Deck 4: Dying: Transition From Life

Question 1

The term "medicalization of dying" refers to:

A) the heavy surveillance that has been undertaken by the medical-bureaucratic complex of the passage from life to death
B) the practice that physicians and bureaucrats engage in when making medical decisions related to the dying process
C) the use of medical terminology that relates to the dying process
D) the term that is used to capture the significant changes that have taken place in the dying process.

Answer 1

A

Question 2

Among the Lugbara of central Africa, a designated member of the community uttered the cere that signaled:

A) the painful transition of a soul from the world of the living to the realm of the spirits
B) the anguish of loss and separation among living family members
C) a shift in the communal arrangements including the redistribution of the deceased person's assets according to traditions
D) the last words of the deceased and a fiercely expressed sorrow by the family.

Answer 2

C

Question 3

Kastenbaum believes that more aged people are dying by slowly slipping away, usually alone, partly because physicians still have a tendency to view patients' deaths as:

A) unimportant so there's no need to see the patients more frequently
B) a failure on their part so they avoid the patient
C) the responsibility of the family in terms of care
D) uninteresting and not worthy of their attention.

Answer 3

B

Question 4

In terms of the time it takes nurses to respond to dying patients as compared to other patients, LeShan (1982) found that nurses:

A) respond faster to dying patients
B) take longer to respond to dying patients
C) respond faster in the morning than in the evening to all patients, whether dying or not
D) respond faster to children than older patients, whether dying or not.

Question 5

Kastenbaum's list of recommended ways physicians should "break the bad news" that a patient is dying includes all of the following EXCEPT:

A) being truthful
B) keeping it simple
C) giving all the facts at once
D) taking the time to establish a relationship with patient and family.

Question 6

Hospitalized patients are most likely to be treated as socially dead if they are on a ________ trajectory.

A) lingering
B) malingering
C) expected quick
D) crisis

Question 7

Kastenbaum's comparison of statements, "he has passed the crisis point and has a real chance of pulling through" and "he is out of immediate danger but probably won't survive very long," is comparing the ________ trajectory to the ________ trajectory.

A) unexpected; lingering
B) expected; lingering
C) lingering; unexpected
D) unexpected; expected

Question 8

The hospital staff is acting with a sense of urgency and interactions between staff and family are tense. This is most likely to occur during the:

A) lingering trajectory
B) malingering trajectory
C) expected quick trajectory
D) unexpected quick trajectory.

Question 9

The patient who is alert, exercising some options, and about to undergo a very risky procedure that will either save or end his life is experiencing the ________ trajectory.

A) will-probably-die
B) crisis
C) pointed
D) danger-period

Question 10

The patient who is not in acute danger at the moment, but whose life might suddenly be threatened at any time, is experiencing the ________ trajectory.

A) danger-period
B) pointed
C) crisis
D) will-probably-die

Question 11

Hospital staff is taking the death of this patient especially hard because they had worked very hard trying to save her. This situation is most likely to occur with the:

A) lingering trajectory
B) malingering trajectory
C) unexpected quick trajectory
D) expected quick trajectory.

Question 12

The SUPPORT study found that:

A) elderly physicians spend more time with terminally ill patients than younger physicians do
B) often physicians misunderstood what the patients wanted with respect to CPR
C) physicians routinely wrote do-not-resuscitate (DNR) orders when patients said they did not want to have CPR
D) about 10 percent of the patients had moderate or severe pain during their final three days of life.

Question 13

The intervention phase of the SUPPORT study found that:

A) communication improved between physicians and patients
B) pain control improved
C) physicians understood and accepted patients' preferences with respect to CPR
D) there was no significant improvement in communication, pain control, or acceptance of patients' preferences.

Question 14

A suggestion for improving communication with a dying person includes all of the following EXCEPT to:

A) be alert to symbolic and indirect communication
B) help the dying person overcome denial
C) help to make competent and effective behavior possible
D) allow the dying person to set the pace and the agenda.

Question 15

According to Kastenbaum's suggestions for communicating with people who are in life-threatening situations, a 75-year-old stonemason in a geriatric hospital used ________ to communicate his eventual death by stating that he was expecting the undertaker and it was time to call his sisters, who were already dead.

