Unit 6: Palliative Care REVIEW QUESTIONS

The majority of hospice care is delivered in: A- The home B- Residential facilities C- Hospitals D- Inpatient hospice facilities

The majority of hospice care is delivered in: *A- The home* B- Residential facilities C- Hospitals D- Inpatient hospice facilities

You are speaking with the sister of a male patient who died after suffering fatal injuries in a car accident. In order to plan for bereavement follow-up for the patient's family, it is important that you assess: A- The family support system B- If the sister can take a month off from work to grieve sudden death C- If the patient qualified for hospice services before the accident D- Whether the patient had an advance directive

You are speaking with the sister of a male patient who died after suffering fatal injuries in a car accident. In order to plan for bereavement follow-up for the patient's family, it is important that you assess: *A- The family support system* B- If the sister can take a month off from work to grieve sudden death C- If the patient qualified for hospice services before the accident D- Whether the patient had an advance directive

Jack is a 6-year-old who just died at home with hospice from an aggressive type of brain cancer. His parents and his 12-year-old sister are having a very difficult time dealing with this terrible loss. Which of the following would be a help to them after Jack's death? A- Hospice bereavement care B- The American Cancer Society C- The hospital's child life worker D- The pediatric oncologist

Jack is a 6-year-old who just died at home with hospice from an aggressive type of brain cancer. His parents and his 12-year-old sister are having a very difficult time dealing with this terrible loss. Which of the following would be a help to them after Jack's death? *A- Hospice bereavement care* B- The American Cancer Society C- The hospital's child life worker D- The pediatric oncologist

Jane, a 72-year-old woman with end-stage renal disease, tells you she thinks she doesn't want to continue dialysis anymore. Which of the following would be your best response to this statement? A- "Of course you want to continue dialysis, it is keeping you alive." B- "Don't talk like that, your family loves taking you to your treatments." C- "That is a very important statement, can you tell me more about that?" D- "I understand why you wouldn't want to do it; it is so exhausting for you."

Jane, a 72-year-old woman with end-stage renal disease, tells you she thinks she doesn't want to continue dialysis anymore. Which of the following would be your best response to this statement? A- "Of course you want to continue dialysis, it is keeping you alive." B- "Don't talk like that, your family loves taking you to your treatments." *C- "That is a very important statement, can you tell me more about that?"* D- "I understand why you wouldn't want to do it; it is so exhausting for you."

What type of pain are antidepressants and anticonvulsants most beneficial for? A- Acute pain B- Somatic nociceptive pain C- Neuropathic pain D- Visceral nociceptive pain

What type of pain are antidepressants and anticonvulsants most beneficial for? A- Acute pain B- Somatic nociceptive pain *C- Neuropathic pain* D- Visceral nociceptive pain

Which disease and dying trajectory best represents the course for a person with Alzheimer's disease? A- Sudden death B- Steady decline C- Short disease trajectory D- Progressive deterioration

Which disease and dying trajectory best represents the course for a person with Alzheimer's disease? A- Sudden death B- Steady decline C- Short disease trajectory *D- Progressive deterioration*

Which of the following individuals would be at highest risk for the under-treatment of pain? A_ A 40-year-old female with cancer B- An 87-year-old male with osteoarthritis C- A 54-year-old male with good prescription coverage D- A 29-year-old female with a history of GI bleed

Which of the following individuals would be at highest risk for the under-treatment of pain? A_ A 40-year-old female with cancer *B- An 87-year-old male with osteoarthritis* C- A 54-year-old male with good prescription coverage D- A 29-year-old female with a history of GI bleed

Which of the following statements is true about serious, chronic illnesses? A- The majority of annual U.S. healthcare spending goes toward chronic illnesses. B- Very little annual U.S. healthcare funding is spent in acute care admissions for chronic illnesses. C- Much attention and financial support goes toward improving quality of life for persons with chronic illnesses. D- The focus of serious illness is often on improving quality of life rather than finding a cure.

