Journal of Gerontological Nursing

CE QUIZ

Abstract

HOW TO OBTAIN CONTINUING EDUCATION UNITS BY READING THIS ISSUE

Instructions: Registered nurses may receive fen contact hours by reading the articles noted below and successfully answering the questions in the following post-tests. Licensed practical nurses who pass the post-tests can petition their state LPN board for acceptance of me CE credits. To obtain continuing education unit credit:

1. Read the articles: 'The Search to End Suffering: A Historical Perspective," "Giving Voice to the Wishes of Elders for End-of-Life Care," "Assessment of DecisionMaking Capacity: Nursing's Role," "A Commitment to Palliative Care: Could it Impact Assisted Suicide?" "Families and End-of-Life Care: How Do We Meet Their Needs?" carefully noting the tables and other illustrative materials mat are provided to enhance your knowledge and understanding of the content.

2. Read each question and record your answers on the answer forms provided on page 56.

3. Type or print your full name and address and your social security number in the spaces provided on lhe registration form below.

4. Forward the completed registration and answer forms with your check or money order for $1 5 per quiz (or $65 for all five quizzes) payable to University of Maryland. Quizzes are accepted up to 1 2 months from date of issue.

Continuing Education Units: The University of Maryland School of Nursing is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. SLACK Inc. and University of Maryland School of Nursing are co-providers of this continuing education home study program.

Answers to the post-tests will be graded and you will be advised that you have passed or failed within 60 days of receipt of your completed test. A score of 70% or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the test(s).

Ten contact hours of participation in an educational offering is awarded one CEU. A contact hour is 50 minutes of instruction. Contact hour verification can be awarded only at the completion of a program. Contact hour units received for successali completion or the posf-test(s} may be used for certification or recertification credit.

CE QUIZ A

OBJECTIVES:

After studying the article: 'The Search to End Suffering: A Historical Perspective," in this issue, the participant will:

1. Discuss the historical roots of the contemporary focus on assisted suicide and euthanasia.

2. Discuss the arguments for and against suicide and euthanasia.

3. Identify the major factors that shaped society's attitudes toward assisted suicide.

4. Identify American physicians' and nurses' professional views on assisted suicide and patient- requested euthanasia.

5. Identify the future goals for nurses' influence on assisted suicide and patient-requested euthanasia.

Select the best response for me question and indicate your choke on the answer form on page 56.

1. Contemporary societal advocacy for assisted suicide and the right to determine one's own death, especially when related to pain and suffering, can be traced to:

A. Ancient Greek society.

B. Early medieval society.

C. Laxity of religious groups.

D. Rapid news distribution.

2. Contemporary society's opposition to assisted suicide and euthanasia, regardless of the pain and suffering involved, can be traced to:

A. Attempts to prevent untimely deaths.

B. Its early religious condemnation.

C. The frequency of mis-diagnoses.

D. The individual nature of suffering.

3. A pro or argument for assisted suicide is, it:

A. Avoids suffering, pain and indignities.

B. Can usually be performed without much notice.

C. Is accepted and recommended by medical groups.

D. Requires little effort and is highly successful.

4. A religious argument against assisted suicide is, it:

A. Condones Hitler's decree of…

HOW TO OBTAIN CONTINUING EDUCATION UNITS BY READING THIS ISSUE

Instructions: Registered nurses may receive fen contact hours by reading the articles noted below and successfully answering the questions in the following post-tests. Licensed practical nurses who pass the post-tests can petition their state LPN board for acceptance of me CE credits. To obtain continuing education unit credit:

1. Read the articles: 'The Search to End Suffering: A Historical Perspective," "Giving Voice to the Wishes of Elders for End-of-Life Care," "Assessment of DecisionMaking Capacity: Nursing's Role," "A Commitment to Palliative Care: Could it Impact Assisted Suicide?" "Families and End-of-Life Care: How Do We Meet Their Needs?" carefully noting the tables and other illustrative materials mat are provided to enhance your knowledge and understanding of the content.

2. Read each question and record your answers on the answer forms provided on page 56.

3. Type or print your full name and address and your social security number in the spaces provided on lhe registration form below.

