Palliative care Hospice/Advanced Directives

Question 1

What is the primary difference between palliative care and hospice care?
- A) Palliative care is only for patients with cancer, while hospice is for all terminal illnesses
- B) Hospice care is limited to patients with a life expectancy of six months or less, while palliative care can be provided at any stage of illness
- C) Palliative care focuses solely on pain management, while hospice focuses on curative treatments
- D) Hospice care includes advanced treatments, while palliative care does not

Answer 1

• B) Hospice care is limited to patients with a life expectancy of six months or less, while palliative care can be provided at any stage of illness

Question 2

Hospice care is intended for patients who:
- A) Have chosen to continue curative treatments
- B) Have a life expectancy of less than six months and elect to forego curative treatment
- C) Are recovering from a serious illness
- D) Have a prognosis of more than one year

Answer 2

• B) Have a life expectancy of less than six months and elect to forego curative treatment

Question 3

Palliative care is:
- A) Provided only in a hospital setting
- B) Focused on relieving suffering and improving quality of life, regardless of the stage of illness
- C) Limited to cancer patients only
- D) Available only through Medicare

Answer 3

• B) Focused on relieving suffering and improving quality of life, regardless of the stage of illness

Question 4

Which of the following services is NOT typically covered by Medicare hospice benefits?
- A) Nursing care
- B) Bereavement services for family members
- C) Emergency surgery for curative purposes
- D) Physical therapy

Answer 4

• C) Emergency surgery for curative purposes

Question 5

Under Medicare guidelines, what is required for a patient to enroll in hospice care?
- A) One doctor’s signature confirming a life expectancy of six months or less
- B) The patient must agree to continue curative treatment
- C) Two physicians must certify that the patient has a life expectancy of six months or less and the patient elects to forgo curative treatment
- D) The patient must be older than 65 years of age

Answer 5

C) Two physicians must certify that the patient has a life expectancy of six months or less and the patient elects to forgo curative treatment

Question 6

What does Medicare require after a patient has been enrolled in hospice for six months?
- A) A mandatory discharge from hospice care
- B) A re-certification by a physician every 30 days
- C) A face-to-face re-evaluation every 60 days to assess the patient’s prognosis
- D) A mandatory shift to palliative care

Answer 6

• C) A face-to-face re-evaluation every 60 days to assess the patient’s prognosis

Question 7

8. What is the primary function of a Living Will?
   
   • A) It designates a person to make healthcare decisions on the patient’s behalf
   • B) It outlines the patient’s wishes for medical care if they are unable to communicate
   • C) It transfers the patient’s property after death
   • D) It appoints a lawyer to manage financial affairs

Answer 7

• B) It outlines the patient’s wishes for medical care if they are unable to communicate

Question 8

A Health Care Proxy (HCP):
- A) Is a legal document that specifies funeral arrangements
- B) Appoints someone to make healthcare decisions for the patient if they become unable to do so
- C) Requires a physician’s approval to be valid
- D) Can only be used in cases of terminal illness

Answer 8

B) Appoints someone to make healthcare decisions for the patient if they become unable to do so

Question 9

What rights does a person designated as a Health Care Proxy (HCP) have?
- A) They can make decisions about financial matters for the patient
- B) They can make decisions about the patient’s medical care if the patient becomes incapacitated
- C) They can only make decisions about life support, not other medical treatments
- D) They must make decisions based on the hospital’s recommendations

Answer 9

• B) They can make decisions about the patient’s medical care if the patient becomes incapacitated

Question 10

A **Non-Hospital DNR (Do Not Resuscitate) ** order is:
- A) Only valid inside a hospital setting
- B) A legal order that prevents healthcare providers from performing CPR in non-hospital settings
- C) A requirement for all hospice patients
- D) Optional and decided upon by the hospital administrator

Answer 10

B) A legal order that prevents healthcare providers from performing CPR in non-hospital settings

Question 11

What is the purpose of a MOLST (Medical Orders for Life-Sustaining Treatment) form?
- A) It allows for the automatic withdrawal of care in nursing homes
- B) It specifies a patient’s preferences for life-sustaining treatments, such as CPR and intubation, across different healthcare settings
- C) It replaces a Living Will and HCP
- D) It is required for all patients in hospice care

