) drowning.

Question 17

Which of the following is NOT cited by your text as one of the factors that contribute to women's lower mortality rates?

A) biological fitness
B) social support
C) fewer risky behaviours
D) health beliefs
E) They are all cited by your text as factors that can contribute to women's lower mortality rates.

Question 18

Suicide between the ages of 15 to 24 is the ________ cause of death while ________ is/are the fourth leading cause of death.

A) second leading; homicide
B) first leading; cancer
C) third leading; homicide
D) second leading; cancer
E) first leading; external causes

Question 19

Poor adjustment for parents of children who have died from SIDS is associated with

A) maternal smoking.
B) alcoholism.
C) socio-economic status.
D) self-blame.
E) fear of having more children.

Question 20

According to the text, one important contributing factor to midlife crisis is the

A) gradual realization of impending death.
B) lower income of many middle-aged adults.
C) cultural emphasis placed on youth.
D) growing awareness that one's risk factors for chronic illness are increasing.
E) declining importance middle-aged adults place on their work.

Question 21

Advancing illness can threaten the of patients.

A) self-image
B) self-morale
C) self-concept
D) self-esteem
E) self-pride

Question 22

The development of a sense that one is leaving behind a legacy through one's children or one's work is termed "symbolic immortality."

Question 23

Which of the following is NOT one of the problematic issues surrounding euthanasia and physician aid in dying cited in your text?

A) It makes the patient comfortable during the last few days.
B) It will cause a change in how society views illness and disease.
C) It could lead to patients being killed or coerced into taking aid-in-dying against their will.
D) It conflicts with the physician's oath to "do no harm."
E) The reduction of patients' autonomy.

Question 24

Cultural differences have been found in beliefs about whether physicians think patients

A) should keep a terminal prognosis a secret from close friends or family.
B) should seek out CAM when all traditional methods have failed.
C) should be informed of all prognoses, terminal or not.
D) should make the decision about the use of life support.
E) work through stages of dying.

Question 25

Palliative care involves

A) ending the life of a patient who is suffering from a painful terminal illness.
B) custodial work designed to make the patient feel comfortable.
C) final attempts to cure the terminally ill patient.
D) life-prolonging interventions such as placing the patient on a respirator.
E) withholding medical information that might upset the patient.

Question 26

The correct order of Kübler-Ross's stages of adjustment to dying is

A) denial, anger, bargaining, depression, acceptance.
B) denial, anger, bargaining, acceptance, depression.
C) denial, bargaining, anger, depression, acceptance.
D) depression, anger, bargaining, denial, acceptance.
E) depression, denial, bargaining, anger, acceptance.

Question 27

In evaluating Kübler-Ross's theory

A) it is shown that the five stages only occur in elderly patients
B) the knowledge of the five stage model may actually create more anxiety and fear about the process of dying
C) research has found that people do go through the five stages in a pre-determined order
D) we see that patients, but not nurses or physicians expect people to go through each and every stage in a particular order
E) the five stages theory has helped to normalize death, and thus reduce the fear of dying significantly

Question 28

The hospitalized terminally ill patient runs the risk of being

A) over-nurtured by the medical staff.
B) overmedicated by the medical staff.
C) undermedicated by the medical staff.
D) ignored by the medical staff.
E) isolated by the medical staff.

Question 29

Which of the following is NOT one of the goals of medical staff who work with the dying?

A) Informing patients of their condition and treatment
B) Enabling patients and their families to experience anticipatory grief
C) Helping patients live as long as possible
D) Helping the patients use their remaining time as well as possible
E) Allowing the patients to achieve death with dignity

Question 30

According to critics, Kübler-Ross's theory has limitations because

A) it recognizes death as a process subject to rules and regulations.
B) it places too much importance on anxiety.
C) there is no evidence to support the proposition that patients go through stages.
D) there is little if any empirical evidence to support the proposition that patients go through five stages in a predetermined order.
E) it recognizes death as a complex and individual process.

Question 31

According to Kübler-Ross, the dying patient who is experiencing "anticipatory grief" is in the stage.

A) depression.
B) anger
C) bargaining.
D) acceptance.
E) denial.

Question 32

Long-term denial of a terminal illness should be a target of therapeutic intervention.

Question 33

Lazarus (1983) argues that early on in adjustment to life-threatening illness is both normal and useful.

A) anger
B) bargaining
C) acceptance
D) denial
E) anxiety

Question 34

Long-term denial of one's life-threatening illness

A) is healthy because it allows the patient to focus on enjoying life.
B) is a barrier to patient provider communication.
C) is functional in coping with anxiety.
D) may require therapeutic intervention.
E) is a typical reaction.

Question 35

Therapy with the dying differs from traditional psychotherapy in that

A) it should focus heavily on preparations that need to be made for survivors, especially dependent children.
B) the frequency and depth of sessions need to depend on the energy level of the patient.
C) therapy with a dying patient is not different from traditional psychotherapy.
D) it is necessary to discuss issues the patient clearly does not wish to discuss before it is too late.
E) it is a long-term commitment.

Question 36

Emotional and social withdrawal in terminally ill patients

A) may be caused by fear of depressing others and becoming an emotional burden.
B) is successfully treated with antidepressants.
C) is always due to anticipatory grieving.
D) is a social problem, unrelated to health concerns.
E) is not an issue because terminally ill patients are hospitalized with others in a similar condition.

Question 37

According to Kübler-Ross, the dying patient who asks "why me?" is experiencing

A) anger.
B) denial.
C) anxiety.
D) bargaining.
E) acceptance.

