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

C. Free from avoidable distress

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. Needless suffering; dishonored wishes

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

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

B. Entire brain, including 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

C. 48 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

A. 24 hours

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

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

B. Physician

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

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

C. Anger

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

B. Bargaining

A dying patient becomes withdrawn, slowed, sleepless, hopeless, and suicidal.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

A) Acceptance

B) Bargaining

C) Denial

D) Depression

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. Withdrawal; hopelessness; sleep disturbance

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

A. Near-death experience

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

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

B. Oceanic unity with infinite power

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

A) Accidents

B) Homicides

C) Chronic illness

D) Suicides

C. Chronic illness

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

A. Sudden unexpected causes

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

B. Accidents, homicides, suicides

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

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

C. Preoperational

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

B. Separation from primary caretaker

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

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

A. Final reality

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

C. School-age children

How do adolescents typically understand death?

A) Temporary and incomplete

B) Inevitable and final

C) Reversible after separation

D) Impossible and unreal

B. Inevitable and final

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

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

C. Integrity versus despair

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

A. Grief

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

A) Bereavement

B) Anniversary reaction

C) Anticipatory grief

D) Mourning

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

B. Bereavement

Which pairing correctly distinguishes grief and mourning?

A) Feeling; resolution process

B) Ritual; depressive syndrome

C) Denial; social isolation

D) Trauma; anniversary trigger

A. Feeling; resolution process

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

C. Grief resolution; deprivation state

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

A) Detachment

B) Reorganization

C) Idealization

D) Protest

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

B. Searching behavior

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

A. Protest; searching; despair; reorganization

Which symptom is considered a more lasting manifestation of grief?

A) Anger

B) Loneliness

C) Euphoria

D) Panic

B. Loneliness

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

A. Anticipatory 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

C. Slow dying process

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

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

B. Anticipatory grief

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

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

A. Anniversary reaction

Bereavement commonly evokes symptoms from which psychiatric domain?

A) Psychotic symptoms

B) Manic symptoms

C) Depressive symptoms

D) Somatic delusions

C. Depressive symptoms

Which term can describe complicated bereavement?

A) Normal

B) Morbid

C) Organized

D) Expected

B. Morbid

Which set contains terms used for complicated bereavement

A) Abnormal; atypical; unresolved

B) Normal; organized; adaptive

C) Preoperational; reversible; temporary

D) Protest; searching; reorganization

A. Abnormal; atypical; unresolved

Which term is NOT typically used for complicated bereavement?

A) Traumatic

B) Distorted

C) Unresolved

D) Reorganized

D. Reorganized

Which pattern is the most common complicated grief syndrome?

A) Hypertrophic

B) Delayed

C) Traumatic

D) Chronic

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

B. Bitterness; idealization

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

C. Social supports

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

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

C. Extraordinarily intense and long-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

B. Delayed grief

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

B. Traumatic bereavement

Which pattern combination defines traumatic bereavement?

A) Chronic and hypertrophic

B) Delayed and anticipatory

C) Protest and searching

D) Restitution and reorganization

A. Chronic and hypertrophic

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

B. Psychiatric illness

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

C. Existing disease exacerbations

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

B. Increased mortality, especially men

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

A. Immediately after bereavement

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

A) Colon cancer

B) Ischemic heart disease

C) Chronic renal failure

D) Pulmonary fibrosis

B. Ischemic heart disease

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

C. Men younger than 65

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

A. Cirrhosis and suicide

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

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

B. Disrupted biologic rhythms

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

C. Reduced lymphocyte proliferation 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

C) Shock and disbelief

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

A. Acute discomfort and withdrawal

Which phase usually culminates the grieving process?

A) Initial denial

B) Social withdrawal

C) Restitution and reorganization

D) Acute biologic disruption

C. Restitution and reorganization

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

A) 1%

B) 4%

C) 15%

D) 25%

B. 4%

What is the most common cause of bereavement in children?

A) Parent death

B) Sibling death

C) Peer death

D) Grandparent death

A. Parent death

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

A) First

B) Second

C) Third

D) Fourth

B. Second

Which life event is often ranked as the most stressful?

A) Starting college

B) Losing employment

C) Death of a spouse

D) Moving homes

C. Death of a spouse

Grief after late perinatal loss is usually most intense for whom

A) Father

B) Sibling

C) Grandparent

D) Mother

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

A. Sleeping medications

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

B. Widows and widowers

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

C. Anxiety; depression; confusion

What happens to psychiatric conditions near the end of life?

A) Markedly increase

B) Completely resolve

C) Remain unchanged

D) Become diagnostically irrelevant

A. Markedly increase

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

A) 4%

B) 10%

C) 15%

D) 50%

C. 15%

Negative affect refers to which paired emotional states?

A) Anger and bargaining

B) Anxiety and depression

C) Denial and shock

D) Confusion and delirium

B. Anxiety and depression

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

A. Primarily somatic 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

C. Restlessness; tachycardia; insomnia

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

A) 15%

B) 35%

C) 65%

D) 85%

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

B. Includes patient, continues after death

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

C. Curative care

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

A. Pain management and opioids

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

C. Acknowledge estimates are inaccurate

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

B. How much patient wants known

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

C. Results of refusing treatment

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

C. Higher brain and brainstem loss

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

B. Gag and corneal

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

A. No self or environmental awareness

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

C. Severe neurologic damage

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

B. No patient benefit

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

C. Terminal condition

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; proxy; DNR

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

A) Physical therapy

B) Feeding tubes

C) Family meetings

D) Bereavement counseling

B. Feeding tubes

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

C. Health care proxy

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

A. Durable power of attorney

Which order prevents attempted cardiopulmonary resuscitation?

A) DNI

B) DNR

C) Proxy

D) Living will

B. DNR

Which order prevents placement of an artificial airway?

A) DNR

B) Proxy

C) DNI

D) Living will

C. DNI

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

A) 1973

B) 1985

C) 1991

D) 2001

C. 1991

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

A. Right to refuse treatment

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

B. Advance directives

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

C. Health care proxy

Palliative care primarily refers to relieving suffering from what

A) Elective procedures

B) Terminal disease symptoms

C) Normal developmental stress

D) Chronic family conflict

B. Terminal disease symptoms

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

C. Quiet private 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

A. Palliative care

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

B. Somatic and visceral

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. Adjuvant medications

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

C. Somatic 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. Visceral 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

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

B. Delirium and hallucinations

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

A) Antidepressants

B) Antibiotics

C) Anticoagulants

D) Antacids

A. Antidepressants

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

B. Antidepressants; steroids; antihistamines

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

C. Neuropathic and sympathetically maintained

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

A) Mood stabilizers

B) Beta blockers

C) Iron chelators

D) Antiplatelets

A. Mood stabilizers

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

A) Antiemetics

B) Amphetamines

C) Opioid antagonists

D) Antifungals

B. Amphetamines

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. Symptom management

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

B. THC

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

C. Six months 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

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

B. Burden on the family

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

A. Ability to feel pleasure

What is the leading cause of death in children?

A) Cancer

B) Accidents

C) Infection

D) Suicide

B. Accidents

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

A) Homicide

B) Congenital disease

C) Cancer

D) Heart disease

C. Cancer