Which of the following statements is true about serious, chronic illnesses? *A- The majority of annual U.S. healthcare spending goes toward chronic illnesses.* B- Very little annual U.S. healthcare funding is spent in acute care admissions for chronic illnesses. C- Much attention and financial support goes toward improving quality of life for persons with chronic illnesses. D- The focus of serious illness is often on improving quality of life rather than finding a cure.

Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000mg every six hours. She rates her pain at a 4 every time you ask. What do you think an appropriate next step would be at this time? A- Discuss increasing the acetaminophen to every four hours with the IDT. B- Discuss adding an immediate-release opioid with the IDT. C- Ask Yolanda what an acceptable pain score is for her. D- Ask the IDT if Yolanda would benefit from an antidepressant for pain.

Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000mg every six hours. She rates her pain at a 4 every time you ask. What do you think an appropriate next step would be at this time? A- Discuss increasing the acetaminophen to every four hours with the IDT. B- Discuss adding an immediate-release opioid with the IDT. *C- Ask Yolanda what an acceptable pain score is for her.* D- Ask the IDT if Yolanda would benefit from an antidepressant for pain.

You are asked to describe palliative care to a family member. Which of the following statements would be best to include in your discussion? A- Palliative care's main purpose is to improve pain. B- Palliative care supports the patient's goals of care. C- Palliative care is end-of-life care for the imminently dying patient and their family. D- Palliative care is curative care.

You are asked to describe palliative care to a family member. Which of the following statements would be best to include in your discussion? A- Palliative care's main purpose is to improve pain. *B- Palliative care supports the patient's goals of care.* C- Palliative care is end-of-life care for the imminently dying patient and their family. D- Palliative care is curative care.

You are making a bereavement visit to the 35-year-old daughter and primary caregiver of a female patient who died three months ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. You should recognize that the daughter is experiencing: A- A normal grief reaction B- A complicated grief reaction C- An abnormal grief reaction D- A dysfunctional grief reaction

You are making a bereavement visit to the 35-year-old daughter and primary caregiver of a female patient who died three months ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. You should recognize that the daughter is experiencing: *A- A normal grief reaction* B- A complicated grief reaction C- An abnormal grief reaction D- A dysfunctional grief reaction

You are teaching your colleagues about myths and realities of communication in palliative care. Which is a correct statement about communication? A- "We can never give someone too much information." B- "We communicate only when we choose to communicate." C- "The majority of messages we send are non-verbal." D- "Communication is primarily words and their meanings."

You are teaching your colleagues about myths and realities of communication in palliative care. Which is a correct statement about communication? A- "We can never give someone too much information." B- "We communicate only when we choose to communicate." *C- "The majority of messages we send are non-verbal."* D- "Communication is primarily words and their meanings."

What should drive decision-making in palliative care? A- Finding a cure for the illness B- The patient's goals of care C- The need for end-of-life care D- The wishes of the inter-professional team

What should drive decision-making in palliative care? A- Finding a cure for the illness *B- The patient's goals of care* C- The need for end-of-life care D- The wishes of the inter-professional team

Which of the following patients should never be given an opioid medication? A- Ms. Jones a 27-year-old with a history of substance abuse B- Mr. Rich who reports severe nausea and vomiting with previous use of opioids for pain C- Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work D- Mr. Hanover who is 72 and has end-stage heart failure

Which of the following patients should never be given an opioid medication? A- Ms. Jones a 27-year-old with a history of substance abuse B- Mr. Rich who reports severe nausea and vomiting with previous use of opioids for pain (this is not an allergy, just adverse reaction) *C- Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work*(this is a true allergic reaction) D- Mr. Hanover who is 72 and has end-stage heart failure

You are caring for Ms. P, a 55-year-old woman with cancer. She received pain medication less than two hours ago. A nursing assistant reports that Mrs. P is complaining of pain again. The nursing assistant says, "She can't be hurting as much as she says she is." What is the most appropriate response? A- Pain is whatever the patient says it is. Let's assess her further. B- Maybe she is just drug-seeking. C- I will tell her gently that she must wait four hours between doses. D- I just gave her pain medication. She can't need anything again so soon.

