Psych 29 Flashcards

Which description best defines a “good death”?

A) Rapid death without planning

B) Death occurring inside hospital

C) Free from avoidable distress

D) Death after aggressive treatment

Which description best defines a “bad death” in palliative care

A) Needless suffering; dishonored wishes

B) Sudden death after trauma

C) Death after chronic illness

D) Death with family present

A patient is declared dead after irreversible loss of circulation and breathing. Which definition is being applied?

A) Loss of cortical awareness

B) Persistent vegetative state

C) Terminal sedation response

D) Cessation of circulatory-respiratory function

Death can also be defined by irreversible cessation of which entire system?

A) Peripheral nervous system

B) Entire brain including brainstem

C) Cerebral cortex excluding brainstem

For brain death determination in an infant aged 1 week to 2 months, two assessments must be separated by at least how long?

A) 6 hours

B) 12 hours

C) 48 hours

D) 72 hours

For brain death determination in an infant aged 2 months to 1 year, two assessments must be separated by at least how long

A) 24 hours

B) 48 hours

C) 72 hours

D) 1 week

For brain death determination in an older child, two assessments must be separated by at least how long?

A) 1 hour

B) 6 hours

C) 24 hours

D) 12 hours

After a patient dies, who is required to sign the death certificate?

A) Primary nurse

B) Physician

C) Social worker

D) Funeral director

Which Kubler-Ross sequence is correctly ordered?

A) Anger; denial; acceptance; depression

B) Depression; bargaining; anger; denial

C) Denial; depression; anger; bargaining

D) Denial; anger; bargaining; depression

A dying patient says, “Why me?” and becomes resentful toward family and staff. Which Kubler-Ross stage best fits?

A) Bargaining

B) Acceptance

C) Anger

D) Depression

A terminally ill patient promises major life changes if given more time. Which Kubler-Ross stage best fits?

A) Anger

B) Bargaining

C) Acceptance

D) Shock

A dying patient becomes withdrawn, slowed, sleepless, hopeless, and suicidal. Which Kubler-Ross stage best fits?

A) Acceptance

B) Bargaining

C) Denial

D) Depression

Which symptom cluster most strongly matches the depression stage of dying?

A) Withdrawal; hopelessness; sleep disturbance

B) Euphoria; grandiosity; pressured speech

C) Flashbacks; hypervigilance; avoidance

D) Rituals; compulsions; intrusive thoughts

A patient reports floating above their body and hearing conversations during resuscitation. This best matches what phenomenon?

A) Near-death experience

B) Dissociative fugue

C) Panic attack

D) Somatic delusion

Which set best matches common near-death experience features?

A) Fever; seizures; hallucinations

B) Amnesia; confusion; agitation

C) Tremor; sweating; tachycardia

D) Peace; tunnel; deceased loved ones

“Unio mystica” refers to which experience?

A) Fear of permanent separation

B) Oceanic unity with infinite power

C) Denial of personal mortality

D) Bargaining with a deity

Compared with children, adults most commonly die from which broad cause?

A) Accidents

B) Homicides

C) Chronic illness

D) Suicides

Compared with adults, children usually die from which broad cause pattern?

A) Sudden unexpected causes

B) Slowly progressive dementia

C) Chronic cardiopulmonary illness

D) Long-term malignancy

Among children aged 1–14, almost half of deaths are due to which cause group?

A) Chronic illness only

B) Accidents, homicides, suicides

C) Congenital cardiac defects

D) Progressive neurologic disease

In late adolescence and early adulthood, nearly 75% of deaths are due to which cause group?

A) Cancer and infections

B) Chronic organ failure

C) Neurodegenerative disease

D) Accidents, homicides, suicides

A preschool child views death as temporary, incomplete, and reversible. Which cognitive stage best explains this?

A) Formal operational

B) Sensorimotor

C) Preoperational

D) Concrete operational

What is the main fear for preschool children facing death or serious illness?

A) Separation from primary caretaker

B) Loss of occupational identity

C) Moral guilt after bargaining

D) Permanent social reputation loss

A seriously ill child develops more nightmares and aggressive play. This reaction best fits which developmental group?

A) Adolescents

B) School-age children

C) Young adults

D) Preschool children

School-age children with concrete-operational thinking usually understand death as what?

