NR 601 Week 7 questions with verified answers
Ans✓✓✓ Assessing Competency
Steps to assess competency: In situations in which a patient is refusing what a
physician considers "standard of care," a competency assessment is essential, but
it can be the source of discord. Reassure the patient that the final choice is his or
hers: "I am not here to argue. My duty as a doctor is to be a good teacher for you
about your health and the options you have. I just want to make sure I've done an
adequate job teaching you." Then assess the patient's understanding,
appreciation, and reasoning by using the format of the open-ended questions
described in Box 8.2.
Competency derives from the ability to make a decision. Evidence of impaired
decision-making capacity may be the first sign of clinically significant cognitive
impairment
1. A 75-year-old man with lung cancer metastatic to the bones is receiving hospice
care in his home. His predominant symptom is nociceptive and neuropathic right
chest wall pain caused by a fourth rib metastasis. In recent days he has
experienced a dramatic increase in his pain, and hospice staff have titrated his
pain regimen to gabapentin 900 mg three times daily, extended release morphine
100 mg three times daily, and immediate release morphine 30 mg every 2 hours
as needed. The hospice nurse calls you to ask about next steps, and reports that
he is still in severe pain but is now nonverbal, and his family is struggling to
administer his medication orally because of his somnolence. The patient's family
is exhausted. What is the best next step to assure the patient's comfort?
Ans✓✓✓ 1. A 75-year-old man with lung cancer metastatic to the bones is
receiving hospice care in his home. His predominant symptom is nociceptive and
neuropathic right chest wall pain caused by a fourth rib metastasis. In recent days
he has experienced a dramatic increase in his pain, and hospice staff have titrated
his pain regimen to gabapentin 900 mg three times daily, extended release
morphine 100 mg three times daily, and immediate release morphine 30 mg
every 2 hours as needed. The hospice nurse calls you to ask about next steps, and
reports that he is still in severe pain but is now nonverbal, and his family is
,struggling to administer his medication orally because of his somnolence. The
patient's family is exhausted. What is the best next step to assure the patient's
comfort?
A
1. Which of the following is true about cultural humility?
a. It is typically accomplished through professional development courses.
b. It can only be achieved by underrepresented minority groups.
c. It places emphasis on power imbalances and promotes interpersonal sensitivity
through partnerships with and learning from patients.
d. It rarely considers the biologic, socioeconomic, and racial impacts of upstream
structural factors on health disparities. Ans✓✓✓ C
1. Which of the following statements is true?
a. Decision-making capacity can be determined only by a psychiatrist.
b. A diagnosis of dementia precludes competent decision making.
c. Lack of decision-making capacity should not be presumed if the patient goes
against medical advice.
d. Expression of a choice is sufficient to indicate decision-making capacity.
Ans✓✓✓ C
2. An 85-year-old woman with congestive heart failure, end-stage chronic
obstructive pulmonary disease, chronic kidney disease stage 4, and frailty is
brought to your office for a routine appointment. She has preserved cognition and
her last Mini-Mental State Examination was 26. Affect is normal, and she has no
history of depression. She has a loving and supportive family with whom she lives.
During the visit, she shares that her quality of life is no longer acceptable, and
,asks about options to hasten the end of her life. Which of the following means of
hastening death is legal throughout the United States? Ans✓✓✓ a. Euthanasia
b. Palliative sedation
c. Voluntary stopping of eating and drinking
d. Physician-assisted death
C
2. Racial disparities have been a part of US healthcare for many decades. How
might this impact the expectations of older Black Americans?
a. Reluctance to participate in medical research because of unethical studies in
the past
b. Underrepresentation of Black physicians in the geriatric workforce
c. Cumulative effects of differences in access to healthcare providers
d. All of these Ans✓✓✓ D
2. Which of the following statements concerning advance directives is true?
a. The Supreme Court has established a standard advance directive form.
b. The living will is used to appoint a healthcare agent to make medical decisions
if an individual loses decision-making capacity.
c. A DNR order is not equivalent to a do-not-treat order.
d. Periods of acute illness are the most appropriate times to begin discussions
with patients about advance directives. Ans✓✓✓ C
3. A 78-year-old woman with atherosclerotic cardiovascular disease (ASCVD),
peripheral vascular disease, and a history of transient ischemic attacks s/p carotid
, endarterectomy is seen as part of an annual wellness visit. She is advised to
create an advance directive but declines, saying "I don't know who to pick" for a
healthcare agent. Which one of the following is a necessary characteristic of a
healthcare agent?
a. Geographic proximity to the patient's home
b. Knows how the patient defines quality of life
c. Is a member of the patient's immediate family
d. Has medical training or experience Ans✓✓✓ B
3. Dementia is a relatively common condition in the geriatric population. It
becomes more common as people age. Which is the most appropriate description
of "personhood" as it relates to people with dementia?
a. Personhood is a universal concept that is defined the same way in all cultures.
b. The ability to relate to others as people, rather than preserving cognitive
independence, is an important aspect of "personhood."
c. The ability to recognize family members by name is an important aspect of
"personhood."
d. A deterioration in cognitive function demonstrates the decreasing value of
older adults in society. Ans✓✓✓ B
3. The following are components of the open disclosure of medical error, except:
a. An apology to the injured patient.
b. An explanation of the error in lay language.
c. A best guess as to why the error occurred.
d. An assurance that a full investigation will take place. Ans✓✓✓ C
Ans✓✓✓ Assessing Competency
Steps to assess competency: In situations in which a patient is refusing what a
physician considers "standard of care," a competency assessment is essential, but
it can be the source of discord. Reassure the patient that the final choice is his or
hers: "I am not here to argue. My duty as a doctor is to be a good teacher for you
about your health and the options you have. I just want to make sure I've done an
adequate job teaching you." Then assess the patient's understanding,
appreciation, and reasoning by using the format of the open-ended questions
described in Box 8.2.