Answer 11

• B) It specifies a patient’s preferences for life-sustaining treatments, such as CPR and intubation, across different healthcare settings

Question 12

Which of the following is true about a MOLST form?
- A) It is only valid in a hospital setting
- B) It is used to specify a patient’s treatment preferences across all healthcare settings, including home and long-term care facilities
- C) It is only signed by the patient
- D) It must be updated every year

Answer 12

• B) It is used to specify a patient’s treatment preferences across all healthcare settings, including home and long-term care facilities

Question 13

In palliative care, what is the primary goal when considering life-support interventions?
- A) To prolong life at all costs
- B) To balance extending life with maintaining the patient’s quality of life and respecting their wishes
- C) To use every available intervention regardless of the patient’s prognosis
- D) To always recommend invasive procedures to prolong life

Answer 13

• B) To balance extending life with maintaining the patient’s quality of life and respecting their wishes

Question 14

. What is a common barrier to effective end-of-life care in the U.S.?
- A) Lack of access to palliative care services
- B) Fragmented care and poor communication between clinicians, patients, and families
- C) High cost of care
- D) Overuse of hospice services

Answer 14

B) Fragmented care and poor communication between clinicians, patients, and families

Question 15

Why is it important to understand a patient’s ethnic and cultural background in palliative care?
- A) It helps to predict the patient’s medical prognosis
- B) It influences their preferences for treatment, response to illness, and decision-making at the end of life
- C) It determines which medications are most effective
- D) It ensures all patients receive the same level of care regardless of background

Answer 15

B) It influences their preferences for treatment, response to illness, and decision-making at the end of life

Question 16

In some cultures, how may families approach decision-making at the end of life?
- A) By always deferring to the patient’s physician
- B) By involving religious or spiritual leaders in discussions of care goals
- C) By avoiding discussions about the patient’s condition
- D) By prioritizing aggressive curative treatments

Answer 16

• B) By involving religious or spiritual leaders in discussions of care goals

Question 17

Which of the following is required for a Health Care Proxy (HCP) to make decisions on behalf of a patient?
- A) The patient must be declared mentally incompetent by a court
- B) The patient must be unable to communicate their wishes
- C) The patient must be admitted to hospice care
- D) The physician must approve the decisions of the HCP

Answer 17

• B) The patient must be unable to communicate their wishes

Question 18

How can advanced directives, such as a Living Will or HCP, improve end-of-life care?
- A) By ensuring healthcare providers follow only the hospital’s policies
- B) By giving clear instructions about the patient’s preferences for medical care and ensuring those preferences are respected
- C) By eliminating the need for healthcare providers to communicate with the patient’s family
- D) By removing the patient’s family from the decision-making process

Answer 18

• B) By giving clear instructions about the patient’s preferences for medical care and ensuring those preferences are respected

Question 19

What is a key quality indicator for palliative care?
- A) Focusing only on physical symptoms and treatments
- B) Addressing the psychological, social, and spiritual needs of both patients and their families
- C) Ensuring all patients are placed on life support
- D) Preventing families from making decisions about care

Answer 19

• B) Addressing the psychological, social, and spiritual needs of both patients and their families

Question 20

Which of the following is a core principle of palliative care?
- A) Only provided to terminally ill patients
- B) Focuses on curing the disease rather than managing symptoms
- C) Provides relief from the symptoms and stress of serious illness, regardless of prognosis
- D) Requires the patient to forgo all other treatments

Answer 20

C) Provides relief from the symptoms and stress of serious illness, regardless of prognosis

Question 21

Hospice care primarily focuses on:
- A) Curing the patient’s illness
- B) Providing symptom management and emotional support to patients with a life expectancy of six months or less
- C) Extending life through aggressive medical treatment
- D) Only providing care in hospital settings

Answer 21

B) Providing symptom management and emotional support to patients with a life expectancy of six months or less

Question 22

. How often must hospice patients be re-certified by a physician after the initial six-month period?
- A) Every month
- B) Every 90 days
- C) Every 60 days
- D) Annually

