Palliative Care

Your patient, Mr. W, has been unresponsive for the past day and is actively dying. His family is with him. He had appeared comfortable but has been showing some signs of restlessness and agitation over the past hour. What should you do?

Assess for evidence of pain, constipation, urinary retention, or other possible physical cause.

You are caring for a 76-year-old patient who is unresponsive and close to end of life from a massive stroke. The patient has a history of breast cancer and had been experiencing severe bone pain in her left hip prior to her stroke. How do you assess her pain now that she is unresponsive?

Assume she continues to have pain and assess for evidence of wincing or facial grimacing.

Which of the following demonstrates good self-care that may help you in preventing compassion fatigue and burnout when taking care of many patients with serious illness and their families?

Establish healthy eating, sleeping, and exercise habits especially when rotating shifts.

You are caring for a patient in end-stage renal disease. The patient has no apparent family or support systems. The patient is taking prescribed opioid analgesics for pain management yet continues to complain of feeling tired. The patient states, "I wish it would all end." Which action should you take first?

Evaluate the patient further for depression.

A year after the loss of her son to suicide, Mrs. Phelps expresses to you that she is still terrified that her surviving son will also commit suicide. Mrs. Phelps reports continuing to have nightmares in which this happens. What type of grief is Mrs. Phelps experiencing?

Exaggerated grief

John is a 70-year-old male whose wife died from COPD two months ago. They were very close, married for 52 years, and had no children. He comes by the nursing unit to bring you all candy and a thank you note for all the times you cared for her the past year. He tells you he is struggling to want to eat since she always was the cook, and is just not ready to go out to dinner with his buddies, even though they keep asking him. Your assessment is that John is

Experiencing normal grief after his wife died two months ago

You are caring for a patient who has just died. In assisting the family to understand what will occur next, you should:

Explain how the body will be cared for immediately following the death.

Which of the following demonstrates the impact serious illness has on the social domain of quality of life?

Financial burdens resulting from the high costs of medical care

Mr. T is nearing end of life and tells you that he has seen his deceased father coming to visit him in his room. What is your best action?

Find out from Mr. T how it feels to have his father visiting, is it frightening him?

You are caring for a patient who just had surgery that revealed stage IV ovarian cancer. She does not know her diagnosis. Which action should you take in preparation for the patient to be told her diagnosis?

Find out how much the patient and family want to know.

You are caring for a veteran who served in World War II and is now near the end of life. He has shared with you how important his service in the Navy was to him. Which of the following interventions would be most appropriate for you to do to honor his service?

Find out if he would like you to see if the local veterans group could visit him.

You are planning to assess the emotional and spiritual needs of a patient in the advanced stages of HIV/AIDS. Your first action to open the communication process should be to:

Find out if the patient feels like talking.

You are talking with the parents of a 2-year-old boy diagnosed with leukemia about pain management. Which statement indicates an understanding about pain management in children?

He needs to be assessed carefully so that he gets enough pain medication.

Jack is a 6-year-old who just died at home with hospice from an aggressive type of brain cancer. His parents and his 12-year-old sister are having a very difficult time dealing with this terrible loss. Which of the following would be a help to them after Jack's death?

Hospice bereavement care

Mr. X has end-stage liver cancer and multiple organ failure. He wants to be home and comfortable. Which intervention would be most appropriate to offer him?

Hospice services

Which of the following statements best describes hospice care?

Hospice supports the patient and family through the dying process.

Which of the following describes palliative care's philosophy and delivery?

It supports the patient and family's hope for quality of life and dignity.

You are providing bereavement support to an 8-year-old child whose father just died on your unit. Which of the following statements would be appropriate for you to use?

Let him know you wish that his father had not died.

You and your nurse colleagues on your unit have all been talking about how hard it is in the ICU to see so many patients who have stated they didn't want any more aggressive treatment be admitted to the ICU. You found one of your colleagues was crying in the bathroom stating, "I can't stand this anymore - I just admitted another patient who told me last time he never wanted to come back here." Your best intervention is to

Listen to her and suggest you both talk with the ICU manager about the unit needing the chaplain or psychiatric nurse liaison for emotional support.

Symptom management in older adults with serious illness is complicated because:

Many have multiple comorbidities.