A) Final reality

B) Temporary absence

C) Reversible sleep

D) Magical punishment

Which developmental stage is most associated with recognizing death as final through concrete-operational thinking?

A) Preschool children

B) Adolescents

C) School-age children

D) Infants

How do adolescents typically understand death?

A) Temporary and incomplete

B) Inevitable and final

C) Reversible after separation

D) Impossible and unreal

Which statement best captures adolescent thinking about personal death?

A) Death is always reversible

B) Death only affects adults

C) Death lacks finality

D) Own death may feel impossible

Erikson’s eighth and final life-cycle stage centers on which psychosocial outcome?

A) Initiative versus guilt

B) Identity versus role confusion

C) Integrity versus despair

D) Generativity versus stagnation

After a loved one dies, a patient describes the private emotional pain of the loss. Which term best applies?

A) Grief

B) Mourning

C) Bereavement

D) Melancholia

Which term describes the process by which grief is gradually resolved?

A) Bereavement

B) Anniversary reaction

C) Anticipatory grief

D) Mourning

A widow is described as being deprived of someone by death and currently in mourning. Which term best applies?

A) Grief

B) Bereavement

C) Protest

D) Detachment

Which pairing correctly distinguishes grief and mourning?

A) Feeling; resolution process

B) Ritual; depressive syndrome

C) Denial; social isolation

D) Trauma; anniversary trigger

Which pairing correctly defines mourning and bereavement?

A) Shock; anger response

B) Loneliness; chronic grief

C) Grief resolution; deprivation state

D) Acute grief; delayed denial

In normal bereavement, what is typically the first response to loss?

A) Detachment

B) Reorganization

C) Idealization

D) Protest

After the initial protest response in normal bereavement, which behavior commonly follows?

A) Permanent withdrawal

B) Searching behavior

C) Immediate acceptance

D) Prolonged denial

Which sequence best matches normal bereavement progression?

A) Protest; searching; despair; reorganization

B) Detachment; bargaining; protest; searching

C) Depression; denial; anger; acceptance

D) Searching; reorganization; protest; despair

Which symptom is considered a more lasting manifestation of grief?

A) Anger

B) Loneliness

C) Euphoria

D) Panic

A patient grieves before a loved one dies from progressive terminal illness. Which term best applies?

A) Anticipatory grief

B) Delayed grief

C) Anniversary reaction

D) Hypertrophic grief

Anticipatory grief is most associated with which situation?

A) Sudden unexpected death

B) Special occasion trigger

C) Slow dying process

D) Incomplete hematopoietic development

Anticipatory grief may cause which maladaptive interpersonal response before death occurs?

A) Searching behavior and attachment

B) Normal reorganization and attachment

C) Acute anniversary sadness and withdrawal

D) Premature separation and withdrawal

A spouse withdraws emotionally while their partner slowly dies from illness. Which grief process best explains this?

A) Chronic grief

B) Anticipatory grief

C) Delayed grief

D) Anniversary reaction

A patient develops acute grief every year on the spouse’s birthday. Which term best applies?

A) Hypertrophic grief

B) Prolonged denial

C) Normal protest

D) Anniversary reaction

An acute grief reaction triggered by a special occasion is best called what?

A) Anniversary reaction

B) Chronic grief

C) Anticipatory grief

D) Bereavement

Bereavement commonly evokes symptoms from which psychiatric domain?

A) Psychotic symptoms

B) Manic symptoms

C) Depressive symptoms

D) Somatic delusions

Which term can describe complicated bereavement?

A) Normal

B) Morbid

C) Organized

D) Expected

Which set contains terms used for complicated bereavement

A) Abnormal; atypical; unresolved

B) Normal; organized; adaptive

C) Preoperational; reversible; temporary

D) Protest; searching; reorganization

Which term is NOT typically used for complicated bereavement?

A) Traumatic

B) Distorted

C) Unresolved

D) Reorganized

Which pattern is the most common complicated grief syndrome?

A) Hypertrophic

B) Delayed

C) Traumatic

D) Chronic

Chronic dysfunctional grief is especially characterized by which features?

A) Brief sadness; rapid reorganization

B) Bitterness; idealization

C) Amnesia; manic symptoms

D) Peace; tunnel experience

Chronic grief is most likely when the relationship was extremely close or when what is lacking?