Competency derives from the ability to make a decision. Evidence of impaired
decision-making capacity may be the first sign of clinically significant cognitive
impairment
1. A 75-year-old man with lung cancer metastatic to the bones is receiving hospice
care in his home. His predominant symptom is nociceptive and neuropathic right
chest wall pain caused by a fourth rib metastasis. In recent days he has
experienced a dramatic increase in his pain, and hospice staff have titrated his
pain regimen to gabapentin 900 mg three times daily, extended release morphine
100 mg three times daily, and immediate release morphine 30 mg every 2 hours
as needed. The hospice nurse calls you to ask about next steps, and reports that
he is still in severe pain but is now nonverbal, and his family is struggling to
administer his medication orally because of his somnolence. The patient's family
is exhausted. What is the best next step to assure the patient's comfort?
Ans✓✓✓ 1. A 75-year-old man with lung cancer metastatic to the bones is
receiving hospice care in his home. His predominant symptom is nociceptive and
neuropathic right chest wall pain caused by a fourth rib metastasis. In recent days
he has experienced a dramatic increase in his pain, and hospice staff have titrated
his pain regimen to gabapentin 900 mg three times daily, extended release
morphine 100 mg three times daily, and immediate release morphine 30 mg
every 2 hours as needed. The hospice nurse calls you to ask about next steps, and
reports that he is still in severe pain but is now nonverbal, and his family is
,struggling to administer his medication orally because of his somnolence. The
patient's family is exhausted. What is the best next step to assure the patient's
comfort?
A
1. Which of the following is true about cultural humility?
a. It is typically accomplished through professional development courses.
b. It can only be achieved by underrepresented minority groups.
c. It places emphasis on power imbalances and promotes interpersonal sensitivity
through partnerships with and learning from patients.
d. It rarely considers the biologic, socioeconomic, and racial impacts of upstream
structural factors on health disparities. Ans✓✓✓ C
1. Which of the following statements is true?
a. Decision-making capacity can be determined only by a psychiatrist.
b. A diagnosis of dementia precludes competent decision making.
c. Lack of decision-making capacity should not be presumed if the patient goes
against medical advice.
d. Expression of a choice is sufficient to indicate decision-making capacity.
Ans✓✓✓ C
2. An 85-year-old woman with congestive heart failure, end-stage chronic
obstructive pulmonary disease, chronic kidney disease stage 4, and frailty is
brought to your office for a routine appointment. She has preserved cognition and
her last Mini-Mental State Examination was 26. Affect is normal, and she has no
history of depression. She has a loving and supportive family with whom she lives.
During the visit, she shares that her quality of life is no longer acceptable, and
,asks about options to hasten the end of her life. Which of the following means of
hastening death is legal throughout the United States? Ans✓✓✓ a. Euthanasia
b. Palliative sedation
c. Voluntary stopping of eating and drinking
d. Physician-assisted death
C
2. Racial disparities have been a part of US healthcare for many decades. How
might this impact the expectations of older Black Americans?
a. Reluctance to participate in medical research because of unethical studies in
the past
b. Underrepresentation of Black physicians in the geriatric workforce
c. Cumulative effects of differences in access to healthcare providers
d. All of these Ans✓✓✓ D
2. Which of the following statements concerning advance directives is true?
a. The Supreme Court has established a standard advance directive form.
b. The living will is used to appoint a healthcare agent to make medical decisions
if an individual loses decision-making capacity.
c. A DNR order is not equivalent to a do-not-treat order.
d. Periods of acute illness are the most appropriate times to begin discussions
with patients about advance directives. Ans✓✓✓ C
3. A 78-year-old woman with atherosclerotic cardiovascular disease (ASCVD),
peripheral vascular disease, and a history of transient ischemic attacks s/p carotid
, endarterectomy is seen as part of an annual wellness visit. She is advised to
create an advance directive but declines, saying "I don't know who to pick" for a
healthcare agent. Which one of the following is a necessary characteristic of a
healthcare agent?
a. Geographic proximity to the patient's home
b. Knows how the patient defines quality of life
c. Is a member of the patient's immediate family
d. Has medical training or experience Ans✓✓✓ B
3. Dementia is a relatively common condition in the geriatric population. It
becomes more common as people age. Which is the most appropriate description
of "personhood" as it relates to people with dementia?
a. Personhood is a universal concept that is defined the same way in all cultures.
b. The ability to relate to others as people, rather than preserving cognitive
independence, is an important aspect of "personhood."
c. The ability to recognize family members by name is an important aspect of
"personhood."
d. A deterioration in cognitive function demonstrates the decreasing value of
older adults in society. Ans✓✓✓ B
3. The following are components of the open disclosure of medical error, except:
a. An apology to the injured patient.
b. An explanation of the error in lay language.
c. A best guess as to why the error occurred.
d. An assurance that a full investigation will take place. Ans✓✓✓ C