You are caring for Mr. S who has been in and out of the hospital for a long time with end-stage liver failure. On this admission, he is unresponsive. Which of the following signs indicate he is close to death?

Mottling of his sacrum

Which of the following patients should never be given an opioid medication?

Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work

Mrs. K's family has informed you that she is Roman Catholic and that her wishes were to have a priest administer the sacrament of the sick when she was close to death. You recognize that she is getting very close and suggest:

"Can I help you call a priest to come and honor her wishes?"

You are taking care of a 68-year-old woman who has advanced metastatic breast cancer. She tells you that she is afraid she is dying and won't be alive to see her first grandchild born in four weeks. You pull up a chair to talk with her and say:

"Can you tell me more about what you are most afraid of?"

Which of the following patients' statements suggest that the patient is experiencing an existential crisis?

"I am so afraid that God has abandoned me in my time of need."

Which of the following statements reflects that you are responding appropriately to a conflict between you and a physician regarding a patient's decision to stop chemotherapy?

"This decision is the patient's decision - it is not ours to make."

Which of the following patients should advocate for getting a palliative care referral?

32-year-old female newly diagnosed with breast cancer

You are caring for the following four patients. Which patient is at the highest risk for developing constipation?

A 48-year-old with metastatic cancer of the breast on high doses of opioids for pain.

Which of the following patients are you most concerned may have an undiagnosed depression?

A 71-year-old grandmother with pancreatic cancer who reports trouble sleeping, fatigue, and doesn't care to see her grandchildren on the weekends anymore.

You are making a bereavement visit to the 35-year-old daughter and primary caregiver of a female patient who died three months ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. You should recognize that the daughter is experiencing:

A normal grief reaction

Geraldine is an 80-year-old woman with Parkinson's disease. She is still functioning at home and is able to safely care for herself. Ever since her diagnosis she has been extremely anxious about her disease and how debilitated she might get as it progresses. Which of the following interventions is most appropriate to help treat her anxiety?

Active listening and presence as she talks about her fears and concerns

You are performing a pain assessment on Matilda. Your assessment reveals that Matilda has pain rated as a 5 in her left hip that worsens with movement. She has been having this pain off and on for the last three years. Which of the following pain assessment components have you not addressed in your assessment?

Alleviating factors

Which of the following individuals would be at highest risk for the under-treatment of pain?

An 87-year-old male with osteoarthritis

John's lung cancer is causing him severe shortness of breath. Which pharmacologic intervention would be of most benefit for his dyspnea?

An opioid like morphine sulfate

During your assessment, you notice Robert, who has a diagnosis of dementia, rubbing his right shoulder. What should you do next?

Ask Robert if he is in pain.

Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000mg every six hours. She rates her pain at a 4 every time you ask. What do you think an appropriate next step would be at this time?

Ask Yolanda what an acceptable pain score is for her.

You are caring for a number of patients and family members who are facing loss or death. In speaking with them about grief, you correctly convey that grief:

Begins before a loss or death, as people consider a pending loss

Which of the following is an important way nurses can improve palliative care access for those who should receive it?

Being knowledgeable of the benefits of palliative and hospice care

Mr. T's wife tells the nurse she doesn't want him to take the morphine the doctor ordered for his cancer pain because she heard from a friend that he could stop breathing because of it. Your best response would be:

Breathing problems are rare when these medications are used as ordered.

Joey is a 3-month-old who has a serious illness and will probably die in the next few months. His mother is concerned that he looks like he is in pain whenever she has to change his diaper. Your best response to her is

Can you explain to me what Joey looks like that makes you concerned he is in pain?

You are talking with the staff on your unit about the emotional challenges of working with dying patients and their families. Which of the following is an appropriate response to the grief the staff has been experiencing recently?

Consult with the hospital chaplain or spiritual care counselor for staff support.

Which of the following statements about dyspnea in patients at end of life is true?

Dyspnea may be relieved by a cool fan blowing on the patient.

Mrs. Smith has suffered with terrible bone pain from metastatic breast cancer for the past three admissions to your unit. She is now nearing end of life. Her family requests that you not give her any pain medications because they are afraid it will hasten her death. What should you do?

Educate the family about the importance of keeping her comfortable and that the pain medication will not hasten her death.

Which of the following statements reflects the importance of learning about palliative care as a student nurse?

