Deck 12: Psychological Issues in Advancing and Terminal Illness

Question 1

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

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

Answer 1

congenital abnormalities and SIDS.

Question 2

Sudden death

A) is preferred by most people compared to slow and painful death.
B) has the disadvantage of not allowing people to prepare their exit.
C) facilitates a more graceful departure.
D) kinder to family members.
E) All of these answers are correct.

Answer 2

All of these answers are correct.

Question 3

Death in the elderly is

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

Answer 3

usually accompanied by a shorter terminal phase.

Question 4

Dignity therapy is administered by family members.

Question 5

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

Question 6

Through death education it may be possible to develop realistic expectations, both about what modern medicine can achieve and about the kind of care the dying want and need.

Question 7

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

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

Question 8

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

Question 9

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

Question 10

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

Question 11

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

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

Question 12

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

Question 13

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

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

Question 14

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

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

Question 15

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 unrelated to socioeconomic status.
D) is higher relative to some Western European countries, is higher for First Nations infants, and is related to socioeconomic status.
E) is higher relative to some Western European countries, is higher for First Nations infants, but is unrelated to socioeconomic status.

Question 16

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 17

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

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

Question 18

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

Question 19

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

Question 20

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

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

Question 21

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

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

Question 22

In evaluating Kübler-Ross's theory

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

Question 23

Currently, physician aid-in-dying is legal in

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

Question 24

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

A) it conflicts with physician's oath to "do no harm"
B) the reduction of patients' autonomy
C) it will cause a change in how society views illness and disease
D) it could lead to patients being killed or coerced into taking aid-in-dying against their will
E) All of these answers are correct.

Question 25

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

A) pain and symptom management
B) seeking forgiveness
C) preparation for death
D) clear decision making
E) completion

Question 26

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

Question 27

Which of the following is NOT one of the factors that have been found to predict mortality in the elderly age group?

A) distant family relationships
B) depression
C) reduced life satisfaction
D) hardiness
E) they all predict mortality in the elderly age group

Question 28

Emotional and social withdrawal in terminally ill patients

A) is successfully treated with antidepressants.
B) is always due to anticipatory grieving.
C) may be caused by fear of depressing others and becoming an emotional burden.
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 29

Palliative care involves

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

Question 30

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

A) it fails to recognize death as a complex and individual process, subject to no rules and few regularities.
B) it does not fully acknowledge the importance of anxiety.
C) there is little if any empirical evidence to support the proposition that patients go through five stages in a predetermined order.
D) there is little if any empirical evidence to support the proposition that patients go through five stages
E) All of these answers are limitations of her theory.

Question 31

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

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

Question 32

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

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

Question 33

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) the conditions under which a patient requests to remain alive.
D) the disposition of one's belongings after death.
E) how children will be taken care of after one's death.

Question 34

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) helping patients live as long as possible
C) enabling patients and their families to experience anticipatory grief
D) involving patients in their treatment, as appropriate

Question 35

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

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

Question 36

The depressed terminally ill patient may be

A) coming to terms with a lack of control.
B) experiencing anticipatory grief.
C) experiencing an expected transitory psychological state which may not require intervention.
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) the depressed terminally ill patient may be in any of these states.

Question 37

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

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

Question 38

The hospitalized terminally ill patient runs the risk of being

A) ignored by the medical staff.
B) isolated by the medical staff.
C) overmedicated by the medical staff.
D) undermedicated by the medical staff.
E) None of these answers are correct.

Question 39

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

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

Question 40

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

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

Question 41

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

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

Question 42

Those who study death and dying are _______________.

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

Question 43

Counselling with terminally ill children

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

Question 44

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) the direction of the viewing and burial rituals is handled by immediate family members.
D) death is a painful event.
E) death is similar in all cultures.

Question 45

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

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

Question 46

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

Question 47

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

Question 48

Symbolic immortality is

A) therapy with the dying.
B) the feeling that children are one's legacy.
C) beliefs about the meaning of death and 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

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

Question 50

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

Question 51

Therapy with the dying differs from traditional psychotherapy in that

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

Question 52

The goals of hospice care include

A) palliative care.
B) psychological comfort.
C) improved social support.
D) relief of suffering rather than the curing of an illness.
E) All of these are goals of hospice care.

Question 53

Dignity therapy

A) was developed from interviews with hospice patients.
B) involves a trained therapist such as a nurse or other health care worker recording an interview with the patient.
C) has a "generativity" document as its end product.
D) effective is dignity therapy for resorting dignity among the terminally ill.
E) All of these answers are correct.

Question 54

Describe the psychological and physiological correlates of grief.

Question 55

The psychological advantages of home-care include

A) having a familiar and comfortable environment.
B) being surrounded by personal items.
C) the opportunity to maintain personal control.
D) the availability of social support.
E) All of these answers are correct.

Question 56

Hospices

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

Question 57

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

Question 58

The grief response appears to be aggravated in

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

Question 59

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 60

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

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