Chapter 19- Death, Dying, and Bereavement

Question 1

This definition of death is a period during which vital signs are absent but resuscitation is still possible.
Presumably, near death experiences occur in this state.

a. clinical death
b. brain death
c. social death

Answer 1

A

Question 2

This definition of death is the absence of vital signs, including brain activity; resuscitation is no longer possible.
The person is considered legally dead.

a. clinical death
b. brain death
c. social death

Answer 2

B

Question 3

This definition of death is the point at which family members and medical personnel treat the deceased person as a corpse.
Family and friends must begin to deal with the loss. This is the point when we say that the person is dead.

a. clinical death
b. brain death
c. social death

Answer 3

C

Question 4

What are three examples for preparing for death?

Answer 4

• obtaining life insurance
• making a (living) will
• advance funeral planning

Question 5

These are directions given by a competent individual concerning what and/or how and/or by whom decisions should be made in the vent that, at some time in the future, the individual becomes incompetent to make certain decisions.

Answer 5

Advance directives

Question 6

Those near to _____ became increasingly more conventional, docile, dependent, and non-introspective.

Answer 6

death

Question 7

______(increasing/declining) neuroticism and ______(increasing/declining) conscientiousness may signal that an older senior is in terminal decline.

Answer 7

Increasing, declining

Question 8

Sharp declines in life satisfaction, commencing in the ___ years prior to death

Answer 8

4

Question 9

There tends to be a gradual, but accelerating, decline in overall cognitive functioning over the course of roughly ___ years.

Answer 9

6

Question 10

A sudden, steep drop in _____ intellectual ability, in particular, seems to signal that death is imminent.

Answer 10

crystallized

Question 11

According to Elisabeth Kubler-Ross, what are the 5 stages of dying?

Answer 11

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 12

In this stage of dying, people confronted with a terminal diagnosis use this as a psychological defense that may be useful in the early hours and days after such a diagnosis.

Answer 12

Denial

Question 13

_____ (stage of dying) often expresses itself in thoughts that life is not fair, but may also be expressed toward God, or toward doctors, nurses, or family members.

Answer 13

Anger

Question 14

In this stage of dying, the patient tries to make “deals” with doctors, nurses, family, or God.

Answer 14

Bargaining

Question 15

When bargaining fails as a result of declining physical status, the patient sinks into ______.

Answer 15

depression

Question 16

Kubler-Ross views depression a s a necessary preparation for the final step of _______, since a person must grieve for all that will be lost with death; when such grieving is finally done, the individual is ready to die.

Answer 16

Acceptance

Question 17

In Kubler-Ross’s stages of dying, ____ and _____ relevance of the stages has been questioned because she only had 200 sample individuals who were mostly adult cancer patients with Westernized, individualistic critical values.

Answer 17

generalizability, cross-cultural relevance

Question 18

Schneiderman suggests “____” to the dying process, rather than stages.

Answer 18

themes

Question 19

Corr suggests four “tasks” for the dying person to take care of:

Answer 19

1. satisfying bodily needs and minimizing physical stress
2. maximizing psychological security, autonomy, and richness of life
3. sustaining and enhancing significant interpersonal attachments
4. identifying, developing, or reaffirming sources of spiritual energy and thereby fostering hope.

Question 20

Do attitudes and behavioral choices have any effect on the physical process of dying?

Answer 20

YES

Question 21

Greer classified women’s attitudes three months after they were diagnosed with breast cancer. These attitudes (5) are:

Answer 21

• denial (positive avoidance)
• fighting spirit
• stoic acceptance (fatalism)
• helplessness/hopelessness
• anxious preoccupation

Question 22

Greer found out that those whose initial reaction was ______ _____ were less likely to die of cancer.

Answer 22

fighting spirit

Question 23

There is a growing body of evidence suggesting that suffering can be lessened while survival can be prolonged by ____ interventions

Answer 23

psychological

Question 24

Cunningham and colleagues investigated the impact of psychological self-help on survival rates among medically incurable cancer patients and they found out that the third of patients who became most engaged in self-help lived much _____ (about 3x on average) than the third who were least engaged.