4. Forward the completed registration and answer forms with your check or money order for $1 5 per quiz (or $65 for all five quizzes) payable to University of Maryland. Quizzes are accepted up to 1 2 months from date of issue.

Continuing Education Units: The University of Maryland School of Nursing is accredited as a provider of continuing education in nursing by the American Nurses Credentialing Center's Commission on Accreditation. SLACK Inc. and University of Maryland School of Nursing are co-providers of this continuing education home study program.

Answers to the post-tests will be graded and you will be advised that you have passed or failed within 60 days of receipt of your completed test. A score of 70% or above will comprise a passing grade. A certificate will be awarded to participants who successfully complete the test(s).

Ten contact hours of participation in an educational offering is awarded one CEU. A contact hour is 50 minutes of instruction. Contact hour verification can be awarded only at the completion of a program. Contact hour units received for successali completion or the posf-test(s} may be used for certification or recertification credit.

CE QUIZ A

OBJECTIVES:

After studying the article: 'The Search to End Suffering: A Historical Perspective," in this issue, the participant will:

1. Discuss the historical roots of the contemporary focus on assisted suicide and euthanasia.

2. Discuss the arguments for and against suicide and euthanasia.

3. Identify the major factors that shaped society's attitudes toward assisted suicide.

4. Identify American physicians' and nurses' professional views on assisted suicide and patient- requested euthanasia.

5. Identify the future goals for nurses' influence on assisted suicide and patient-requested euthanasia.

Select the best response for me question and indicate your choke on the answer form on page 56.

1. Contemporary societal advocacy for assisted suicide and the right to determine one's own death, especially when related to pain and suffering, can be traced to:

A. Ancient Greek society.

B. Early medieval society.

C. Laxity of religious groups.

D. Rapid news distribution.

2. Contemporary society's opposition to assisted suicide and euthanasia, regardless of the pain and suffering involved, can be traced to:

A. Attempts to prevent untimely deaths.

B. Its early religious condemnation.

C. The frequency of mis-diagnoses.

D. The individual nature of suffering.

3. A pro or argument for assisted suicide is, it:

A. Avoids suffering, pain and indignities.

B. Can usually be performed without much notice.

C. Is accepted and recommended by medical groups.

D. Requires little effort and is highly successful.

4. A religious argument against assisted suicide is, it:

A. Condones Hitler's decree of mercy killing.

B. Prevents the undoing of evil acts.

C. Supports devil worship and rituals.

D. Violates a sacred trust from God.

5. Which of the following played an important role in shaping society's attitudes and beliefs about assisted suicide and euthanasia?

A. Specialization of the tasks involved in caring for the sick.

B. The belief that physicians should make decisions about death.

C. The proliferation of groups that clarified the related issues.

D. The social change that increased women as research subjects.

6. Among the reasons for the escalation of the right-to-die movement is:

A. Advanced medical technology.

B. Lay and religious groups' opposition.

C. Rebellion against medical complacency.

D.The claiming of constitutional rights.

7. The American Medical Association opposes honoring patient requests for the right-do-die and assisted suicide because it:

A. May lead to undesired outcomes.

B. Sometimes leads to unnecessary deaths.

C. Violates physicians' autonomy rights.

D. Violates physicians' oath to do no harm.

8. Based on survey results, which conclusion is true about American nurses' perceived ability to manage patient care in life and death situations? Nurses are concerned

A. And feel capable.

B. And knowledgeable.

C. But complacent.

D. But refuse involvement.

9. By labeling decisions to withhold treatment as appropriate, nurses

A. May contribute to society's acceptance of euthanasia.

B. Have alienated physicians as partners in care.

C. Have become leaders of advocacy for euthanasia.

D. Have distinguished between active and passive euthanasia.

10. A future goal for nurses relevant to assisted suicide and patient-requested euthanasia is to:

A. Demand end-of-life dignity for patients.

B. Determine acceptable end-of-life care.

C. Develop appeal procedures for ethical boards.

D. Influence legislature and public policy.

CE QUIZ B

OBJECTIVES:

After studying the article: "Giving Voice to trie Wishes of Elders for End-of-life Care" in this issue, the participant will:

1. Verbalize a clear definition of "Patient Advocacy" specific to care involving elders faced with end-of-life issues.

2. Compare and contrast two instructional directives utilized in end-of-life care for elders.

3. Describe how the process of proxy designation works.

4. Discuss the impact that advance directives has had on patients and the care they receive.

5. Identify a method they can use to impact end-of-life care for elders in their practice.

Select the best response for the question and indicate your choke on the answer form on page 56.

