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Robert Milch, M.D
J. Donald Schumacher, Psy. D.
LIVING WITH DYING IN AMERICA

1) Thanks to the overwhelming response to the findings of the SUPPORT study, the majority of terminally ill people in the United States are now cared for either by a hospice or other palliative care team
True
 False

2) Barbara Wein did NOT experience:

a) A one-year remission of her ovarian cancer
b) Extensive pain from her tumor
c) Depression and anxiety while coping with ovarian cancer
 d) A referral to hospice care
e) A sense of control over her medical care at the very end of her life

Dale G. Larson, Ph.D.
CONVERSATIONS

3) The three-step communication process outlined here does NOT include:
a) Talking to health professionals and family members once illness strikes
 b) Completing advance medical directives while still well
 c) If death is near, talking about what is happening for you with people you love
 d) Avoiding conversations about these issues because you don't want to open a "Pandora's Box"
e) a, b, and c
4) Tips offered by Larson for people facing life-threatening illness do NOT include:
a) Tying up loose ends
 b) Telling your story
 c) Researching your disease and writing out questions for your physician
 d) Replacing accepted medical treatments with alternative approaches
e) Building a team of health professionals to help you live life to the fullest

Myra Christopher
WIDOWHOOD

5) The widows and widowers in this article all:
a) Had similar cultural and socioeconomic backgrounds
 b) Experienced a profound change in identity or sense of self that accompanied the loss of their spouse
 c) Relocated to another part of the country after their loss
d) Changed professions after their loss
 e) Had all their friends be highly supportive and really "come through"
6) The number of Americans widowed each year is approximately
a) 100,000
 b) 250,000
 c) 500,000
 d) 1,000,000
 e) 1,250,000

Russell K. Portenoy, M.D.
PALLIATIVE CARE

7) According to Portenoy, palliative care:
a) Is not available anywhere in the United States
b) Cannot be combined with hospice care
 c) Is only offered for inpatient hospital care
 d) Focuses on pain and symptom management and relief of suffering
 e) Is less widely practiced and known in the United Kingdom and Australia
8) Madeleine Corbett had the following experiences with palliative care:
a) Symptomatic relief of her coughing, chest pain, shortness of breath, and fatigue
b) Support and guidance for her husband
 c) Discussions about her advance medical directives
d) Referral to a hospice program which helped her die comfortably at home
 e) All of the above

Robert A. Bendiksen, Ph.D.
Bernard Hammes, Ph.D.
ADVANCE DIRECTIVES

9) Which of the following is NOT true:
a) The living will and durable power of attorney are two types of advance directives
 b) Once in place, advance directives cannot be changed, so it is important to be sure they reflect the person's true wishes
 c) Discussions with health care providers and family members about one's wishes should begin before a health crisis occurs
d) Five Wishes is a popular version of advance directives
 e) Only about 25% of Americans have written advance directives before they become ill.
10) Which is true of advance medical directives?
a) All states now have identical legal requirements for them
 b) The Karen Ann Quinlan case in the 1970's prompted increasing attention to planning for medical care at the end of life
 c) It is not important that your health care proxy be able to make complex decisions in stressful situations because the form takes care of this for him or her
 d) Americans seem to find it quite easy to discuss illness and death
 e) Hospital emergency rooms are almost always able to honor advance directives

LaVera Crawley, M.D.
CULTURE AND DIVERSITY

11) End-of-life care for minorities
a) Is complicated by communication failures
 b) Is often of lower quality than it is for whites
 c) Could be improved by the presence of more trained medical interpreters
 d) Is complicated by the fact that these services are often seen as another form of abandonment by the medical system
 e) All of the above
12) African Americans
a) Are often reported to be less likely to want aggressive life-sustaining interventions
 b) Have excellent access to hospice care and are as likely to receive hospice care as their white counterparts
 c) Consistently report inadequate treatment of pain when compared with whites
d) Have no distrust of the American health care system
 e) Are the only minority population not adequately cared for at the end of life
Martha Rutland-Wallis, D. Min
Hugh Maddry, M.Div., DRE
SPIRITUALITY AND FAITH

13) Rose Thomason found spiritual comfort in
a) The Catholic tradition she was raised in
 b) Meditating regularly
 c) Kum Nye, a Buddhist form of body prayer, similar to yoga
 d) Keeping a personal journal
 e) All of the above
14) What factor does NOT play a role in defining spirituality?
a) Religious faith
 b) Values
 c) Socioeconomic status
d) Ethics
 e) Principles and morals

Thomas Lynch
LAST RITES

15) According to Lynch, which is NOT a key goal of funerals?
a) Healthy expression of grief
b) Remembering family history
 c) The reading of the will
 d) Expressions of faith
 e) Forgiveness
16) Lynch offers the following suggestion for how to plan for a death in your family
a) Seek out "memorial counselors"
 b) Make arrangements using the services of "death care professionals"
 c) Find the most expensive casket that suits the deceased
 d) Avoid seeking spiritual comfort if you have lapsed in your faith
 e) Make time to mourn