Future employers expect you to have education and training in palliative care services.

Ms. H's family is in the waiting room of the intensive care unit. Ms. H is very ill and the family has been told she will probably die during this hospital admission. You are walking by the waiting room and you see that they are all seated together, crying. What is your best response?

Go into the waiting room, sit next to them, and give them time to talk with you.

What is the most common adverse effect related to the use of acetaminophen?

Liver dysfunction

You are asked to describe palliative care to a family member. Which of the following statements would be best to include in your discussion?

Palliative care supports the patient's goals of care.

You are developing a plan of care for a patient with cancer-related pain who is taking sustained-release morphine sulfate 30 mg twice a day, along with 15 mg of immediate release morphine sulfate every three hours as needed for breakthrough pain. Which goal is important to include in the patient's plan of care?

Patient will have a bowel movement at least once every three days.

Mrs. Smith is suffering with severe bone pain from metastatic cancer. Which domain of quality of life is this affecting?

Physical

Mrs. Woodrow tells you that her mother has been staying with her and is having difficulty sleeping due to poorly controlled pain. Which quality of life domain is Mrs. Woodrow's mother struggling with?

Physical

Which disease and dying trajectory best represents the course for a person with Alzheimer's disease?

Progressive deterioration

You are caring for a patient who has just died. In caring for the body after death, the goal of care is to:

Provide a clean, peaceful impression of the deceased for the family.

You are caring for a 55-year-old female patient with metastatic breast cancer. During a home visit, you find the patient's 22-year-old daughter weeping at the kitchen table. The daughter explains that she just realized that her mother will not be alive when she gets married or has children of her own. Recognizing anticipatory grief in the young woman, the best first intervention is:

Provide active listening and therapeutic presence.

One of the nurse's most important roles in caring for seriously ill patients and their families is:

Providing listening and presence

Mr. E tells you he is feeling "down" about his new diagnosis of advanced lung cancer. In which of the domains of quality of life does this statement reflect that he is suffering?

Psychological

Mr. Jones is taking two oxycodone/acetaminophen 5/325 mg tablets every four hours for bone pain related to metastatic cancer. His pain is a constant 6 on a 0 to 10 scale. Since the current regimen is not meeting his goals, and is keeping him from moving, you decide to call his physician. The doctor suggests increasing the medication to two tablets every three hours around-the-clock. What would your action be?

Question the safety of the total daily dose of acetaminophen that Mr. Jones would be taking.

Mr. Rodriquez tells you that he is very frightened by not knowing what happens after death. Which domain of quality of life is being affected by his serious illness?

Spiritual

You are caring for a 77-year-old patient at the end of life who has not had a bowel movement in five days. Which sign should you assess the patient for to determine if a fecal impaction is present?

Sudden onset of liquid stool

The hospice interdisciplinary team is creating a bereavement plan for the family of Mr. A, a 50-year-old patient with advanced HIV/AIDS. The patient defines his family as consisting of his partner, his parents, four siblings, as well as his two closest friends. In creating the plan, each member of the interdisciplinary team understands that bereavement interventions must:

Take into account each survivor's cultural practices in mourning and grief reactions

A 92-year-old patient dying of end stage heart failure tells you that she is worried that her life had no meaning. What member of the palliative care team would you want to be sure is involved in her care?

The chaplain

Which of the following family members is at greatest risk for complicated grief?

The daughter who has a long history of substance use and has just recently returned home to be at her dying mother's bedside.

You are teaching a patient how to take her new prescription for morphine, an opioid pain medication. Which of the following teaching statements reflects an understanding of potential adverse effects?

This medication causes constipation, so you need to take a laxative to prevent that.

During your pain assessment, Randall describes his pain as a burning pain in his lower extremities. What type of pain does this describe?

Neuropathic pain

What type of pain are antidepressants and anticonvulsants most beneficial for?

Neuropathic pain

During your pain assessment, Lenora describes her pain as an aching and cramping pain in her lower abdomen. What type of pain does this usually describe?

Nociceptive pain

Mr. Jones is struggling with fatigue from his advanced heart failure. Which of the following referrals would you recommend to help him with this debilitating symptom?

Occupational therapy

A colleague comes to you to talk about a conflict he is having with another healthcare professional. Which of the following would be good information to give him about handling conflict?