1. Which of the following is the responsibility of institutions as relates to tfie "Patient Self-Deteimination Act" of 1991?

A. Have the telephone numbers of all family at immediate place of access.

B. Have a policy in place which ensures that the patient's physician knows his responsibility for end-of-life decisions of elders.

C. Determine if a client has an advance directive and document the presence or absence of directive in the client's record.

D. Make sure that the client's insurance company is aware that an advance directive exists.

2. Instructional directives specify a client's desires for medical treatment under specific conditions. Which of the following becomes effective when a person is terminally ill, and expresses the person's desire to the without the use of life-prolonging medical interventions?

A. Medical directives.

B. Living wills.

C. Proxy designation.

D. Patient Selr-Determination Act.

3. Ada is an 84-year-old with end stage metastatic bone cancer. Her best friend, 82-year-old Mae, is visiting with her one day and sees the condition her friend is in. She immediately goes to the nurses' station and states that the life-prolonging measures should be discontinued because her friend Ada does not wish to have them. The nurse tells Mae that she cannot act on her demand because she (Mae) was not the person chosen by Ada to make those decisions for her. What is the nurse referring to?

A. Medical directives.

B. Living wills.

C. Proxy designation.

D. Patient Selr-Determination Act.

4. Which one of the following was not a concern related to advance directives as documented by SUPPORT (1995)?

A. Patients experienced considerable pain.

B. Communication between physicians and patients was poor.

C. Physicians disregarded patients' refusals of interventions.

D. Nurses did not do patient education related to advance directives.

5. Which one of the following is not a way in which nurses can impact end-of-life decision-making?

A. Become politically active and make sure proper legislation is in place in their state.

B. Facilitation of discussion of a patient's desires.

C. Public education.

D. Determine that the directive is current and consistent with the patient's expressed desire for care.

6. Joseph Adams, 88 years old, has been a resident of long-term care since his CVA 3 years ago. Two weeks ago he stopped eating, saying he had had enough. His daughter is requesting insertion of a PEG tube and tube feeding. Which of the following should be the nurse's initial consideration?

A. Does the daughter have durable power of attorney for health care purposes?

B. Has Mr, Adams signed a living will?

C. How many calories can be force fed to Mr. Adams in a day?

D. Is Mr. Adams capable of making and communicating a rational decision?

7. Which of the following is a requirement of the Patient Self-Détermination Act tPSDA)? Health care institutions:

A. Cannot resuscitate a person with a living will.

B. Must deliver the medical care desired in a living will.

C. Must determine if a client has an advance directive and document its presence or absence in the record.

D. Must notify the patient's health care proxy when a patient with a durable power of attorney for health care purposes is admitted.

8. J.L, 74 years old, has an advance directive which states in the event of a coma, he does not desire CPR. However, 'rf he should have an Ml, the directive specifies he wants to be defibri Hated. His directive is an example of:

A. Health care proxy designate. C. Medical directive.

B. Living will. D. Substituted judgment standard.

9. Concerns about proxy decision-makers include:

A. The elder may not have explained what proxy decision-making entailed.

B. The proxy decision-maker may incorporate his/her own beliefs or misinterpret the elder's wishes.

C. The proxy decision-maker may have difficulty determining the elder's best interests when there are financial or emotional conflicts.

D. All of the above.

10. Which of the following represents one of the three primary questions the ANA recommends nurses ask clients in their care about advance directives?

A. Do you have basic information about advance directives?

B. Who would you trust to make a decision if you could not?

C. Would you like me to witness your advance directive?

D. Do you have any relatives to involve in this?

CE QUIZ C

OBJECTIVES:

After studying the article: "Assessment of Decision-Making Capacity: Nursing's Role," in this issue, the participant will:

1. Differentiate between the legal standard of competence and the clinical determination of capacity.

2. Describe the concept of decision-specific capacity.

3. Identify measures to determine decisional capacity.

4. Describe three patient conditions that may impair decision capacity.

5. Describe how nurses can contribute to accurate determination of decisional capacity.

Select the best response for the question and indicate your choice on the answer form on page 56.