You are caring for Ms. P, a 55-year-old woman with cancer. She received pain medication less than two hours ago. A nursing assistant reports that Mrs. P is complaining of pain again. The nursing assistant says, "She can't be hurting as much as she says she is." What is the most appropriate response? *A- Pain is whatever the patient says it is. Let's assess her further.* B- Maybe she is just drug-seeking. C- I will tell her gently that she must wait four hours between doses. D- I just gave her pain medication. She can't need anything again so soon.

Mr. G has just been told he has a serious illness. Which of the following statements reflects respectful communication with him about his treatment and illness? A- "We will decide which treatment options are best for you Mr. G." B- "It is important that we understand what your hopes are for your treatment of this illness." C- "Treatment will be difficult; you just have to be strong and get through it." D- "This disease is terminal and there is nothing we can do for you."

Mr. G has just been told he has a serious illness. Which of the following statements reflects respectful communication with him about his treatment and illness? A- "We will decide which treatment options are best for you Mr. G." *B- "It is important that we understand what your hopes are for your treatment of this illness."* C- "Treatment will be difficult; you just have to be strong and get through it." D- "This disease is terminal and there is nothing we can do for you."

Mr. T. is taking an NSAID for bone pain. Which of the following statements suggests he may be experiencing a worrisome side effect from the NSAID? A- I am having trouble urinating. B- I noticed that my skin has gotten very dry. C- Yesterday I had an episode of black, tarry stools. D- My eyes have been very itchy and irritated lately.

Mr. T. is taking an NSAID for bone pain. Which of the following statements suggests he may be experiencing a worrisome side effect from the NSAID? A- I am having trouble urinating. B- I noticed that my skin has gotten very dry. *C- Yesterday I had an episode of black, tarry stools.* D- My eyes have been very itchy and irritated lately.

You are assessing Mrs. Smith's husband's well-being during Mrs. Smith's recent hospitalization. He tells you he has had trouble with heart failure this past year and then says, "All that matters is my wife. I don't have time to go to my doctor even though my prescriptions have run out. Don't you realize how many medications I have to give my wife around the clock? I can't deal with any more medications. I will have time to take care of myself later on." Your best response is: A- "I understand. Your wife certainly requires a lot of care and it is so hard to keep track of all her medications, let alone your own." B- "I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled." C- "That is nonsense; don't you know that not taking your heart failure medications could put you in the hospital?" D- "Later on may never come if you don't take care of yourself now; you have to take better care of yourself and get your medications filled."

You are assessing Mrs. Smith's husband's well-being during Mrs. Smith's recent hospitalization. He tells you he has had trouble with heart failure this past year and then says, "All that matters is my wife. I don't have time to go to my doctor even though my prescriptions have run out. Don't you realize how many medications I have to give my wife around the clock? I can't deal with any more medications. I will have time to take care of myself later on." Your best response is: A- "I understand. Your wife certainly requires a lot of care and it is so hard to keep track of all her medications, let alone your own." *B- "I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled."* C- "That is nonsense; don't you know that not taking your heart failure medications could put you in the hospital?" D- "Later on may never come if you don't take care of yourself now; you have to take better care of yourself and get your medications filled."

You have been the pediatric nurse caring for a young boy with a malignant brain tumor who just died on your unit. The parents are in the room with their son and ask you if you would stay with them. Your best response is: A- "I am here and I will not leave you until you are ready for me to." B- "I have to take care of my other patients, but I will be back to check on you in a few minutes." C- "I am so sorry this has happened to you." D- "I know you are sad but your son is in a better place now and is no longer suffering."

You have been the pediatric nurse caring for a young boy with a malignant brain tumor who just died on your unit. The parents are in the room with their son and ask you if you would stay with them. Your best response is: *A- "I am here and I will not leave you until you are ready for me to."* B- "I have to take care of my other patients, but I will be back to check on you in a few minutes." C- "I am so sorry this has happened to you." D- "I know you are sad but your son is in a better place now and is no longer suffering."