Answer 24

longer

Question 25

In Canada, the majority of deaths (67%) occur in ___

a. hospitals
b. hospice care

Answer 25

A

Question 26

_____ is a holistic approach to care for the terminally ill that emphasizes individual and family control of the process of dying. This can be provided in a home, nursing home, hospitals
- this does not attempt to cure or slow down the disease process

Answer 26

Hospice care

Question 27

In hospice care, medical care should be primarily ____ care rather than curative

Answer 27

palliative

Question 28

This is a form of care for the terminally ill that focuses on relieving patients’ pain and symptoms, rather than curing their diseases or disorders.

Answer 28

Palliative care

Question 29

WHO (2016) defines _____ as an approach that improves quality if life of patients and their families who are facing the problems associated with life-threatening illnesses.

Answer 29

palliative care

Question 30

In 2010, they found out that although 90% of Canadians who die can benefit from palliative care, only 16-30% have access to or received palliative care or end of life services.

What are two explanations for this?

Answer 30

• there’s a lack of awareness of services
  -financial considerations

Question 31

______ care may be combined with life prolonging treatments, whereas ____ care doe snot aim to prolong life or to cure disease.

Choices: palliative, hospice

Answer 31

palliative, hospice

Question 32

_____ care is appropriate for patients in any stage of illness- terminal or not while ____ care are for those with terminal illness.

Choices: palliative, hospice

Answer 32

palliative, hospice

Question 33

Hospice palliative care helps dying patients and their families to address ______, _______, _______, _______, and _____ issues, as well as their associated expectations, needs, hopes, and fears

Answer 33

physical, psychological, social, spiritual, and practical

Question 34

Hospice palliative care complements traditional curative biomedical care with a wellness, ______-person orientation

Answer 34

whole

Question 35

_____-based care has a numerous benefits for the patient

Answer 35

Dignityy

Question 36

The Canadian Society of Palliative Care Physicians estimates that integrating palliative care into existing health care systems would provide about 30% in ____ in direct health care costs.

Answer 36

savings

Question 37

_____ for dying patients have a considerable burden, including a grief response.

Answer 37

Caregivers

Question 38

_________ enables health care professionals to interact directly with informal care providers.
Provides access to a range of palliative hospice care services
Brings medical expertise to the home and to rural and remote areas of Canada.

Answer 38

Canadian virtual hospice

Question 39

This is the most important bioethical issue wherein a physician or nurse prescribes a drug that is self-administered to cause death.
This is also known as physician-assisted suicide or physician-assisted death.

Answer 39

Medically assisted suicide

Question 40

Eligibility criteria for medical assistance in dying (5)

Answer 40

• be eligible for federal or provincial healthcare services
• be at least 18 years old and mentally competent
• have a grievous and irremediable medical condition or unbearable physical or mental suffering that cannot be relieved
• make a request for MAID that is not a result of outside pressure and influence
• give informed consent to receive MAID

Question 41

This is the natural response to the loss of someone or something that is very dear to a person, which may or may not involve death, e.g., the death of a pet, the loss of a job or a home.

Answer 41

Grief

Question 42

What are the common elements (4) of grief?

Answer 42

• yearning
• longing
• sorrow
• thoughts and memories of the person or thing that is gone

Question 43

What are the psychosocial functions (4) of death rituals?

Answer 43

• they help family members manage their grief by giving them a specific set of roles to play, providing shape to the first hours and days.
• they bring family members together; they can strengthen family ties, clarify the new lines of influence or authority within a family, and pass on the torch in some way to the next generation
• they may help survivors understand the meaning of death itself, in part by emphasizing the meaning of the life of the person who has died.
• they may give some transcendent meaning to death itself by placing it in some philosophical or religious concept.

Question 44

Knowing that a loved one is ill and in danger helps _____cope with the loss in advance, just a sit does for those who are older.