"Check that the conflict is not about you and getting your own way."

Mrs. F., a 78-year-old Italian woman, is caring for her husband who has end-stage COPD and is experiencing anorexia and cachexia. She tells you that she is so upset that he won't eat her pasta anymore, which was "always his favorite." She cannot understand why he doesn't like it anymore. Which of the following is your best response?

"Food is such an important way that we show we care; it must be so hard for you that he doesn't feel like eating."

Mr. J is in the final hours of life. He is dying from his end-stage chronic lung disease. His breathing pattern has changed and is very irregular and he is even going 10-15 seconds without a breath. The family asks you to please call respiratory therapy to see what they can do to help his breathing. You respond:

"His breathing pattern is difficult to watch, but the irregularity is a normal part of the dying process."

You are assessing Mrs. Smith's husband's well-being during Mrs. Smith's recent hospitalization. He tells you he has had trouble with heart failure this past year and then says, "All that matters is my wife. I don't have time to go to my doctor even though my prescriptions have run out. Don't you realize how many medications I have to give my wife around the clock? I can't deal with any more medications. I will have time to take care of myself later on." Your best response is:

"I am concerned about you too. Keep in mind you can't take care of Mrs. Smith if you get sick; you need to get your prescriptions filled."

You have been the pediatric nurse caring for a young boy with a malignant brain tumor who just died on your unit. The parents are in the room with their son and ask you if you would stay with them. Your best response is:

"I am here and I will not leave you until you are ready for me to."

Roland was just told that his therapy for advanced prostate cancer is not working. He asks you, "Why is this happening to me?" What is the most appropriate response?

"I don't know. I wish I had an answer for you, but I don't."

You are working with Mr. T who has just been told his heart failure is getting worse. You go into his room to see how he is doing after the team has shared this information with him. He is staring out the window, looking sad. How do you start your conversation?

"I saw that the team was just here, can you tell me about their conversation with you?"

You are working on developing your communication techniques to use when talking to patients and families. Which of the following indicates you have a good understanding of important communication skills in palliative care?

"I should acknowledge the emotions that the patient and family is expressing."

You are asking a nursing student to describe the assessment of a patient for dyspnea as part of end-of-life care. Which statement by the student indicates understanding of the best method to assess for dyspnea?

"I will ask my patient about his breathing."

You are helping a new member of the palliative care team understand the ways the behavior of healthcare professionals can produce a communication barrier. Which statement by the team member indicates the need for additional education on communication barriers?

"I will keep an emotional distance in order to maintain a professional relationship with patients."

Mr. G had a meeting with the physician this morning about his wife's condition. He was told she has weeks to live and that they should consider hospice. You have known Mr. and Mrs. G for about 6 months, as she has been in and out of the hospital frequently. Mr. G asks to talk with you because he is upset about this news. Your best initial response is:

"I wish this news was different for you and Mrs. G."

You are caring for a 12-year-old child who is imminently dying from leukemia. The child is unconscious and has been for days. The child's mother tells you that she hopes her daughter would open her eyes one last time before dying. Knowing that this is unlikely, what is your best response?

"If that is not possible, what else might you hope for?

Mr. G has just been told he has a serious illness. Which of the following statements reflects respectful communication with him about his treatment and illness?

"It is important that we understand what your hopes are for your treatment of this illness."

You are talking with the wife of a patient who died recently. Which statement can you make that would be most helpful?

"It must be hard to accept that this has happened."

You are caring for an elderly woman who is dying from Parkinson's disease. Her husband died years ago and all of her friends are also now deceased. She has no children or living family members. You are sitting with her and she tells you how lonely she feels. Your best response is:

"It must feel so lonely with your family and friends no longer with you."

You are caring for Ms. F who is dying from lung cancer. She is no longer taking in food or fluids and the family asks you why the team doesn't feed her with a tube? They state, "It seems like you are all trying to starve her to death." You respond:

"Ms. F's body can no longer handle food or fluids; it would cause her more harm than good to feed her with a tube."

You have been assigned to care for a woman who was recently admitted for advanced cancer, and who reports ongoing fatigue. Her husband offers observations about his wife's fatigue. Which statement by the husband indicates the most correct understanding of his wife's fatigue?