A 92-year-old patient dying of end stage heart failure tells you that she is worried that her life had no meaning. What member of the palliative care team would you want to be sure is involved in her care? A- The physician B- The chaplain C- The advanced practice nurse D- The occupational therapist

A 92-year-old patient dying of end stage heart failure tells you that she is worried that her life had no meaning. What member of the palliative care team would you want to be sure is involved in her care? A- The physician *B- The chaplain* C- The advanced practice nurse D- The occupational therapist

During your assessment, you notice Robert, who has a diagnosis of dementia, rubbing his right shoulder. What should you do next? A- Ask Robert if he is in pain. B- Give Robert pain medication. C- Contact Robert's healthcare provider to order an x-ray. D- Apply heat to the shoulder.

During your assessment, you notice Robert, who has a diagnosis of dementia, rubbing his right shoulder. What should you do next? *A- Ask Robert if he is in pain.* B- Give Robert pain medication. C- Contact Robert's healthcare provider to order an x-ray. D- Apply heat to the shoulder.

John is a 70-year-old male whose wife died from COPD two months ago. They were very close, married for 52 years, and had no children. He comes by the nursing unit to bring you all candy and a thank you note for all the times you cared for her the past year. He tells you he is struggling to want to eat since she always was the cook, and is just not ready to go out to dinner with his buddies, even though they keep asking him. Your assessment is that John is: A- Experiencing normal grief after his wife died two months ago B- Depressed because he doesn't want to go out with his buddies C- At high risk for complicated grief because his wife died in the hospital D- Is doing poorly alone at home because he is not eating well and needs counseling

John is a 70-year-old male whose wife died from COPD two months ago. They were very close, married for 52 years, and had no children. He comes by the nursing unit to bring you all candy and a thank you note for all the times you cared for her the past year. He tells you he is struggling to want to eat since she always was the cook, and is just not ready to go out to dinner with his buddies, even though they keep asking him. Your assessment is that John is: *A- Experiencing normal grief after his wife died two months ago* B- Depressed because he doesn't want to go out with his buddies C- At high risk for complicated grief because his wife died in the hospital D- Is doing poorly alone at home because he is not eating well and needs counseling

Mr. X has end-stage liver cancer and multiple organ failure. He wants to be home and comfortable. Which intervention would be most appropriate to offer him? A- Admission to the ICU to get his organ failure under control B- Hospice services C- Home care with a nursing expert in rehabilitation services D- Placement in a nursing facility for 24-hour nursing care

Mr. X has end-stage liver cancer and multiple organ failure. He wants to be home and comfortable. Which intervention would be most appropriate to offer him? A- Admission to the ICU to get his organ failure under control *B- Hospice services* C- Home care with a nursing expert in rehabilitation services D- Placement in a nursing facility for 24-hour nursing care

Which of the following demonstrates good self-care that may help you in preventing compassion fatigue and burnout when taking care of many patients with serious illness and their families? A- Establish healthy eating, sleeping, and exercise habits especially when rotating shifts. B- Volunteer for extra shifts to cover your overworked colleagues. C- Ask to take care of all the very ill patients and families because you have the expertise many of your colleagues don't have. D- Make sure you go to every funeral and service for all the deceased patients you have cared for.

Which of the following demonstrates good self-care that may help you in preventing compassion fatigue and burnout when taking care of many patients with serious illness and their families? *A- Establish healthy eating, sleeping, and exercise habits especially when rotating shifts.* B- Volunteer for extra shifts to cover your overworked colleagues. C- Ask to take care of all the very ill patients and families because you have the expertise many of your colleagues don't have. D- Make sure you go to every funeral and service for all the deceased patients you have cared for.

You are helping a new member of the palliative care team understand the ways the behavior of healthcare professionals can produce a communication barrier. Which statement by the team member indicates the need for additional education on communication barriers? A- "I will complete a cultural assessment in order to understand the patient's communication preferences." B- "I will keep an emotional distance in order to maintain a professional relationship with patients." C- "I may not always know the answers to questions that the patient or family may ask." D- "My lack of personal experience with death can make me reluctant to discuss death and dying."

