Module test - CHSS eLearning

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Each of the Managed Clinical Networks (MCNs) in Scotland will be given the names of those who have been awarded Module Test Certificates within their areas. We do not collect or share information on the number of times a person attempts the Test, or where a certificate is not awarded.
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This is the module test for ‘Sensitive and effective conversations at end-of-life care after stroke’. It is strongly recommended that you work though the learning materials of the module prior to commencing this test. By going straight to the test you may miss out on valuable learning contained within the module. The answers to all the test questions are contained within the module. This information may have been provided in the 'Additional Information' boxes on some of the pages.

There are 9 questions and you must answer all of these correctly to obtain a certificate of completion.

You should allow approximately 20 minutes to complete this test.

Sensitive and effective conversations: Module test – Part 1. Q. Which of the following statements in relation to conversations about end of life care after stroke are true? (Select all that apply)*
- Select All
- A. Families and patients are likely to have discussed preferences for life saving interventions prior to the stroke
- B. It is generally easy for health care professionals to predict whether a patient will die or not
- C. Families generally know whether a patient would prefer survival with severe disability rather death as an outcome
- D. Sensitive conversations about end-of-life care after stroke helps families cope better with bereavement
- E. Most patients who have a stroke will already have appointed a Power of Attorney

Part 1. Answer.

Unfortunately, you have answered Question 1 incorrectly.
Part 1. Answer.

Well done, the correct answer is D.

Sensitive and effective conversations: Module test – Part 2. Q. When the patient is aphasic or lacks capacity and cannot be involved in the discussions about end of life care, which statements are true? (Select all that apply)*
- Select All
- A. Gather as much information as you can about the patient’s clinical status including co-morbidities before you meet with the family
- B. The conversation with the family is best done face to face if possible
- C. Check if any family member is a welfare power of attorney
- D. Avoid eye contact if the relatives are upset
- E. Distressed families should only be given information once

Part 2. Answer.

Unfortunately, you have answered Question 2 incorrectly.
Part 2. Answer.

Well done, the correct answers are A, B and C.

Sensitive and effective conversations: Module test – Part 3. Q. If a patient is admitted with an acute stroke and thought highly likely to die within the next few hours, which of the following statements are true? (Select all that apply)*
- Select All
- A. It is best to avoid the use of the term ‘dying’ as this will be too upsetting for the family
- B. It is often helpful to show families the brain scan and explain what it shows
- C. Cardiopulmonary resuscitation will often be unsuccessful -this decision by the team should be communicated to the family sensitively that this is a treatment option which will not work and could be very distressing
- D. It would be inappropriate to discuss tissue or organ donation at this point even if the family ask about it
- E. There is no need to document the outcome of the meeting in the medical notes as you are planning to tell the nursing staff straight after the meeting

Part 3. Answer.

Unfortunately, you have answered Question 3 incorrectly.
Part 3. Answer.

Well done, the correct answers are B and C.

Sensitive and effective conversations: Module test – Part 4. Q. Your patient survives the initial stroke and was given Thrombolysis but then develops life threatening pneumonia. Which of the following statements are true in this sort of scenario? (Select all that apply)*
- Select All
- A. The family may have expected that the patient would improve with Thrombolysis treatment
- B. Families sometimes remember only parts of a conversation, not the entire conversation, or might misinterpret information at times of grief, shock or distress
- C. It is unhelpful to repeat information that you know has been conveyed previously by other members of staff
- D. The decision about stopping antibiotics if they are not effective should be made by the health care team and be informed by family views
- E. When Thrombolysis has been unsuccessful and the patient develops pneumonia-you should ignore the advanced care plan

Part 4. Answer.

Unfortunately, you have answered Question 4 incorrectly.
Part 4. Answer.

Well done, the correct answers are A, B and D.

Sensitive and effective conversations: Module test – Part 5. Q. Caring for the patient who is seriously ill or dying can be stressful for staff. Relatives can also be stressed and can sometimes respond by being distressed, frustrated, anxious or angry. Which of the following strategies/comments are helpful in this situation? (Select all that apply)*
- Select All
- A. ‘I’ve not got a crystal ball’
- B. ‘I’m just the on-call doctor and I’ve not met your mother’
- C. ‘Let me find the nurse in charge who will be able to give you that information’
- D. Listen to the family in a private place without interrupting until they have finished speaking
- E. ‘It’s not my fault that your mother was moved out of the side room- I wasn’t here yesterday’

Part 5. Answer.