Answer 44

children

Question 45

_____ may be more likely to experience prolonged grief than children or adults, due to cognitive characteristics.

Answer 45

Teens

Question 46

Widows who have cared for spouses during a period of _____ prior to death are less likely to become depressed after the death,

Answer 46

illness

Question 47

_____ and ____ deaths evoke more intense grief responses

Answer 47

sudden and violent

Question 48

_____ survivors may be more likely to experience long-term negative effects.

Answer 48

suicide

Question 49

______ is a term that refers to the loss of a spouse

Answer 49

widowhood

Question 50

Effects of widowhood on physical health (3)

Answer 50

• immune system functions are suppressed somewhat immediately after the death
• most return to normal by a year after the death
• the immune dysfunction can last beyond obvious signs of grief.

Question 51

In the year following bereavement, the incidence of ______ among widowers rises substantially.

Answer 51

depression

Question 52

Grief symptoms for more than __ months following the loss of a loved one may indicate a prolonged grief disorder.

Answer 52

2

Question 53

Grief lasting longer than ___ months can lead to long-term depression, a decreased quality of life, and physical ailments.

Answer 53

6

Question 54

This approach to managing grief can be helpful in preventing grief-related depression

Answer 54

“talk-it-out”

Question 55

Returning from work to soon following death of a loved one can contribute to _____ and _____.

Answer 55

illness and depression

Question 56

There is substantial ____(rise/decline) in mortality for both men and women following the death of their spouse, universally and independent of cause of death.

Answer 56

rise

Question 57

The sudden loss of whatever social and emotional buffering effects that marriage provides may play a role in the ____ effect.

Answer 57

widowhood

Question 58

_____ report a sense of being cheated by death.

a. young adults
b. middle-aged adults
c. older adults

Answer 58

A

Question 59

_____ begin to confront their own mortality and undergo a change in their sense of time lived and time until death.

a. young adults
b. middle-aged adults
c. older adults

Answer 59

B

Question 60

______ are more accepting of death

a. young adults
b. middle-aged adults
c. older adults

Answer 60

C

Question 61

_____ is the apprehensive, uneasy, or nervous feeling brought on by the awareness of death.

Answer 61

Death anxiety

Question 62

Paul Wong suggests that our fear of death stems from six existential uncertainties. What are these?

Answer 62

1. The finality of death
2. The uncertainty of what follows
3. Annihilation anxiety or fear of non-existence
4. The ultimate loss
5. Fear of the pain and loneliness in dying
6. Fear of failing to complete life work

Question 63

This aspect of death means there is no reversal, no remedy, no more tomorrow. Therefore, death signifies the cessation of all hope with respect to this world.

Answer 63

The finality of death

Question 64

In this aspect of death, Socrates has made the case that, since we really don’t know what will happen, we should not fear. But uncertainty coupled with finality can create a potential for terror.

Answer 64

The uncertainty of what follows

Question 65

This aspect of death implies that the concept of nonbeing can be very threatening, because it seems to go against a strong and innate conviction that life should not be reduced to nonbeing.

Answer 65

Annihilation anxiety or fear of nonexistence

Question 66

This aspect of death implies that when death occurs, we are forced to lose everything we have ever valued. Those with the strongest attachments toward things of this world are likely to fear death most. Loss of control over affairs in the world and loss of the ability to care for dependents also contribute to death anxiety.

Answer 66

The ultimate loss

Question 67

This aspect of death implies that many are afraid that they will die alone or die in pain, without any family or friends around them.

Answer 67

Fear of the pain and loneliness in dying

Question 68

This aspect of death implies that many people are more afraid of a meaningless existence than death itself; their fear if death stems from fear of not being able to complete their mission or calling in life.

Answer 68

Fear of failing to complete life work

Question 69

For _____, the sense of unique invulnerability probably prevents intense fears of death.

Answer 69

young adults

Question 70

_____ adults are most fearful of death. A belief in one’s own immortality begins to break down, resulting in increasing anxiety about the end of life.

Answer 70

Middle-aged

Question 71

By late life, the inevitability of death has been ____, and anxieties are focused on how death will actually come about.