You are helping a new member of the palliative care team understand the ways the behavior of healthcare professionals can produce a communication barrier. Which statement by the team member indicates the need for additional education on communication barriers? A- "I will complete a cultural assessment in order to understand the patient's communication preferences." *B- "I will keep an emotional distance in order to maintain a professional relationship with patients."* C- "I may not always know the answers to questions that the patient or family may ask." D- "My lack of personal experience with death can make me reluctant to discuss death and dying."

You are working with Mr. T who has just been told his heart failure is getting worse. You go into his room to see how he is doing after the team has shared this information with him. He is staring out the window, looking sad. How do you start your conversation? A- "Isn't it a beautiful day today Mr. T.?" B- "I saw that the team was just here, can you tell me about their conversation with you?" C- "Are you feeling ok?" D- "I heard you just got bad news, but I know of someone just like you who lived for three more years."

You are working with Mr. T who has just been told his heart failure is getting worse. You go into his room to see how he is doing after the team has shared this information with him. He is staring out the window, looking sad. How do you start your conversation? A- "Isn't it a beautiful day today Mr. T.?" *B- "I saw that the team was just here, can you tell me about their conversation with you?"* C- "Are you feeling ok?" D- "I heard you just got bad news, but I know of someone just like you who lived for three more years."

You are performing a pain assessment on Matilda. Your assessment reveals that Matilda has pain rated as a 5 in her left hip that worsens with movement. She has been having this pain off and on for the last three years. Which of the following pain assessment components have you not addressed in your assessment? A- Duration B- Aggravating factors C- Alleviating factors D- Intensity

You are performing a pain assessment on Matilda. Your assessment reveals that Matilda has pain rated as a 5 in her left hip that worsens with movement. She has been having this pain off and on for the last three years. Which of the following pain assessment components have you not addressed in your assessment? A- Duration B- Aggravating factors *C- Alleviating factors* D- Intensity

You are providing bereavement support to an 8-year-old child whose father just died on your unit. Which of the following statements would be appropriate for you to use? A- Use the phrase "your father has gone away" rather than "your father has died." B- Tell him he will get over the loss of his father when he gets a little older. C- Let him know his father's death was peaceful and that he "just went to sleep." D- Let him know you wish that his father had not died.

You are providing bereavement support to an 8-year-old child whose father just died on your unit. Which of the following statements would be appropriate for you to use? A- Use the phrase "your father has gone away" rather than "your father has died." B- Tell him he will get over the loss of his father when he gets a little older. C- Let him know his father's death was peaceful and that he "just went to sleep." *D- Let him know you wish that his father had not died.* ("I wish" = desire but reality of limitations...and we use the word "died/death/dead")

You are talking with the wife of a patient who died recently. Which statement can you make that would be most helpful? A- "I know exactly how you are feeling." B- "It must be hard to accept that this has happened." C- "His suffering is over. He's in a better place now." D- "I'm here for you. Call me if you need anything."

You are talking with the wife of a patient who died recently. Which statement can you make that would be most helpful? A- "I know exactly how you are feeling." (no, you don't) *B- "It must be hard to accept that this has happened."* C- "His suffering is over. He's in a better place now." (she's not ready to hear this) D- "I'm here for you. Call me if you need anything." (offer specific aid, otherwise don't offer)

Mr. S. has stage IV lung cancer and was admitted to your unit yesterday because of shortness of breath. His breathing has improved with treatment and you tell him you are hoping to get to know him better so you can provide the best care possible. Which of the following statements reflects your interest in getting to know him? A- "Can you tell me what has given your life meaning?" B- "Do you know much about your disease?" C- "Is your cancer treatment helping you?" D- "If I can do anything to help you, let me know."

Mr. S. has stage IV lung cancer and was admitted to your unit yesterday because of shortness of breath. His breathing has improved with treatment and you tell him you are hoping to get to know him better so you can provide the best care possible. Which of the following statements reflects your interest in getting to know him? *A- "Can you tell me what has given your life meaning?"* B- "Do you know much about your disease?" C- "Is your cancer treatment helping you?" D- "If I can do anything to help you, let me know."