"She's been in pain. If we control that maybe, she'll have more energy."

Mr. C's family tells you they are very worried about his granddaughter who is 13 years old. She has lived with her mother and grandparents since she was three and seems to be having a hard time accepting that her grandfather is near end of life. The granddaughter is acting out in school, not doing her homework, and has been bullying friends. Mr. C has end-stage heart failure and will be discharged home tomorrow with home hospice care. What should you say to Mr. C's family regarding his granddaughter?

"Some children display a change in their behavior when they are experiencing grief. Would you like me to contact our child life worker to speak with you today?"

A patient's daughter asks you what she can do to help make her mother, who is dying, more comfortable. The daughter has been sitting at her mother's bedside for the past two days and is feeling helpless. Your best response would be

"Some patients relax when we give them a gentle foot massage. Would you like me to show you how?"

Jane, a 72-year-old woman with end-stage renal disease, tells you she thinks she doesn't want to continue dialysis anymore. Which of the following would be your best response to this statement?

"That is a very important statement, can you tell me more about that?"

You are caring for a man who is near the end of life. During morning care, the man asks you if he is dying. Your best response would be:

"That is a very serious question. What is it that makes you ask that today?"

You are teaching your colleagues about myths and realities of communication in palliative care. Which is a correct statement about communication?

"The majority of messages we send are non-verbal."

Mrs. Smith has end-stage COPD and is admitted with severe dyspnea and is started on morphine sulfate. Which of the following statements by her husband demonstrates he understands the use of morphine in patients with COPD?

"The morphine is being used to treat her shortness of breath."

The family of a patient who is dying asks you why the nurses always come in and look under the sheets at his legs when they are checking his blood pressure. You explain:

"They are assessing for signs that death may be near."

Mr. C, whose wife of 14 years died five months ago, returns to your unit to thank you all for your great care. He states, "I still can't get through a week without crying sometimes. I know I should be at least starting to move on a bit." Your best response would be:

"This is very hard; can you tell me a bit about what moving on means to you?"

You are teaching the son of a 65-year-old male patient with cancer about his father's anorexia. Which statement by the son reassures you that the son understands your teaching and ways to help his father?

"We can offer Dad small, frequent feedings rather than large, overwhelming meals."

You are working in the emergency room and a patient came in with a massive heart attack and cannot be resuscitated. The doctor has just informed the family that the patient is dead and asks you to go to the private room where they have been waiting to see if they need anything. While sitting with them, they ask you if the body can stay in the emergency room until the other family members arrive. The remaining family live 1½ hours away. The ER is full and the secretary told you they need the room. What should you tell the family?

"We will do everything we can to give the other family members time to get to the ER."

Your patient, who has end-stage renal disease, has been asked by the doctor covering the hospital if he would like to have "everything done," including CPR. The patient asks you if CPR is a good thing to do. Your best response is:

"What do you know about CPR? Have you ever heard about it before?"

You are doing a spiritual assessment on Mrs. H. Which of the following questions are the most important to understanding her spirituality?

"What gives your life meaning?"

Ms. P is offered hospice care for her end-stage cardiac disease. Which statement reflects a need for the nurse to provide further education?

"Why would I get hospice? I thought hospice is really for patients with cancer."

You are caring for a patient with end-stage liver disease. He tells you that he knows he only has a few weeks to live and is so sad that he won't be around to see his daughter graduate next year from college. You listen attentively and then respond:

"Would it be helpful to write a letter to her or a card that can be given on that special day?"

The parents of a 2-year-old child who is dying from leukemia tell you they are so afraid that they will forget who their child was years after he dies. How should you respond?

"Would you like me to call our child life team who can help you with some memory making activities?"

Mr. Tate tells you that he is very worried about dying. He knows his disease is terminal and he only has a few months to live. He tells you he has done "some bad things" in his younger days and thinks God is going to make him suffer with pain now because of his past. After listening to his story, what is your best response?

"Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours?"

Mr. S. has stage IV lung cancer and was admitted to your unit yesterday because of shortness of breath. His breathing has improved with treatment and you tell him you are hoping to get to know him better so you can provide the best care possible. Which of the following statements reflects your interest in getting to know him?

"Can you tell me what has given your life meaning?"