A) Funeral rituals

B) Medical documentation

C) Social supports

D) Religious beliefs

Hypertrophic grief is most often seen after which type of death?

A) Chronic terminal illness

B) Expected peaceful death

C) Remote childhood loss

D) Sudden unexpected death

Which description best matches hypertrophic dysfunctional grief?

A) Mild and short-term

B) Extreme denial and long-term

C) Extraordinarily intense and long-term

D) Quiet loneliness only and short-term

A patient has prolonged denial after losing a loved one. Which complicated grief pattern fits best?

A) Chronic grief

B) Delayed grief

C) Hypertrophic grief

D) Anniversary reaction

A patient has grief that remains persistently chronic and extraordinarily intense after a violent loss. Which term best fits

A) Normal bereavement

B) Traumatic bereavement

C) Anniversary reaction

D) Anticipatory grief

Which pattern combination defines traumatic bereavement?

A) Chronic and hypertrophic

B) Delayed and anticipatory

C) Protest and searching

D) Restitution and reorganization

A patient with traumatic bereavement is being evaluated for risk factors. Which history is frequently present?

A) Autoimmune disease

B) Psychiatric illness

C) Childhood asthma

D) Substance allergy

Bereavement-related medical complications most often include which pattern?

A) Only psychiatric symptoms

B) Only acute infections

C) Existing disease exacerbations

D) Permanent immune recovery

Which mortality pattern is associated with bereavement overall?

A) Increased mortality, especially women

B) Increased mortality, especially men

C) No mortality effect

D) Increased mortality, especially children

A recently bereaved man dies shortly after his spouse’s death. When is mortality risk highest after bereavement?

A) Immediately after bereavement

B) Five years after loss

C) During anniversaries

D) After full reorganization

Immediately after bereavement, which cause of death is particularly increased?

A) Colon cancer

B) Ischemic heart disease

C) Chronic renal failure

D) Pulmonary fibrosis

The greatest mortality effect after bereavement is seen in which group?

A) Women younger than 40

B) Men older than 80

C) Men younger than 65

D) Children younger than 15

After bereavement, widows may have increased relative risk of death from which causes?

A) Cirrhosis and suicide

B) Asthma and seizures

C) Diabetes and pneumonia

D) Stroke and anemia

Which type of death is more likely to precipitate PTSD in survivors?

A) Natural expected death

B) Chronic illness death

C) Peaceful hospice death

D) Unnatural violent death

During acute grief, which biologic disruption may occur?

A) Increased hemoglobin synthesis

B) Disrupted biologic rhythms

C) Enhanced neutrophil maturation

D) Improved sleep architecture

Acute grief may impair immune function through which changes?

A) Increased platelets and ferritin

B) Higher transferrin and ferritin

C) Reduced lymphocyte proliferation and NK function

D) Increased thymic T-cell maturation and NK function

Which phase begins many models of the grieving process?

A) Restitution and reorganization

B) Acute discomfort withdrawal

C) Shock and disbelief

D) Premature separation withdrawal

In grief models, the intermediate phase is best characterized by what?

A) Acute discomfort and withdrawal

B) Full restitution and reorganization

C) Immediate acceptance and peace

D) Hypertrophic denial only

Which phase usually culminates the grieving process?

A) Initial denial

B) Social withdrawal

C) Restitution and reorganization

D) Acute biologic disruption

Approximately what percentage of US children lose one or both parents by age 15?

A) 1%

B) 4%

C) 15%

D) 25%

What is the most common cause of bereavement in children?

A) Parent death

B) Sibling death

C) Peer death

D) Grandparent death

In childhood bereavement, sibling death is ranked as which cause?

A) First

B) Second

C) Third

D) Fourth

Which life event is often ranked as the most stressful?

A) Starting college

B) Losing employment

C) Death of a spouse

D) Moving homes

Grief after late perinatal loss is usually most intense for whom

A) Father

B) Sibling

C) Grandparent

D) Mother

When professional help is sought for grief, what request is commonly made to the PCP?

A) Sleeping medications

B) Antipsychotic injections

C) Stimulant medications

D) Cognitive testing

Bereavement care and grief therapy have been most effective in which group?