Answer 71

accepted

Question 72

Older adults are ____(more/less) likely to fear the period of uncertainty before death than they are to fear death itself.

Answer 72

more

Question 73

______ and _____ beliefs are protective factors against fear of death

Answer 73

religious and spiritual

Question 74

The belief that God exists _____(increases/decreases) with age; The belief in life after death ___(increases/decreases) with age.

Answer 74

increases, decreases

Question 75

Ley and Van Bommel state that the spiritual search for meaning in our lives is often intensified by the ____ of death. This is an important aspect in palliative care

Answer 75

reality

Question 76

Adults have less fear of death if: (2)

Answer 76

• they have accomplished goals or believe they have become the person they set out to be
• believe that life has purpose or meaning.

Question 77

fear of death may be an aspect of the _____ described in Erikson’s theory of ego integrity vs. despair

Answer 77

despair

Question 78

By the age of ____, most children seem to understand both the performance and universality of death because it is the end of Piaget’s preoperational stage.

Answer 78

7

Question 79

Unrealistic beliefs about personal death appear to contribute to adolescent _____

Answer 79

suicide

Question 80

Like those of children, ____’s ideas about death are affected by their personal experiences

Answer 80

adolescent

Question 81

This is the belief that bad things, including death, happen only to others.
This is in early adulthood

Answer 81

Unique invulnerability

Question 82

In ____, many individuals switch the way they think about time from “time since birth” to ‘time until death”

Answer 82

middle age

Question 83

The most pervasive meaning of death for adults of all ages is ___

Answer 83

loss

Question 84

In this theory, you have a feeling of time running out, a person’s social goals shift from being knowledge-related to emotion-related

Answer 84

Socioemotional selectivity theory

Question 85

At what point must friends and family begin to deal with the loss of a loved one?
a. social death
b. clinical death
c. brain death
d. legal death

Answer 85

A

Question 86

When the cortex shows no electrical activity but the brain stem is not affected, the person may

a. be treated as a corpse.
b. be declared legally dead.
c. survive for long periods in a vegetative state.
d. have a near-death experience.

Answer 86

C

Question 87

All of the following would be elements of hospice care except

a. encouraging the dying person to talk openly about the death.
b. viewing death as something that is a normal part of life.
c. utilization of invasive techniques that can prolong life.
d. family involvement in the patient’s care.

Answer 87

C

Question 88

Which of the following statements about hospice care is true?

a. Although the idea of hospice care sounds good, patients and caregivers actually prefer traditional hospital care.
b. Hospice care relieves the dying patient and the family of the need to make decisions about the dying process.
c. Hospice care can take place in a person’s home.
d. A hospice is the best choice for a dying person who is seeking experimental treatment for his or her condition.

Answer 88

C

Question 89

Middle-aged and older adults who think about life in terms of “time remaining”

a. are less fearful of death than those who think of their lives as “time flies.”
b. usually fail to develop a sense of ego integrity in old age.
c. are more fearful about their inevitable death than those who think in terms of “time lived.”
d. have less fear of death than those who think of their lives as “time lived.”

Answer 89

D

Question 90

Research on the effect of religious beliefs on attitudes toward death indicates that adults who

a. are deeply religious have the greatest fear of death because they fear their lives have not been good enough or pure enough.
b. are deeply religious and those who are totally irreligious report less fear of death than those who are uncertain about or uncommitted to any religion.
c. have not committed to any religious convictions have the lowest level of fear of death.
d. have only recently developed strong religious beliefs are the most fearful because they don’t feel that they have enough time remaining to redeem their lives.

Answer 90

B

Question 91

There tends to be a gradual, but accelerating, decline in overall cognitive functioning over the course of roughly six years prior to death. In particular, a sudden, steep drop in ______________ seems to signal that death is imminent.

a. short-term memory abilities
b. fluid intellectual ability
c. crystallized intellectual ability
d. language abilities

Answer 91

C

Question 92

Which of the following is one of the tasks of dying proposed by Charles Corr?

a.ignoring or avoiding sources of spiritual energy
b. minimizing bodily needs
c. sustaining and enhancing significant personal attachments
d. minimizing autonomy

Answer 92

C

Question 93

The scientific study of death and dying is called

a. euthanology.
b. tocology.
c. thanatology.
d. entomology.