Karen Orloff Kaplan, Sc.D.
Ira Byock, M.D.
CAREGIVING

17) Which of the following statements about caregivers and caregiving is NOT true:
a) 25% of caregivers in the United States care for more than one relative at a time
 b) The average caregiver is a married woman in her mid-forties who works full time
 c) Nearly 83% of caregivers have no paid professional help such as nurses, physical therapists, or social workers
 d) More than 80% of caregivers have home health aides as assistants
e) About 25 million caregivers provide care for elderly or critically ill family members
18) Which of the following practical tips is NOT suggested by Kaplan and Byock:
a) The best resource for family caregivers is other family caregivers
 b) Determine at what point you can no longer provide care
 c) Make time for yourself
 d) Ask your home health aides to teach you proper hands-on techniques
 e) Provide information on a "need to know" basis to other family members

Stephen R. Connor, Ph.D
HOSPICE

19) Which is NOT true about hospice care in the United States?

a) In 2001 about 700,000 people were cared for by hospice
 b) More than 3000 hospice programs are available throughout the United States
c) Most hospice care occurs in inpatient hospice units or special units in hospitals
d) About 90% of Americans don't know that Medicare pays for hospice care
e) Hospice care is available 24 hours per day, 7 days per week
20) The Medicare hospice benefit does NOT cover
a) Regular home visits by nurses
 b) Physician-assisted suicide
 c) Drugs for symptom control and pain relief
 d) Physical therapy, speech therapy, occupational therapy, and dietary counseling
 e) Chaplain services for the patient and loved one, if desired

Muriel R. Gillick, M.D.
Len Fishman, JD
NURSING HOMES AND LONG-TERM CARE

21) Which is NOT true about nursing home care in the United States?
a) 43% of Americans over age 65 will live in a nursing home for some period before they die
 b) 24% of all Americans over the age of 85 live in a nursing home
 c) The odds of a nursing home patient surviving a cardiac arrest is less than 3%
 d) Between 40 and 80% of nursing home residents experience pain regularly
 e) Hospice care is never offered in nursing homes
22) When choosing a nursing home, Gillick and Fishman recommend all but which of the following?
a) Ask to see the two most recent state and federal inspection reports for the facility you are considering
 b) Talk to members of the nursing home's resident council
 c) Determine any particular affiliation (religious, ethnic, fraternal, or otherwise) that the nursing home might have and see if it is suitable for your loved one
 d) Don't be concerned about where the nursing home is located-just look for quality and fit with your family's needs
 e) Contact your state or county offices on aging to get listings of nursing homes

Bruce Himelstein, M.D.
Joanne Hilden, M.D.
WHEN A CHILD IS DYING

23) All but which of the following are true about pediatric palliative care teams?
a) They take over when doctors have given up and the search for a cure has stopped
b) They can provide continuous care for the child as he or she moves through the health care system
 c) They can assist family members to say their goodbyes and prepare for what lies ahead
 d) They are not widely incorporated in mainstream medical care for children
 e) They can include professionals from many disciplines, including hospice professionals, child life specialists, and psychologists
24) Himelstein and Hilden do NOT recommend that parents dealing with the life-threatening illness and death of a child
a) Find a doctor who is an expert in symptom control
 b) Get help from experts in grieving even if they don't think they need it
 c) Find out from the doctors what will happen in the actual time their child is dying
 d) Always continue pursuing therapy despite severe side effects
 e) Let siblings help prepare for the funeral

Charles A. Corr, Ph.D.
VIOLENCE AND UNEXPECTED DEATH

25) What is NOT true about unexpected deaths in the United States?
a) Motor vehicle accidents are the most common cause of violent death
 b) Each unexpected death affects approximately 10 other people
 c) Firearms are the second leading cause of injury-related deaths
 d) Death rates from motor vehicle accidents and firearms has increased in recent years
 e) The United States continues to lead all civilized countries in motor vehicle accidents and firearm deaths
26) If you experience bereavement as a result of unexpected loss, Corr recommends that you
a) Realize that this traumatic event may challenge the assumptions you hold about your world, faith, and society
 b) If appropriate, seek help from organizations skilled in victim advocacy
 c) Don't let others impose their own timetable for your bereavement
 d) Be patient with yourself and with others
e) All of the above

Marcia Lattanzi-Licht, RN, MA.
LIVING WITH LOSS

27) Symptoms of grief do NOT include
a) Guilt or anger
b) Difficulty sleeping
 c) Renewal of energy
 d) A sense of unreality about the loss
 e) A need to talk about him or her
28) Which of the following is NOT a way to aid a bereaved person?
a) Telling them to think of things to be grateful for (e.g., no more suffering, remaining children)
 b) Offering practical help of meals, rides, or babysitting
 c) Talking about the person who died
 d) Attending the funeral or making calls and sending notes
 e) Being available to listen

Dan Tobin, M.D.
A VISION FOR THE FUTURE

29) Laura Letson did NOT
a) Become a strong advocate for her father Willie
 b) Ignore her intuitive feelings that Willie's life was fading after the defibrillator implant surgery
 c) Talk openly about medical planning
 d) Act as a hospice family caregiver for her father in her home
 e) View life's end in a positive and proactive manner
30) Tobin's vision for the future of end-of-life care does NOT include:
a) Increasing demands by baby boomers for improved care
 b) A continuing lack of knowledge about hospice and palliative care in the general public
 c) Nurses and social workers will work as care coordinators who assist patients to navigate the health care system and their confrontation with life-threatening illness
 d) A strengthening of community networks that support family caregivers
 e) Better pain management will be offered to patients at the end of life
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