A) descriptions of dreams
B) indirect language
C) leave-taking actions
D) crazy talk

Question 16

Regarding the influence of the dying person's age, Kastenbaum observed all of the following EXCEPT that age:

A) affects the order in which the person moves through the stages of dying
B) affects the way a person comprehends dying and death
C) is a factor in the legal and personal ability to exercise control over the situation
D) affects the way others perceive and treat the person.

Question 17

Direct care to the dying person is usually provided:

A) equally by men and women
B) more often by women
C) more often by men
D) by certified thanatologists.

Question 18

Generally, end-of-life care planning occurs among all of the groups below EXCEPT:

A) traditional families with children
B) traditional families without children
C) minority populations
D) members of LGBT communities.

Question 19

Weisman and Worden found that hospitalized patients who died more rapidly than others with the same physical condition had:

A) fewer friends
B) more distant relationships with their families
C) more often expressed the wish to die
D) all of the above.

Question 20

The Buddhist conception of life and death emphasizes the:

A) need to resist change in order to preserve one's identity
B) impermanence of human experience at all times
C) spiritual equality of all people at the time of death
D) foolishness of thinking about death while we still have life to enjoy.

Question 21

The Buddhist journey toward death includes eight stages. The first four involve:

A) a progressive sense of closeness to God the Father
B) a sharpening of all the senses
C) a diminishment of the senses, followed by cessation of breathing
D) gradually increasing pain and pressure, as though experiencing birth again.

Question 22

The last four stages in the Buddhist perspective on dying:

A) focus on one's relationships with other people
B) are a desperate attempt to return to life until one finally gives up
C) involve transformation into another life form
D) are a series of visionary experiences, concluding with the pure light of death.

Question 23

The Kübler-Ross stages of dying are said to begin when the patient:

A) first becomes ill
B) gives up hope
C) becomes aware of his or her terminal condition
D) experiences a spiritual transformation.

Question 24

While considered groundbreaking at the time, the work of Kübler-Ross has come to be regarded as limited in applicability because:

A) acceptance as a final stage and necessary condition for coping effectively with one's own impending death is not always attainable or realistic
B) the concept of universal stages has led to misuse by some who prefer to oversimplify the experiences of the dying person
C) recent studies that have been conducted on this model have shown that men may approach the stages of dying process differently than women
D) both a and b.

Question 25

Corr's coping theory of the dying process advocates:

A) greater empowerment for the dying person
B) recognition that the dying person is alive and attempting to cope with the situation
C) doing away with the concept of stages
D) all of the above

Question 26

Corr's four challenges in the developmental-coping mode of the dying process include all of the following EXCEPT the:

A) intellectual
B) physical
C) social
D) spiritual.

Question 27

The term partial models relates to:

A) a process the dying person goes through of compartmentalizing feelings about facing death
B) a framework of 17 different models, each of which can be used to observe and respond to a specific aspect of the dying person's situation
C) theories on the dying process that have been partially developed but have not yet been actually tested
D) a later version of Corr's model that places stronger emphasis on the role that spiritual aspects can have in assisting the dying person to at least partially come to terms with facing death.

Question 28

Most students in death education courses expect their deaths will be:

A) slow and painful
B) in a long-term care facility
C) at home with loving companions
D) while unconscious, confused, or demented.

Question 29

A national survey commissioned by Last Acts found that most:

A) physicians have received formal training for end-of-life care
B) U.S. hospitals have programs to comfort terminally ill patients
C) people prefer to die at home, but most die in a hospital
D) all of the above.

Question 30

The National Institute of Health (2005) conducted a recent inquiry into the status of care for terminally ill people in the United States and concluded that:

A) programs for spiritual well-being have been ignored
B) end-of-life training for all care providers is inadequate
C) many end-of-life care interventions have been validated
D) communication between patient, family, and providers is adequate.

Question 31

In Irish tradition, the banshee's cry announced the painful transition of a soul from the world of the living to the realm of the spirits.