Question 38

The depressed terminally ill patient may be

A) out of a state of morose.
B) experiencing anticipatory relief.
C) coming to terms with a lot of control.
D) depressed as a result of experiencing tangible evidence that the illness is not going to be cured, such as a worsening of symptoms.
E) experiencing an expected transitory psychological state which requires intervention.

Question 39

As a patient's prognosis worsens, interpersonal communications often deteriorate. The reasons for this breakdown are generally due to

A) health care providers often have feelings of guilt or failure and are therefore reluctant to talk about the future.
B) a worry that focusing on death will cause the patient to die sooner.
C) indifference among medical staff members.
D) the belief that others do not want to talk about death.
E) long-term communication problems in the family.

Question 40

Kübler-Ross's theory has made an important contribution in identifying the universal stages of dying and breaking the taboo surrounding death.

Question 41

Cognitive-behavioural therapy can be employed with dying patients, especially

A) progressive muscle relaxation.
B) self-monitoring.
C) progressive muscle relaxation and positive self-talk.
D) positive self-talk.
E) positive self-talk and self-monitoring.

Question 42

Which of the following factors does NOT impact how well caregivers cope with the stress of dealing with a family member who is dying at home?

A) receiving clear information delivered in a patient-centered manner by health-care professionals.
B) regular contact between medical personnel and family members.
C) the patient acknowledging the caregivers efforts.
D) the caregiver's outlook on life.
E) having a good relationship with the patient.

Question 43

Those who study death and dying are _.

A) geriatricians
B) thanatologists
C) epidemiologists
D) grief assistants
E) palliologist

Question 44

Dignity therapy

A) involves a thanatologist recording an interview with the patient.
B) has a "generativity" document as its end product.
C) is widely used for restoring dignity among the terminally ill.
D) was developed from interviews with stroke patients.
E) is not a commonly used technique because of low success rates.

Question 45

Both caregiver and patient characteristics can impact how well caregivers cope with the stress of dealing with a family member who is dying at home.

Question 46

Canada's Aboriginal people view death as one of the the human spirit through the circle of life.
Stages of the journey of

A) five
B) six
C) four
D) three
E) seven

Question 47

The psychological response to bereavement is _.

A) grief
B) depression
C) sorrow
D) empathy
E) sympathy

Question 48

Symbolic immortality is

A) beliefs about the meaning of death and dying.
B) the feeling that children are one's legacy.
C) therapy with the dying.
D) short-term, palliative care for the dying.
E) therapy with the dying that finds a sense that one is leaving behind a legacy through their children or work or that one is joining the afterlife and becoming one with God.

Question 49

People from another culture witnessing the death practices in Canada would think that

A) the majority of deaths take place in hospices.
B) there are strong social pressures on the friends and relatives of the deceased to show little sign of emotion.
C) death is a painful event.
D) death is similar in all cultures.
E) the direction of the viewing and burial rituals is handled by immediate family members.

Question 50

Counselling with terminally ill children

A) involves taking cues of what to say directly from the parents.
B) is very different from counseling with terminally ill adults.
C) can proceed very much like counselling with a terminally ill adult.
D) involves directing the child to talk about topics the therapist thinks are important to discuss.
E) cannot proceed if the parents are unhappy, frightened, and confused.

Question 51

Evaluations of hospice care indicate that, compared to patients who receive traditional treatment, hospice patients

A) report a lack of care.
B) live longer.
C) report lower levels of anxiety.
D) are more satisfied with their interpersonal care.
E) receive fewer invasive procedures.

Question 52

The psychological advantages of home care do NOT include

A) having a familiar and comfortable environment.
B) being surrounded by personal items.
C) the availability of social support.
D) loneliness during the day when all family members leave for work.
E) the opportunity to maintain personal control.

Question 53

According to your text, by 2046 of Canadians will need home care.

A) just over two million
B) just over a million
C) 75,000
D) 7,500,000
E) 750,000

Question 54

Dignity therapy is administered by family members.

Question 55

Hospices

A) are seldom affiliated with hospitals due to fears of malpractice litigation.
B) are providing more individualized care than in the past.
C) are increasingly being incorporated into traditional treatment.
D) have had only limited success as a treatment model.
E) are decreasing due to lack of support by communities.

Question 56

Explain how children's understanding of death differs from when they are under age 5 to when they are over age 5.

Question 57

Studies of patient satisfaction and medical outcomes have clearly established that hospice care is superior to traditional terminal care.

Question 58

The grief response appears to be aggravated in

A) people with pets.
B) young children who experience the death of a sibling.
C) women and those who experience sudden and unexpected loss.
D) survivors whose family members have experienced a protracted and painful death.
E) men and those who experience sudden and unexpected loss.

Question 59

The goals of hospice care do NOT include

A) psychological comfort.
B) improved social support.
C) relief of suffering rather than the curing of an illness.
D) administration of invasive therapies to reduce the symptoms of pain experienced by the patient.
E) palliative care.

Question 60

In Canada, where do the majority of deaths take place?

A) In mental hospitals
B) In walk-in clinics
C) In hospices
D) In hospitals
E) At home

Question 61

Explain the medical, social, and psychological factors associated with continuing treatment of a terminal illness. What options are now available to terminally ill patients and their families?

Question 62

Describe Kübler-Ross's theory of dying. Evaluate the usefulness of her theory.

Question 63

Describe the psychological and physiological correlates of grief.

Question 64

What are the concerns in the psychological management of the terminally ill patient for medical staff? How can these concerns be managed?

Question 65

There has been a great deal of interest in hospice and home care for the terminally ill. What are the advantages and disadvantages of each for patients and care providers (both family and medical
staff)?