Answer 22

• C) Every 60 days

Question 23

What is the purpose of an advance directive like a Living Will?
- A) It specifies a patient’s preferences for financial decisions
- B) It outlines a patient’s wishes for medical care if they become unable to communicate their decisions
- C) It appoints someone to make legal decisions for the patient
- D) It ensures the patient receives all life-sustaining treatments

Answer 23

• B) It outlines a patient’s wishes for medical care if they become unable to communicate their decisions

Question 24

A Non-Hospital DNR is primarily used:
- A) To prevent CPR and other life-sustaining measures in hospital settings
- B) To prevent resuscitation outside of hospital settings, such as at home or in long-term care facilities
- C) To stop all forms of medical treatment
- D) Only in emergency room settings

Answer 24

• B) To prevent resuscitation outside of hospital settings, such as at home or in long-term care facilities

Question 25

Which of the following is a **Health Care Proxy (HCP)** responsible for? - A) Making financial decisions on behalf of the patient - B) Overriding the patient’s wishes for medical care - C) Making healthcare decisions based on the patient’s preferences when the patient is unable to communicate - D) Handling the patient’s estate and assets

Answer 25

- C) Making healthcare decisions based on the patient’s preferences when the patient is unable to communicate

Question 26

How do **MOLST** (Medical Orders for Life-Sustaining Treatment) forms differ from advance directives? - A) MOLST forms apply across healthcare settings and provide actionable medical orders based on patient preferences - B) MOLST forms are only applicable in hospital settings - C) MOLST forms cannot be altered once completed - D) MOLST forms are used to manage financial decisions

Answer 26

- A) MOLST forms apply across healthcare settings and provide actionable medical orders based on patient preferences

Question 27

. In hospice care, what type of treatment can still be provided under Medicare guidelines? - A) Only curative treatments - B) Comfort care treatments such as antibiotics for infections and pain management - C) Major surgeries and life-prolonging treatments - D) Experimental treatments

Answer 27

- B) Comfort care treatments such as antibiotics for infections and pain management

Question 28

Why is communication a key component of effective palliative and hospice care? - A) To ensure patients receive aggressive treatments regardless of their preferences - B) To make decisions on behalf of the patient without consulting them - C) To ensure that patient preferences, cultural considerations, and family dynamics are respected in care planning - D) To expedite end-of-life procedures without patient or family input

Answer 28

- C) To ensure that patient preferences, cultural considerations, and family dynamics are respected in care planning

Question 29

Which of the following is a goal of **palliative care** in addressing the spiritual needs of patients? - A) To extend life at all costs - B) To address the patient's spiritual and religious concerns and support their emotional well-being - C) To replace medical treatments with spiritual practices - D) To defer all decision-making to the patient’s family

Answer 29

- B) To address the patient's spiritual and religious concerns and support their emotional well-being

Question 30

What is the main goal of palliative care? - A) To cure the patient's illness - B) To relieve suffering and improve quality of life for patients with serious illness - C) To provide emergency interventions - D) To prolong life through aggressive treatments

Answer 30

- B) To relieve suffering and improve quality of life for patients with serious illness

Question 31

Hospice care is primarily for patients who: - A) Have a terminal illness and have chosen to forgo curative treatment - B) Are receiving aggressive curative treatments - C) Have a stable chronic illness - D) Are seeking a second medical opinion

Answer 31

- A) Have a terminal illness and have chosen to forgo curative treatment

Question 32

What is the primary difference between hospice care and palliative care? - A) Hospice care is only for cancer patients - B) Palliative care can be given at any stage of illness, while hospice care is for patients with a prognosis of six months or less - C) Palliative care focuses on emotional support only, while hospice provides full medical care - D) Hospice care is available for children only, while palliative care is for adults

Answer 32

- B) Palliative care can be given at any stage of illness, while hospice care is for patients with a prognosis of six months or less

Question 33

Under Medicare guidelines, which condition must be met for a patient to be eligible for hospice care? - A) The patient must be over the age of 65 - B) The patient must have a prognosis of six months or less and choose to forgo curative treatments - C) The patient must have a chronic illness but no life-threatening condition - D) The patient must be undergoing surgery

Answer 33

- B) The patient must have a prognosis of six months or less and choose to forgo curative treatments