A) Children and adolescents

B) Widows and widowers

C) Unmarried young adults

D) Hospitalized trauma survivors

Which set best lists common psychological states in end-of-life care?

A) Mania; psychosis; euphoria

B) Obsessions; compulsions; tics

C) Anxiety; depression; confusion

D) Somatization; fugue; amnesia

What happens to psychiatric conditions near the end of life?

A) Markedly increase

B) Completely resolve

C) Remain unchanged

D) Become diagnostically irrelevant

In end-of-life care, approximately what proportion have major depression?

A) 4%

B) 10%

C) 15%

D) 50%

Negative affect refers to which paired emotional states?

A) Anger and bargaining

B) Anxiety and depression

C) Denial and shock

D) Confusion and delirium

In advanced disease, anxiety usually presents with which symptom pattern?

A) Primarily somatic symptoms

B) Purely delusional symptoms

C) Mostly suicidal thoughts

D) No physical symptoms

Which symptom cluster best matches anxiety in advanced disease?

A) Bradycardia; hypersomnia; euphoria

B) Aphasia; paralysis; seizures

C) Restlessness; tachycardia; insomnia

D) Jaundice; pruritus; ascites

In advanced disease, delirium prevalence can rise to approximately what level?

A) 15%

B) 35%

C) 65%

D) 85%

Which description best defines family-centered grief therapy

A) Treats family only after death

B) Includes patient, continues after death

C) Avoids discussing the patient

D) Focuses only on medications

A physician caring for a dying patient must first decide when which treatment goal has ended?

A) Pain control

B) Family communication

C) Curative care

D) Spiritual support

Which skill set is essential for palliative care physicians?

A) Pain management and opioids

B) Surgical airway management

C) Chemotherapy protocol design

D) Forensic death certification

When estimating survival in terminal illness, what is the best physician approach?

A) Give precise dates confidently

B) Avoid all prognosis discussion

C) Acknowledge estimates are inaccurate

D) Promise maximal survival time

Before disclosing details of a serious condition, doctors should first ask what?

A) Who should make decisions

B) How much patient wants known

C) Whether family wants disclosure

D) Which medication patient prefers

Valid informed consent should include risks, benefits, alternatives, and what else?

A) Physician’s personal opinion

B) Family’s religious beliefs

C) Results of refusing treatment

D) Hospital insurance policies

Which finding set best defines brain death?

A) No awareness but preserved brainstem

B) Lost cortex but preserved breathing

C) Higher brain and brainstem loss

D) Sleep-wake cycles without cognition

Brain death includes loss of respiration plus which reflexes?

A) Pupillary and patellar

B) Gag and corneal

C) Babinski and biceps

D) Vestibular and plantar

Persistent vegetative state is best defined by which pattern?

A) No self or environmental awareness

B) Preserved awareness, absent speech

C) Intact cognition, motor paralysis

D) Fluctuating confusion and agitation

Persistent vegetative state is associated with which underlying condition?

A) Mild psychiatric illness

B) Acute grief reaction

C) Severe neurologic damage

D) Normal brainstem function

For patients in persistent vegetative state, medical treatment generally provides what?

A) Curative neurologic recovery

B) No patient benefit

C) Improved environmental awareness

D) Restored cortical function

Advance directives primarily document patient wishes about care under what condition?

A) Temporary febrile illness

B) Minor outpatient procedure

C) Terminal condition

D) Normal aging

Which set contains the major advance directive types?

A) Living will; proxy; DNR

B) Consent; certificate; discharge plan

C) Autopsy; biopsy; guardianship

D) Hospice; chemotherapy; insurance

A living will may specifically reject which life-prolonging measure?

A) Physical therapy

B) Feeding tubes

C) Family meetings

D) Bereavement counseling

A patient names someone to make medical decisions if incapacitated. Which directive is this?

A) Living will

B) DNR order

C) Health care proxy

D) Informed consent

A health care proxy is also known as what?

A) Durable power of attorney

B) Patient self-determination

C) Physician death certification

D) Do-not-intubate order

Which order prevents attempted cardiopulmonary resuscitation?

A) DNI

B) DNR

C) Proxy

D) Living will

Which order prevents placement of an artificial airway?

A) DNR

B) Proxy

C) DNI

D) Living will

The Federal Patient Self-Determination Act was enacted in which year?