1. A major distinction between competency and capacity is mat competency is:

A. Less disruptive to health care decisions.

B. Characterized by simplicity.

C. Based on a clinical judgment.

D. Only determined by a judge.

2. Which of the following is a drawback of the clinical approach to capacity decisions?

A. It is based on subjective observations.

B. Its legitimacy is uncertain.

C. It disregards family willingness to participate.

D. It applies to decisions.

3. The notion of decision-specific capacity assumes:

A. Most older people retain sufficient cognition to make some, but not all decisions.

B. Standardized methods ana1 protocols are used to determine capacity.

C. Older people can make global decisions but not specific decisions.

D. The individual is unable to understand the consequences of decisions.

4. The decision-making capacity needed to execute a living will is thought to be ______ mat needed to execute a health care proxy.

A. No different than.

B. Greater than.

C. Less than.

D. Totally separate from.

5. Which of the following should not be construed as impairing decisional capacity?

A. Hearing deficits.

B. Fatigue.

C. Aphasia.

D. Sleep deprivation.

6. According to Roth's "levels of evidence" to determine capacity at the second level, the patient would:

A. Consent and cooperate with the plan.

B. Express understanding of the consequences of decisions.

C. Logically express how their opinions relate to the situation.

D. Repeat information in their own words.

7. Proof or verification of capacity lies in the:

A. Idiosyncratic beliefs of the individual.

B. Physician's final diagnosis.

C. Stability of the person's decision.

D. Region of clinical observations.

8. The accuracy and reliability of a capacity assessment is not affected by:

A. Education, ethnicity and race.

B. Mental status test results.

C. Method of information disclosure.

D. Need for repeated information sessions.

9. The current "standard" in determination of decision-making capacity is:

A. Physician's evaluation.

B. Mental status tests.

C. Judicial rating.

D. Psychiatric diagnosis.

10. Nurses can best contribute to accurate determination of decisional capacity by:

A. Supporting the physician's assessment during interdisciplinary team meetings.

B. Not relying on nursing diagnosis since it does not address etiology.

C. Periodically documenting patient statements and actions.

D. Utilizing a charting by exception method as a standard.

CE QUIZ D

OBJECTIVES:

After studying the article: "A Commitment to Palliative Care: Could it Impact Assisted Suicide?" in this issue, the participant will:

1. Discuss the philosophy and nature of hospice and palliative care.

2. Describe the barriers to older adults obtaining palliative care.

3. Explain the relationship of suffering to assisted suicide.

4. Describe the related nursing implications.

5. Identify strategies to facilitate widespread provision of palliative care for older adults.

Select the best response for the question and indicate your choice on the answer form on page 56.

1. Which of the following is not a precursor to decreased quality of life?

A. Depression.

B. Increased socialization.

C. Pain.

D. Cognitive dysfunction.

2. Which of the following is a necessary criteria for admission to hospice?

A. A prognosis of 6 months or less.

B. Malignant disease.

C A signed "DNR" (Do Not Resuscitate) directive.