Mrs. Woodrow tells you that her mother has been staying with her and is having difficulty sleeping due to poorly controlled pain. Which quality of life domain is Mrs. Woodrow's mother struggling with? A- Social B- Psychological C- Physical D- Spiritual

Mrs. Woodrow tells you that her mother has been staying with her and is having difficulty sleeping due to poorly controlled pain. Which quality of life domain is Mrs. Woodrow's mother struggling with? A- Social B- Psychological *C- Physical* D- Spiritual

Ms. H's family is in the waiting room of the intensive care unit. Ms. H is very ill and the family has been told she will probably die during this hospital admission. You are walking by the waiting room and you see that they are all seated together, crying. What is your best response? A- Leave them alone to give them private time to do their grieving. B- Find a social worker to go into the waiting room to see if they need anything. C- Call the hospital chaplain to visit them and offer prayers. D- Go into the waiting room, sit next to them, and give them time to talk with you.

Ms. H's family is in the waiting room of the intensive care unit. Ms. H is very ill and the family has been told she will probably die during this hospital admission. You are walking by the waiting room and you see that they are all seated together, crying. What is your best response? A- Leave them alone to give them private time to do their grieving. B- Find a social worker to go into the waiting room to see if they need anything. C- Call the hospital chaplain to visit them and offer prayers. *D- Go into the waiting room, sit next to them, and give them time to talk with you.*

Which of the following describes palliative care's philosophy and delivery? A- Care is provided by one healthcare provider, usually a nurse. B- Palliative care is offered when the patient no longer wants treatment for their disease. C- It supports the patient and family's hope for quality of life and dignity. D- The focus is only on the final six months of life.

Which of the following describes palliative care's philosophy and delivery? A- Care is provided by one healthcare provider, usually a nurse. B- Palliative care is offered when the patient no longer wants treatment for their disease. *C- It supports the patient and family's hope for quality of life and dignity.* D- The focus is only on the final six months of life.

Which of the following statements reflects that you are responding appropriately to a conflict between you and a physician regarding a patient's decision to stop chemotherapy? A- "Why can't you understand that this patient has had enough?" B- "This decision is the patient's decision - it is not ours to make." C- "Just because there is a chemotherapy available, it doesn't mean you have to give it to her." D- "I am so tired of you doctors continuing to treat patients who are ready to let nature take its course."

Which of the following statements reflects that you are responding appropriately to a conflict between you and a physician regarding a patient's decision to stop chemotherapy? A- "Why can't you understand that this patient has had enough?" *B- "This decision is the patient's decision - it is not ours to make."* C- "Just because there is a chemotherapy available, it doesn't mean you have to give it to her." D- "I am so tired of you doctors continuing to treat patients who are ready to let nature take its course."

You are caring for a 55-year-old female patient with metastatic breast cancer. During a home visit, you find the patient's 22-year-old daughter weeping at the kitchen table. The daughter explains that she just realized that her mother will not be alive when she gets married or has children of her own. Recognizing anticipatory grief in the young woman, the best first intervention is: A- Educate about signs and symptoms of disease progression. B- Foster hope by stressing that prognosis is difficult to predict. C- Provide active listening and therapeutic presence. D- Advise the daughter to focus more on the present time with her mother rather than the future.

You are caring for a 55-year-old female patient with metastatic breast cancer. During a home visit, you find the patient's 22-year-old daughter weeping at the kitchen table. The daughter explains that she just realized that her mother will not be alive when she gets married or has children of her own. Recognizing anticipatory grief in the young woman, the best first intervention is: A- Educate about signs and symptoms of disease progression. B- Foster hope by stressing that prognosis is difficult to predict. *C- Provide active listening and therapeutic presence.* D- Advise the daughter to focus more on the present time with her mother rather than the future.