A) 1973

B) 1985

C) 1991

D) 2001

Under the Patient Self-Determination Act, hospitals must provide information about which right?

A) Right to refuse treatment

B) Right to demand antibiotics

C) Right to choose physician

D) Right to avoid diagnosis

The Patient Self-Determination Act specifically requires facilities to ask about what?

A) Organ donation

B) Advance directives

C) Psychiatric history

D) Family bereavement patterns

Hospitals must keep written records of whether patients have an advance directive or what else?

A) Opioid allergy history

B) Hospice insurance status

C) Health care proxy

D) Funeral home preference

Palliative care primarily refers to relieving suffering from what

A) Elective procedures

B) Terminal disease symptoms

C) Normal developmental stress

D) Chronic family conflict

Which room arrangement supports palliative care for a dying patient?

A) Busy shared hallway bed

B) Bright procedure suite

C) Quiet private room

D) Locked isolation room

Allowing family members to be present is an important part of what care approach?

A) Palliative care

B) Forensic evaluation

C) Experimental consent

D) Brain death testing

Which pain types usually respond well to opiates?

A) Neuropathic and sympathetically maintained

B) Somatic and visceral

C) Psychogenic and existential

D) Phantom and deafferentation

Neuropathic or sympathetically maintained pain often requires what in addition to opiates?

A) Adjuvant medications

B) Feeding tubes

C) Death certification

D) Advance directives

A terminal cancer patient describes constant, aching, gnawing pain that is easy to point to. Which pain type best fits?

A) Neuropathic pain

B) Visceral pain

C) Somatic pain

D) Sympathetic pain

A patient with bowel obstruction reports deep squeezing pain that is difficult to localize. Which pain type best fits?

A) Visceral pain

B) Somatic pain

C) Neuropathic pain

D) Psychogenic pain

A hospice patient describes pain as burning and electric-like. Which pain type is most likely?

A) Somatic pain

B) Visceral pain

C) Referred pain

D) Neuropathic pain

Which opioid adverse effects can occur frequently?

A) Bradycardia and hypothermia

B) Delirium and hallucinations

C) Seizures and aphasia

D) Mania and euphoria

In palliative care, which medication class can serve as an adjuvant for neuropathic pain?

A) Antidepressants

B) Antibiotics

C) Anticoagulants

D) Antacids

Which set contains commonly used pain adjuvants in palliative care?

A) Diuretics; statins; fibrates

B) Antidepressants; steroids; antihistamines

C) Antivirals; antifungals; antibiotics

D) Laxatives; antacids; bronchodilators

Adjuvant medications are especially crucial for which pain categories?

A) Somatic and visceral pain

B) Acute and nociceptive pain

C) Neuropathic and sympathetically maintained

D) Localized and gnawing pain

Which medication group is listed as a common adjuvant in palliative pain control?

A) Mood stabilizers

B) Beta blockers

C) Iron chelators

D) Antiplatelets

Which medication group is also listed as a common adjuvant for palliative pain management?

A) Antiemetics

B) Amphetamines

C) Opioid antagonists

D) Antifungals

In palliative care, what clinical goal is considered a high priority?

A) Symptom management

B) Cure of disease

C) Diagnostic certainty

D) Surgical correction

A palliative patient has severe nausea and vomiting despite standard measures. Which therapy is noted as effective?

A) SSRI

B) THC

C) Lithium

D) Digoxin

Under Medicare hospice criteria, a physician must certify what prognosis?

A) One month or less

B) Three months or less

C) Six months or less

D) One year or less

A physician considers withholding intensive care for a severely disabled child. Which quality-of-life issue is relevant?

A) Parent income level

B) Hospital bed availability

C) Physician specialty preference

D) Extent of bodily damage

Which consideration is used by physicians supporting withholding intensive care in children?

A) Family social media support

B) Burden on the family

C) Child’s school performance

D) Insurance reimbursement level

When considering withholding intensive care, which child-centered factor is relevant?

A) Ability to feel pleasure

B) Parents’ preferred physician

C) Hospital room size

D) Available research protocols

What is the leading cause of death in children?

A) Cancer

B) Accidents

C) Infection

D) Suicide

After accidents, which cause ranks second for death in children?

A) Homicide

B) Congenital disease

C) Cancer

D) Heart disease