Question 32

Physicians tend to spend more time with patients whose cases are deemed hopeless as a means to cope with feelings of failure or inadequacy regarding the services they provided.

Question 33

Often, a terminally ill person dies alone, due to intermittent visits by medical staff and family.

Question 34

In his discussion of dying Kastenbaum contrasts Greg, a college student with leukemia, and Matilda, an 86-year-old suffering from several problems including rheumatoid arthritis.

Question 35

According to Kastenbaum, dying usually begins with apoptosis.

Question 36

In "breaking the bad news" to a patient, physicians are encouraged to make it clear that there is nothing more that can be done for the patient.

Question 37

The lingering trajectory is becoming the most typical pattern of dying in Western society.

Question 38

The pointed trajectory is one in which the patient is not alert and may not survive a stressful experience.

Question 39

Although paramedics or nurses on the scene of an emergency may know that the victim is beyond resuscitation, it may be necessary to carry out CPR and other procedures in order to conform to regulations.

Question 40

The acronym SUPPORT, as used in the 1995 study, stands for "Survey of Under-represented Patients' Patterns of Rational Treatment."

Question 41

The SUPPORT study found that physicians often showed little interest in the patients' own preferences regarding CPR and little inclination to honor them.

Question 42

In the intervention phase of the SUPPORT study researchers found that bringing in additional nurses with special training significantly improved physician-patient communication.

Question 43

Dying patients who refuse to discuss death or appear to be denying their situation may have worked out a reasonable coping strategy that is advantageous in their particular situation.

Question 44

Misperceptions have resulted in some physicians believing that infants do not experience pain to any appreciable extent during procedures such as taking bone marrow samples. As a result, adequate pain relievers may not be utilized.

Question 45

Researchers have found that terminally ill patients who were experiencing the most distress also were those with the most interpersonal difficulties.

Question 46

The Dalai Lama states that Buddhism asserts that all people move through the prescribed eight stages as they die.

Question 47

The Buddhist stages of dying focus on the experiential state of the dying person.

Question 48

Kübler-Ross advocated for quick movement through the stages of dying to achieve acceptance and relief as soon as possible.

Question 49

According to a national survey (Last Acts, 2002), despite a desire to die at home surrounded by friends and families, a majority of Americans die in hospitals.

Question 50

The National Institute of Health Survey (2005) found that the spiritual well-being of terminally ill patients is still ignored in most institutional caregiving environments.

Question 51

What is the definition of the terms

-Apoptosis

Question 52

What is the definition of the terms

-Cardiopulmonary resuscitation (CPR)

Question 53

What is the definition of the terms

-Colostomy bag

Question 54

What is the definition of the terms

-Danger list (D.L.)

Question 55

What is the definition of the terms

-Institutional evasions

Question 56

What is the definition of the terms

-Middle knowledge

Question 57

What is the definition of the terms

-Stage theory

Question 58

What is the definition of the terms

-Trajectories of dying

Question 59

Name the four contexts that may certify that dying has begun.

Question 60

Give four suggestions of better ways physicians can "break the bad news" to dying patients.

Question 61

List the four types of expected quick trajectories of dying.

Question 62

Compare and contrast the role of the staff, family, and patient in the lingering trajectory, the expected quick trajectory, and the unexpected quick trajectory. Describe each type, highlight how each is unique, and where there are similarities or overlap.

Question 63

List any three of the five types of problems that are more likely to arise when there is a life-or-death emergency in a community setting (as compared with a health-care facility).

Question 64

Discuss the primary findings of both the observational phase and the intervention phase of the SUPPORT study. Then, in response to these findings, describe the four suggestions for improving communication.

Question 65

Name any four of the six factors that influence the experience of dying and explain the influence that each factor has on the dying process.

Question 66

Name and describe each of stages of dying proposed by Kübler-Ross.

Question 67

Discuss the six criticisms or shortcomings of stage theory and apply those criticisms to the stages of dying proposed by Kübler-Ross.

Question 68

Compare and contrast the findings of the survey commissioned by Last Acts (2002) with those of the NIH (2005) regarding the care given to terminally ill patients.