You are caring for a 76-year-old patient who is unresponsive and close to end of life from a massive stroke. The patient has a history of breast cancer and had been experiencing severe bone pain in her left hip prior to her stroke. How do you assess her pain now that she is unresponsive? A_ Ask her anyway and see if she can nod "yes" to your question. B- Assume she continues to have pain and assess for evidence of wincing or facial grimacing. C- You don't need to assess this, as she is now unresponsive. D- Ask the family to report a pain score, using a 0-10 numeric rating scale, for her.

You are caring for a 76-year-old patient who is unresponsive and close to end of life from a massive stroke. The patient has a history of breast cancer and had been experiencing severe bone pain in her left hip prior to her stroke. How do you assess her pain now that she is unresponsive? A- Ask her anyway and see if she can nod "yes" to your question. *B- Assume she continues to have pain and assess for evidence of wincing or facial grimacing.* C- You don't need to assess this, as she is now unresponsive. D- Ask the family to report a pain score, using a 0-10 numeric rating scale, for her.

You are caring for a patient with end-stage liver disease. He tells you that he knows he only has a few weeks to live and is so sad that he won't be around to see his daughter graduate next year from college. You listen attentively and then respond: A- "Would it be helpful to write a letter to her or a card that can be given on that special day?" B- "Let's hope you will be here; no one ever really knows when the final days are near." C- "I am so sad for you; I would hate if my dad couldn't come to my graduation." D- "I am sure your daughter will understand that you wished you would be there."

You are caring for a patient with end-stage liver disease. He tells you that he knows he only has a few weeks to live and is so sad that he won't be around to see his daughter graduate next year from college. You listen attentively and then respond: *A- "Would it be helpful to write a letter to her or a card that can be given on that special day?"* B- "Let's hope you will be here; no one ever really knows when the final days are near." C- "I am so sad for you; I would hate if my dad couldn't come to my graduation." D- "I am sure your daughter will understand that you wished you would be there."

You are entering a room to administer a medication to your patient and as you come in you find that the three family members and the patient are all crying. What should you do next? A- Leave the room and come back with the medication when everyone is feeling better. B- Apologize for intruding and let the patient know you are nearby if he needs you. C- Remain silent to give permission to talk with you, holding off on the medication initially. D- Administer the medication and then ask if everything is ok.

You are entering a room to administer a medication to your patient and as you come in you find that the three family members and the patient are all crying. What should you do next? A- Leave the room and come back with the medication when everyone is feeling better. B- Apologize for intruding and let the patient know you are nearby if he needs you. *C- Remain silent to give permission to talk with you, holding off on the medication initially.* D- Administer the medication and then ask if everything is ok.

You are talking with the staff on your unit about the emotional challenges of working with dying patients and their families. Which of the following is an appropriate response to the grief the staff has been experiencing recently? A- Avoid talking about the recent deaths, focusing on the patients who have survived. B- Seek the support of the family of the dying patient to comfort the staff. C- Share with the staff that personal grief should not be expressed by healthcare professionals. D- Consult with the hospital chaplain or spiritual care counselor for staff support.

You are talking with the staff on your unit about the emotional challenges of working with dying patients and their families. Which of the following is an appropriate response to the grief the staff has been experiencing recently? A- Avoid talking about the recent deaths, focusing on the patients who have survived. B- Seek the support of the family of the dying patient to comfort the staff. C- Share with the staff that personal grief should not be expressed by healthcare professionals. *D- Consult with the hospital chaplain or spiritual care counselor for staff support.*

You are teaching a patient how to take her new prescription for morphine, an opioid pain medication. Which of the following teaching statements reflects an understanding of potential adverse effects? A- Be careful with these medications because they can cause addiction. B- Only take this medication if you are really suffering. C- This medication causes constipation, so you need to take a laxative to prevent that. D- This is the medication they prescribe when you are getting near the end of life.

You are teaching a patient how to take her new prescription for morphine, an opioid pain medication. Which of the following teaching statements reflects an understanding of potential adverse effects? A- Be careful with these medications because they can cause addiction. B- Only take this medication if you are really suffering. *C- This medication causes constipation, so you need to take a laxative to prevent that.* D- This is the medication they prescribe when you are getting near the end of life.