Question 34

In hospice care, which treatment is typically NOT provided? - A) Symptom management - B) Curative treatments - C) Pain relief - D) Emotional support for families

Answer 34

- B) Curative treatments

Question 35

What services does Medicare typically cover for patients in hospice care? - A) Experimental treatments - B) Bereavement services for the family, nursing care, and medications related to symptom control - C) Any curative treatments the patient chooses - D) Long-term hospitalizations

Answer 35

B) Bereavement services for the family, nursing care, and medications related to symptom control

Question 36

. A health care proxy becomes active when: - A) The patient turns 65 years old - B) The patient is no longer able to make decisions on their own - C) The patient enters the hospital for surgery - D) The patient is diagnosed with a chronic illness

Answer 36

- B) The patient is no longer able to make decisions on their own

Question 37

A **Living Will** differs from a **Health Care Proxy (HCP)** in that: - A) It specifies a patient’s medical wishes, while an HCP appoints someone to make decisions on their behalf - B) It must be renewed annually - C) It only applies to financial matters - D) It is valid only if the patient is terminally ill

Answer 37

- A) It specifies a patient’s medical wishes, while an HCP appoints someone to make decisions on their behalf

Question 38

**MOLST (Medical Orders for Life-Sustaining Treatment)** forms are primarily used to: - A) Outline a patient’s wishes for life-sustaining treatments like CPR and ventilation - B) Provide instructions for financial and legal decisions - C) Replace all advance directives - D) Authorize the use of antibiotics for minor infections

Answer 38

- A) Outline a patient’s wishes for life-sustaining treatments like CPR and ventilation

Question 39

What is required for a MOLST form to be valid? - A) The patient’s lawyer must sign the form - B) A healthcare professional must complete and sign the form with the patient or representative’s input - C) It must be completed by a family member - D) It must be signed by a judge

Answer 39

- B) A healthcare professional must complete and sign the form with the patient or representative’s input

Question 40

What is the role of life support in palliative care? - A) It is used solely to prolong life indefinitely - B) It is used to support failing body functions and can be temporary or permanent based on the patient’s condition and wishes - C) It is required for all patients receiving palliative care - D) It is only used in hospice settings

Answer 40

- B) It is used to support failing body functions and can be temporary or permanent based on the patient’s condition and wishes

Question 41

Who is responsible for completing the medical portion of a death certificate? - A) The funeral director - B) The patient's lawyer - C) The physician or nurse practitioner who was caring for the patient - D) The patient’s family

Answer 41

- C) The physician or nurse practitioner who was caring for the patient

Question 42

What information is typically included on a death certificate under "cause of death"? - A) The time of day the death occurred - B) The immediate cause of death and any underlying conditions that contributed - C) The name of the patient’s physician - D) The type of treatment the patient received

Answer 42

- B) The immediate cause of death and any underlying conditions that contributed

Question 43

What should be done if an error is found on a paper death certificate? - A) Use white-out to correct it - B) Erase the error and rewrite it - C) Complete a new death certificate or correct it electronically if possible - D) Leave the error and submit the certificate

Answer 43

C) Complete a new death certificate or correct it electronically if possible

Question 44

Which of the following is a key question when considering life-sustaining treatments? - A) Will the treatment improve the patient's financial status? - B) Does the treatment align with the patient’s values and goals for care? - C) Is the treatment required for all patients over 65? - D) Will the treatment result in a permanent cure?

Answer 44

B) Does the treatment align with the patient’s values and goals for care?

Question 45

. Why is it important to discuss advance directives early, even when a patient is not terminally ill? - A) It avoids difficult decisions being made during a crisis and ensures the patient’s wishes are known - B) It prevents doctors from providing any treatment - C) It allows for all medical decisions to be made by the family - D) It ensures that the patient will not receive life support

Answer 45

- A) It avoids difficult decisions being made during a crisis and ensures the patient’s wishes are known

Question 46

. How often must a **MOLST** form be reviewed and updated in a healthcare setting? - A) Every 6 months - B) Every 60 to 90 days - C) Every year - D) It does not need to be updated once completed

Answer 46

- B) Every 60 to 90 days