D. A life-threatening illness.

3. Health care in the United States is built around a model of.

A. Palliative care.

B. Supportive care.

C. Cure.

D. Pain management.

4. Which of the following is a correct statement about palliative care?

A. It always involves actively dying patients.

B. It is based on the acute care model of practice.

C. It is focused on control of symptoms.

D. It is well understood by people outside of health care.

5. The most important characteristic of effective palliative care is:

A. Knowledge of analgesics.

B. Knowledge of invasive therapies for pain relief.

C. Commitment to relief of physical and emotional pain.

D. Commitment to keeping costs of care contained.

6. Pain in patients with chronic cancer can be managed effectively in ___ of this population.

A. 90%.

B. 80%.

C. 100%.

D. 50%.

7. Pain specialists believe that patients requesting assisted suicide:

A. Are usually in hospice.

B. Anticipate pain or are suffering from psychological disturbances.

C. Are generally older than 65.

D. Have often failed palliative treatment.

8. Of the following, which would be the best approach for treatment of severe pain in an older adult?

A. Avoidance of opioids.

B. High doses of nonsteroidal antiinflammatory drugs.

C. Multidrug therapy.

D. Opioids titrated to patient response.

9. Of the following, which facilitates the provision of adequate pain control?

A. Commitment to advocacy among nurses.

B. Refusal to order medications for symptom control.

C. Agency policy delaying request of medication for pain.

D. Acceptance as standards of practice withholding treatment for pain.

10. Strategies to facilitate provision of palliative care for older adults would include which of the following?

A. Education.

B. Research

C. Exposure to palliative care.

D. All of the above.

CE QUIZ E

OBJECTIVES:

After studying the article: "Families and End-of-Life Care: How Do We Meef Their Needs?" in this issue, the participant will:

1 . Identify the nurse's first action in dealing with family members of the dying patient.

2. Identify two educational goals for helping families cope with their loved one's process of dying.

3. Distinguish between "prolonging life" and "prolonging death."

4. Identify the four steps related to assisting the family through the end-of-life process.

5. Identify two strategies to assist family members to deal with the end-of-life process.

Select the best response for the question and indicale your choke on the answer form on page 56,

1 . A nurse's first action in helping families to deal with the process of a dying family member should be to assess each family's:

A. Interpersonal relationships and conflicts.

B. Knowledge and expectations about end of life.

C Health status and cultural variables.

D. Understanding of durable power of attorney.

2. Use of feeding tubes and ventilators are interventions that:

A. Prolong death.

B. Prolong life.

C. Hasten death.

D. Provide comfort.

3. Although the Patient Self -Determination Act and use of advance directives have taken care of the family's burden of decision-making about the end of life, most family members:

A. Do not comply with the wishes as stated in the directives.

B. Do not question the health care provider's actions.

C. Do not realize how difficult it is to watch someone die.

D. Do not participate in the end-of-life care of their family member.

4. Which of the following is not true about end-of-life care?

A. Nurses can play a critical role in helping families cope with endof-life care.

B. The focus is often on what is not done versus what is done in caring for the dying.

C. Families have little exposure to end-of-life care other than what they see on television.

D. Hospice is the only setting in which end-of-life care is available.

5. Which of the following might provide the family with information to assist them to understand the care given in prolonging life as part of the process of dying?

A. Explain that medication can be used to provide a pain- free state.

B. Remind them that you are the professional who knows how to care for the person.

C. Delegate care activities to family members to include them in the process.

D. Pull back from the family members to let them come to terms with the situation.

6. A most common theme related to the end-of-life process that causes family members' guilt is that:

A. It is easier not to be involved in the process.

B. The only "good death" is one that happens at home.

C. The health care providers could have done more.

D. The process gets easier each time it is experienced.

Questions 7-9 refer to the four steps that the nurse can use in facilitating the process of involving the family in the end-of-life process.

7. Which of the following questions is useful to assess what the family knows about the death process (second step)?

A. Is there some part of the care you would like to do?

B. Have you noticed that as time goes on, the breathing is changing?

C. Is this the first time you have experienced the death of a family member or friend?

D. Is this process too overwhelming for you?

8. Which of the following questions is useful in providing the family tion about with realistic information about what will happen as their loved one dies?

A. Would you like me to stay with you while you bathe your loved one?

B. Have you noticed that as time goes on, the fingertips are more mottled?

C. Have you been through this process before?

D. What are the concerns you nave about the end-of-life process?

9. Which of the following questions is helpful in assisting the family member to identify a role for themselves in this end-of- life process?

A. Would you like to help straighten his/her position?

B. It seems to me that the periods of no breaths called apnea, are getting longer. .have you noticed this?

C. What are trie concerns you have about the end-of-life process?

D. Have you said good-bye to your loved one yet?

10. The word used by the author to describe the facilitative role of the nurse during the end-of-life process is:

A. Authority.

B. Educator.

C. Partner.

D. Presence.

10.3928/0098-9134-19970301-16

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