Answer 93

C

Question 94

Among grieving people, death in the context of a natural disaster tends to be associated with

a. prolonged grieving and development of symptoms of PTSD.
b. a sense that the death was not without purpose.
c. high levels of denial.
d. feelings of rejection and anger.

Answer 94

A

Question 95

The widowhood effect refers to the finding that

a. widows but not widowers are greatly impacted by the death of a spouse.
b. the risk of death from any cause is increased by 30–90% among widows and widowers during the first three months of bereavement.
c. after an initial phase of grieving, life satisfaction often increases greatly during widowhood.
d. the risk of death from any cause is decreased by 30–90% among widows and widowers during the first three months of bereavement.

Answer 95

B

Question 96

What has research shown helps widows and widowers manage grief?

a. returning to work as soon as possible to avoid complicated grief
b. withdrawing from social activities in the early months of bereavement
c. developing a coherent personal narrative of events surrounding the spouse’s death
d. waiting at least a year before discussing the events surrounding the spouse’s death

Answer 96

C

Question 97

he vast majority of people in Canada die

a. in nursing homes.
b. in hospitals.
c. in relatives’ homes.
d. at home.

Answer 97

B

Question 98

Which group of people is most afraid of death?

a. men
b. older adults
c. middle-aged adults
d. young adults

Answer 98

C

Question 99

Older adults who are experiencing the terminal decline experience all the following except a

a. decline in life satisfaction beginning about four years before death.
b. change toward being more conventional, docile, dependent, and non-introspective three years prior to death.
c. slow and steady decline in cognitive functioning from about six years before death.
d. sudden significant drop in all physical and mental functioning a few months before death.

Answer 99

D

Question 100

Which of the following is not an accurate statement about criticisms of Kübler-Ross’s model of the psychological stages of dying?

a. Reactions to dying may be culturally conditioned, and Kübler-Ross’s model may not apply to other cultures.
b. Clinicians and researchers do not agree that the emotions are experienced in the order specified in the model.
c. The model has been criticized for failing to convey clear ideas or meaningful concepts about the process of dying.
d. Other researchers have failed to replicate the findings of Kübler-Ross, including the universal experience of the five stages.

Answer 100

C

Question 101

Research into the relationship between an individual’s emotional response to impending or probable death and the actual outcome suggests, in general, that

a. emotional response to a condition does not affect outcome or survival rate.
b. difficult patients who express their anger and hostility openly die sooner.
c. individuals who question and challenge and have a fighting spirit have a more difficult recovery experience.
d. emotional responses contribute to disease progress.

Answer 101

D

Question 102

How does involvement in self-help exercises affect cancer survival?

a. Those who are most engaged in self-help live longer.
b. Those who practise self-help need less medical treatment.
c. Those who engage in self-help die sooner but more happily.
d. Practising self-help does not affect outcome or survival.

Answer 102

A

Question 103

Which of the following is not a typical psychological function of death rituals?

a. bringing family members together
b. giving some transcendent meaning to death
c. helping the survivors understand the meaning of death itself
d. showing others how much the survivors loved the person who died

Answer 103

D

Question 104

Which of the following is not an accurate statement about the way widowhood affects physical and mental health?

a. Depression is a universal symptom of grief that is unaffected by cultural factors.
b. Older adults who enter widowhood with a history of depression are more likely to experience depression after the death of their spouse.
c. In the year after bereavement, the incidence of depression among widows and widowers rises significantly.
d. The experience of widowhood has a negative effect on immune system functioning.

Answer 104

A

Question 105

Which of the following is not an accurate statement about prolonged grief? Prolonged grief is characterized by

a. intense emotional pain.
b. guilt or anger.
c. complete denial of the loved one’s death.
d. persistent yearning or preoccupation for the deceased.

Answer 105

C