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Course 2D Quiz



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While no one can predict exactly what clients/patients will want or need when they are sick or dying, this research can ....
help us - as providers - to offer End-of-Life Care based on preferences held by the majority of patients under similar circumstances.
help us - as providers - to maneuver the client toward the End-of-Life decision which WE feel is best for them.
neither of the above
Advance Directives .....
are formal legal documents specifically authorized by State law - also known as Living Wills
allow clients/patients to continue their personal autonomy [despite serious or terminal illness or threat to life]
provide instructions for care in case they become incapacitated and cannot make decisions
may also be a Durable Power of Attorney
All above
A Durable Power of Attorney....
is illegal in some states
is a document also known as a Health Care Proxy
allows the patient to designate a surrogate, i.e., a person who will make treatment decisions for the patient if the patient becomes too incapacitated to make such decisions
All of the above
only the second and third answers
Discussions about End of Life Care are clinically appropriate ONLY with people who are terminally ill or whose death is imminent.
True False
The FEDERAL ACT that guarantees patients the right to accept or refuse treatment and to complete Advance Medical Directives IS ENTITLED (select one)
The Patient Choice Act
The Patient Self-Determination Act
The Patient Indemnity Act
Which answer below is NOT CORRECT, for completion of this statement: Predicting what treatments patients will want at the end of life is complicated by .....
the patient's age.
the ability of medicine to sustain life.
the nature of the illness.
the fact that most patients reject Advance Care Planning.
the emotions families endure when loved ones are possibly dying.
In this study WHAT PERCENTAGE OF severely or terminally ill patients had an Advance Directive in their medical record?
less than 25 percent
less than 30 percent
less than 50 percent
In this study, what percentage of PHYSICIANS were NOT AWARE that their patients had an Advance Directive in their medical records?
between 10 and 16 percent
between 20 and 25 percent
between 65 and 76 percent
This research found that physicians were only about 65 percent accurate in PREDICTING their patients' End of Life Care PREFERENCES ..... and they also tended to make errors of UNDERTREATMENT, even AFTER reviewing the patient's Advance Directive.
True False
Surrogates who were FAMILY MEMBERS tended to make prediction errors of OVERTREATMENT, even if they had reviewed or discussed the advance directive with the patient.
True False
According to patients who are dying [and their families], lack of communication with physicians and other health care providers causes ....
failure of the medical team to implement needed medical interventions
confusion about medical treatments, conditions and prognoses
confusion about the choices that patients and their families need to make
all of the above
only the second and third answers
Which of the following are mentioned as opportunities for Advance Care Planning discussions?
During routine outpatient office visits
During any admission to a hospital which accepts Medicaid or Medicare money
Hospitalization for a serious and progressive illness
all of the above
Only the third answer above
What additional opportunities were mentioned for initiating Advance Care Planning discussions?
During discussions about prognoses or treatment options that have poor outcomes
When the patient or family expresses concern about hospital debt collection policies
When approaching death within the reasonably near future (e.g., within 6 months)
all of t he above
only the first and third options above
In Step #1 - Initiate a Guided Discussion - we learned that by presenting various hypothetical scenarios and probable treatments, and noting when the patient’s preferences change from “treat” to “do not treat,” we ....
know when we need to change our approach, to bring about the option that we think is best for the patient.
can begin to identify the patient’s personal preferences and values.
Both of the above
Neither of the above
In Step #1, we also learned that one study indicated that elderly patients typically understand their realistic chances for a positive outcome.
True False
In Step #1, we also learned that in one study, after patients were told their probability of survival following CPR, only 25 percent changed their treatment preference from wanting CPR to refusing CPR.
True False
In Step #2 - Introduce the Subject of Advance Care Planning and Offer Information - individuals need to understand that when no advance directive or durable power of attorney exists, they are essentially leaving treatment decisions to their physicians and family members.
True False
In Step #2 - Introduce the Subject of Advance Care Planning and Offer Information - we are told that it is probably too soon to encourage individuals to complete an Advance Directive and a Durable Power of Attorney.
True False
In Step #3 - Prepare and Complete Advance Care Planning Documents - we learn that ...
Terms such as “no advanced life support” are sufficiently clear to offer guidance on the individual's intentions for End of Life Care.
AHRQ studies indicate that the standard language contained in Advance Directives often is not specific enough to be effective in directing care.
Advance care planning documents should contain specific instructions, e.g., If a patient does not want to be on a ventilator, we should ask the patient if this is true under all circumstances or only specific circumstances.
One study found that because patient preferences were not clear in advance directives, life-sustaining treatment was discontinued only when it was clearly medically futile.
All except the first answer above
From information in Step #3, we can infer that it is UNNECESSARY for instructions to state the point in the individual's illness that should be used to discontinue treatment and allow the person to die.
True False
In Step #4 - Review the Patient’s Preferences on a Regular Basis and Update Documentation - we learn that ......
Some patients who stated that they would rather die than endure a certain condition did NOT choose death once that condition occurred.
Both those with and those without a Living Will were more likely to change their preferences, [to now wanting] increased treatment, once they became hospitalized, suffered an accident, became depressed, or lost functional ability or social activity.
Increased depression was associated with patients’ changing their initial preference from refusal of CPR to acceptance of CPR.
All of the above
Only the first and second options above
In Step #4, we learn that it is unnecessary to document which preferences stay the same and which change over time, because it is difficult for people to fully imagine what a prospective health state might be like until they experience that health state.
True False
In Step #5 - Apply the Patient’s Desires to Actual Circumstances - we learned that AHRQ research indicates that patients choose treatment based on the quality of the prospective health state, the invasiveness and length of treatment, and possible outcomes.
True False
In Section 2 of this paper, AHRQ research shows that adults of various ages, whose current health states ranged from well to terminally ill
were not significantly different in their their perception of various hypothetical health states as being worse than death.
differed in their perception of hypothetical health states as being worse than death
In Section 2 of this research material, we find graphic data that shows clear trends about which health conditions (or states) are considered worse than death, by persons in various categories of health and age. QUESTION: Which health condition (or state) is considered to be worse than death by more people, regardless of their health condition or age?
severe pain
permanent coma
severe stroke
From graphic data presented in Section 2 of this material .... which group(s) of individuals more frequently consider PERMANENT COMA to be worse than death? [Select only one answer.]
stroke survivors
persons with chronic illness
persons with AIDS, and younger well adults
persons with terminal cancer
nursing home residents
From graphic data presented in Section 2 of this material .... which group(s) of individuals more frequently consider SEVERE STROKE to be worse than death? [Select only one answer.]
persons with AIDS and older well adults
nursing home residents
nursing home residents
persons with terminal cancer
stroke survivors
From graphic data presented in Section 2 of this material .... which group(s) of individuals more frequently consider SEVERE PAIN to be worse than death? [Select only one answer.]
nursing home residents
persons with AIDS and older well adults
persons with terminal cancer
persons with chronic illness
stroke survivors
Patients prefer treatment if they will retain cognitive awareness.
True False
This research study was authored by ....
The Agency for Healthcare Research and Quality
Barbara L. Kass-Bartelmes, M.P.H., C.H.E.S., and Ronda Hughes, Ph.D.
Margaret K. Rutherford


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