Unfortunately, you have answered Question 5 incorrectly.
Part 5. Answer.

Well done, the correct answers are C and D.

Sensitive and effective conversations: Module test – Part 6. Q. Which of the following statements about nutrition are correct? (Select all that apply)*
- Select All
- A. Because nutrition is a basic human right, it follows that all stroke patients should be fed by a tube if they cannot take food orally
- B. In UK law, clinically assisted nutrition and hydration are judged by law to be medical treatments
- C. Time limited trials of artificial feeding can sometimes be helpful-with a plan to review decisions days or weeks later
- D. Decisions about nutrition may change over time as the patient’s condition changes
- E. Families are often concerned about stopping clinically assisted nutrition because they do not wish to ‘starve’ the patient

Part 6. Answer.

Unfortunately, you have answered Question 6 incorrectly.
Part 6. Answer.

Well done, the correct answers are B, C, D and E.

Sensitive and effective conversations: Module test – Part 7. Q. An elderly lady has been on the stroke unit for three weeks and has deteriorated slowly despite active treatment including clinically assisted nutrition and she has had several episodes of aspiration pneumonia treated with antibiotics. The team feels that she is now dying. Which of the following statements are correct? (Select all that apply)*
- Select All
- A. When you talk to her family, it is helpful to use the phrase ‘withdrawal of treatment’
- B. It is useful but not essential to seek a second opinion about whether to discontinue clinically assisted nutrition
- C. End-of-life care should always be provided in hospital and so it is not necessary to enquire about preferred place of dying
- D. Inform the family that you cannot be precise about how long it will take for the lady to die
- E. Once a decision has been made that the patient is dying, there is no need for the patient to be included in ward rounds providing you have ensured that ‘anticipatory medications’ are prescribed

Part 7. Answer.

Unfortunately, you have answered Question 7 incorrectly.
Part 7. Answer.

Well done, the correct answers are B and D.

Sensitive and effective conversations: Module test – Part 8. Q. If you are considering discharging a stroke patient home-or back to a nursing home, and the patient is expected to die within a few days or a few weeks, which of the following are true? (Select all that apply)*
- Select All
- A. Ensure that the family are aware of the advantages and disadvantages of this approach
- B. It’s important to communicate with the primary care team to ensure that appropriate care can be provided
- C. If the patient deteriorates and is so close to death that he/she might die on the way home or shortly after arrival-you should discuss this possibility with the family before proceeding with the discharge
- D. In Scotland, the key information summary (or KIS) is created by the hospital consultant
- E. The key information summary (KIS) is not relevant to patients with chronic disease

Part 8. Answer.

Unfortunately, you have answered Question 8 incorrectly.
Part 8. Answer.

Well done, the correct answers are A, B and C.

Sensitive and effective conversations: Module test – Part 9. Q. After the patient dies, good communication with the family can help them adjust better to bereavement. Which of the following statements are true? (Select all that apply)*
- Select All
- A. There is no need to discuss the content of a death certificate with the family after a stroke diagnosis is obvious
- B. The clinical team should discuss the practical processes with the family after the death such as how to register the death
- C. There is no need to offer access to chaplaincy services when the patient is dying or has died unless you know that the family have a particular faith
- D. If the Procurator Fiscal (Scotland) or Coroner (England) or equivalent needs to be informed about the death, ensure the family are aware of this at the time of death
- E. Offer the family some private time but be available to answer any questions

Part 9. Answer.

Unfortunately, you have answered Question 9 incorrectly.
Part 9. Answer.

Well done, the correct answers are B, D and E.

Stroke Training and Awareness Resources (STARs)

Part 1. Answer.

Part 1. Answer.

Part 2. Answer.

Part 2. Answer.

Part 3. Answer.

Part 3. Answer.

Part 4. Answer.

Part 4. Answer.

Part 5. Answer.

Part 5. Answer.

Part 6. Answer.

Part 6. Answer.

Part 7. Answer.

Part 7. Answer.

Part 8. Answer.

Part 8. Answer.

Part 9. Answer.

Part 9. Answer.