John tells you that he doesn't want his wife to know that he has cancer. You sit down to talk about this with him. You begin this conversation with

"Can you tell me what it is about your wife knowing about the cancer that is bothering you?"

John is admitted to the hospital for a pain crisis from his sickle cell disease. He usually takes morphine 30mg every 12 hours by mouth. He states his pain is a 10 on a 0-10 scale. You tell your colleague that his pain can't be that bad because he is watching television and talking on the phone. Which important principle of pain management are you violating?

Pain is a subjective experience and is what the patient reports it is.

You are caring for Ms. P, a 55-year-old woman with cancer. She received pain medication less than two hours ago. A nursing assistant reports that Mrs. P is complaining of pain again. The nursing assistant says, "She can't be hurting as much as she says she is." What is the most appropriate response?

Pain is whatever the patient says it is. Let's assess her further.

You are caring for an 85-year-old man who is dying. He has been comatose for several days. His respirations are now shallow and rattling. His adult children at the bedside state, "We don't want our father to suffocate." Which action should you take?

Reassure the family that terminal secretions are normal and try repositioning the patient.

You are caring for an elderly woman who has severe osteoporosis and is suffering with bone pain from several spinal fractures. She is in bed most of the day, on a low dose opioid for the most recent fracture, and is not eating or drinking much. Which of the following nursing interventions to prevent constipation is best?

Recommend a physician order for a scheduled laxative and stool softener.

Your unit has experienced many deaths in the past month and the staff is feeling very sad. What might you suggest to address this issue?

Recommend starting a reflection ritual to honor patients who die on the unit.

An 85-year-old patient with end-stage heart disease arrives unconscious at the emergency department after sustaining her third myocardial infarction. The physician has told the daughter that without resuscitation, her mother could die today. You find the daughter crying by the patient's bedside. Which intervention is most appropriate in communicating with this family member?

Remain present with the daughter, using silence to impart comfort.

You are entering a room to administer a medication to your patient and as you come in you find that the three family members and the patient are all crying. What should you do next?

Remain silent to give permission to talk with you, holding off on the medication initially.

You are caring for a patient who is in the advanced stages of AIDS. The patient is reporting severe fatigue. Which finding is commonly associated with the symptom of fatigue?

Sedating medications

Mr. F has advanced prostate cancer with bone metastasis. He is unresponsive and is being cared for at home by his daughter. You are teaching the daughter about assessing her father's pain. Which statement by the daughter indicates an understanding of her father's pain status?

Since he was in pain when he was conscious, I assume he's still in pain.

You have been working on the end-stage heart failure unit for eight months. Many of your patients have died awaiting transplant. You are aware that you are not sleeping well at night and dread going to work each day. Many of your colleagues are irritating you and you are moody when at home. Which of the following would be best to do first?

Speak with your nurse manager about how you are feeling and ask for help.

You are caring for a 65-year-old male patient who has just died. In planning for follow-up bereavement care, which person is at risk for disenfranchised grief?

The ex-wife of the patient who lives nearby

You are speaking with the sister of a male patient who died after suffering fatal injuries in a car accident. In order to plan for bereavement follow-up for the patient's family, it is important that you assess:

The family support system

The majority of hospice care is delivered in:

The home

Which of the following statements is true about serious, chronic illnesses?

The majority of annual U.S. healthcare spending goes toward on chronic illnesses.

What should drive decision-making in palliative care?

The patient's goals of care

Mr. Johnson tells you that taking one tablet of his opioid medication was no longer controlling his pain so he increased it to two tablets. He states that taking two tablets provides much better pain relief than one tablet did. What behavior does this represent?

Tolerance

You are speaking with the family of a patient recently diagnosed with end-stage heart failure. How can you best demonstrate attentive listening?

Use non-verbal signals such as nodding one's head and eye contact.

You have been caring for a Hispanic patient with advanced obstructive lung disease for the past several weeks. The family has been at the bedside daily, with one member spending the night throughout the hospital stay. In assessing cultural beliefs and practices related to death and dying for the patient and family, it is necessary for you to consider which of the following factors?

What rituals, practices, and beliefs about death are important to the patient and family

Mr. T. is taking an NSAID for bone pain. Which of the following statements suggests he may be experiencing a worrisome side effect from the NSAID?

Yesterday I had an episode of black, tarry stools