Student Evaluation

Objective Test (5 questions total)

1. Mrs. Amin, a 76-year-old highly functional lady, is dropped off in clinic by her busy son, who will be back later to pick her up. Mrs. Amin came to see you a few weeks ago is here for follow up of a CT scan of her abdomen. You want to talk to her about end-of-life issues today. You should:

	Ask her preferences about resuscitation and other end –of-life issues.
	Make her a ‘do-not-resuscitate’ as you feel that you know her well and are quite sure that this is what she would want.
	You would never talk to a Pakistani lady about end-of-life issues, ever.
	You should ask her to bring her son with her for the next visit.

Correct

Correct! Many older Pakistani women may prefer to defer decision making to their sons or daughters.

Incorrect

Incorrect - try again.

2. Mr. Ibrahim, a devout Moslem with a history of hypertension, returns to clinic after 3 months and tells you that he has not been taking his medicine. You should:

	Refer him to a Moslem physician who has a better chance of understanding him.
	Stop the old medicine and add a new and experimental medicine.
	Ask him if he has any reservations/concerns about taking the medicine.
	Pretend to ignore his non-compliance; after all, it is his life and his choice to make.

Correct

Correct! Mr. Ibrahim may consider an illness as atonement for his sins. Illness is thought to be one of the forms of experience by which Moslems arrive at knowledge of God. Sensitive questioning and gentle persuasion/education is called for when faced with this communication barrier.

Incorrect

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3. You are a nurse who has been caring for Mr. Asraff an 80-year-old man who just died of prostate cancer in the VA Hospice Care Center. He has no family or friends. Earlier he had requested you to turn him in the direction of the Qiblah as soon as he dies. You should:

	Turn Mr. Asraff ‘s physical remains to face Northeast.
	Do nothing; Islam forbids you to move Mr. Asraff’s physical remains.
	Turn Mr. Asraff’s physical remains to face East.
	Turn Mr. Asraff ‘s physical remains to face Southeast.

Correct

Correct! In North America the direction of the Qiblah is the southeast.

Incorrect

Incorrect - try again.

4. Mrs. Nawaz is a 65-year-old lady with poorly controlled diabetes. You talk to her about starting insulin. Mrs. Nawaz looks uncomfortable, takes the insulin prescription, and does not fill it; nor does she return to see you again. Why do you think Mrs. Nawaz will not take insulin?

	She does not trust you anymore and so will not listen to you.
	She is uncomfortable taking insulin, which she knows may be derived from porcine pancreas.
	She is afraid of pain caused by insulin shots.
	She has decided to give up and die and so will never seek medical care again.

Correct

Correct! All forms of pork, bacon, etc. are forbidden to Moslems. Explaining that you could specifically prescribe non-porcine insulin will make Mrs. Nawaz more willing to take insulin.

Incorrect

Incorrect - try again.

5. You want to start a support group for elderly Pakistani immigrants. Your group meets on Fridays. Though you had a lot of eager elders who were interested in coming to the group initially only 2 of the 40 elders who signed up come to the group. What should you do now?

	Serve coke and pepperoni pizza to draw in the elders.
	Just work with the 2 elders who came. After all quality is more important than quantity.
	Stop the support group. Support groups are taboo in Moslem culture.
	Move your support group to another day of the week.

Correct

Correct! Many traditional Moslems go to the Masjid (Mosque or Islamic Church) on Fridays to offer special prayers.

Incorrect

Incorrect - try again.

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