ELNEC module questions

Mr. Jonson tells you that taking on tablet of this 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. You are aware he has a past history of substance use disorder. What should be your next action? -A. support him in his decision to increase the medication to relieve his pain -B. discuss the issue with the provider and the team for next steps -C. inform him that he has once again become a drug addict -D. ensure he still has enough pain medication until his next visit

B. discuss the issue with the provider and team for next steps

Mrs. Smith is suffering with severe bone pain from metastatic cancer. Which domain of quality of life is this affecting? -A. physical -B. psychological -C. social -D. spiritual

A. physical

What is the most common adverse effect related to the use of acetaminophen? -A. GI bleeding -B. liver dysfunction -C. constipation -D. respiratory depression

B. liver dysfunction

You are caring for a 77 yo patient at the end of life who has not had a bowel movement in five days. Which sign should you assess the patient to determine if a fecal impaction is present? -A. foul-smelling diarrhea -B. sudden onset of liquid stool -C. fatty-looking stools -D. blood and mucous strands in stool

B. sudden onset of liquid stool

Which of the following patients should the nurse advocate for obtaining a palliative care referral? -A. a 32 yo with advanced breast cancer -B. a 65 yo male with kidney stones -C. a 49 yo male with chronic back pain -D. a 10 yo female with a broken leg

A. a 32 yo with advanced breast cancer

You are caring for Ms. P, a 55 yo woman with cancer. She received pain medications less than two hours ago. a nursing assistant reports that Mrs. P is complaining of pain again. The nursing assistant tells you that Ms. P cannot be hurting as much as she says she is. What is your most appropriate response? -A. pain is whatever the patient says it is. Let's assess her further -B. maybe she is just drug-seeking -C. I will tell her gently that she must wait four hours between doses -D. I just gave her pain medication. She can't need anything again so soon

A. pain is whatever the patient says it is. Let's assess her futher

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 regiment 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? -A. question the safety of the total daily dose of acetaminophen that Mr. Jones would be taking -B. accept the orders and provide education to Mr. Jones on the charge -C. accepts the orders but tell Mr. Jones to continue taking the medication every four hours -D. tell the physician that this medication is too severe for this type of pain

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

Which of the following statements is true about serious, chronic illnesses? -A. the majority of annual US healthcare spending goes toward chronic illnesses -B. very little annual US healthcare funding is spent in acute care admissions from chronic illnesses -C. much attention and financial support goes toward improving quality of life for persons with chronic illnesses -D. the focus of serious illness is often on improving quality of life rather than finding a cure

A. the majority of annual US healthcare spending goes towards chronic illnesses

You are teaching the son of a 85 yo male patient with cancer about his father's anorexia. Which statement by the son reassures you that the son understand your teaching and ways to help his father -A. We can offer Dad small, frequent feedings rather than large, overwhelming meals -B. we need to limit Dad to a high protein diet so he gets good calories in -C. I need to insist that Dad eat at least half of every meal we give him, even if he doesn't feel like eating -D. since dad isn't eating, it's probably time to put in a feeding tube, whether he agrees or not

A. we can offer Dad small, frequent feedings rather than large, overwhelming meals

Roland was just told that his therapy for advanced prostate cancer is not working. He asks you why this is happening to him. What is the most appropriate response? -A. I don't know. I wish you did not have to go through this -B. perhaps you are being tested and this will make you a stronger person -C. I'll ask the doctor to more fully explain the disease process -D. If i were you, I'd explore additional therapies and treatment options

A.. I don't know. i wish you did not have to go through this

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, lookign sad. How should you start your conversation to begin to understand his needs? -A. it's a beautiful day today. Would you like to go outside -B. I saw that the team was just here, can you tell me about their conversation with you? -C. are you feeling ok? -D. I heard you just got bad news, but I know of someone just like you who lived for three more years

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

Mr. E tells you he is feeling down about his new diagnosis of advanced lung cancer. Which of the domains of quality of life is impacted for Mr. E? -A. physical -B. psychological -C. social -D. spiritual

B. psychological

You are taking care of 68 yo woman who has advanced metastatic breast cancer. She tells you that she is afraid she is dying and will not be alive to see her first grandchild born in four weeks. You pull up a chair to talk with her. which of the following statements would be your BEST response? -A. try not to think like that, the baby will be here soon -B. tell me more about what you are most afraid of -C. i know you will make it, you are such a fighter -D. you have something so important to live for, so just hang in there

B. tell me more about what you are most afraid of

The hospice interdisciplinary team is creating a bereavement plan for the family of Mr. A a 50 yo patient with advanced HIV/AIDS. The patient defines his family as consisting of his husband, his parents, and his four siblings, as well as his two closest friends. In creating the plan, what bereavement interventions MUST the interdisciplinary team include? -A. Focus mainly on the patient's parents and siblings -B. Include a referral to a religious group -C. Take into account each survivor's cultural practices in mourning and grief reactions -D. This plan only includes interventions from the chaplain

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

Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000 mg every 6 hours. She rates her pain at a 5 every time you ask. What do you think an appropriate next step would be at this time? -A. discuss increasing the acetaminophen to every four hours with the IDT -B. discuss adding an immediate-release opioid with the IDT -C. ask Yolanda what an acceptable pain score is for her -D. as the IDT if Yolanda would benefit from an antidepressant for pain

C. ask Yolanda what an acceptable pain score is for her

Mrs. Smith has suffered with terrible bone pain from metastatic breast cancer during the past three admissions to your unit. She is now nearing end of life. Her family requests that you not giver her any pain medications because they are afraid it will hasten her death. What should you do? -A. Honor the family's wishes so that they will be more comfortable with her plan of care -B. Offer to get the doctor to make the pain medications as needed rather than around the clock -C. Tell the family that she probably will not need her pain medications much longer -D. Educate the family about the importance of keeping her comfortable and that the pain medication will not hasten her death

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

You are talking with the wife of a patient who died recently. Which statement ca you make that would be MOST helpful to the bereaved wife? -A. I know exactly how you are feeling -B. It must be hard to accept that this has happened -C. His suffering is over. He's in a better place now -D. So many people go through losing a spouse and they are doing fine

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

Geraldine is an 80 yo 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 debillitated she might get as it progresses. Which of the following interventions is MOST appropriate to help treat her anxiety? -A. a benzodiazepine like valium -B. active listening and presence as she talks about her fears and concerns -C. activities to distract her from her anxiety so she will not dwell on the future -D. suggest she go to an exercise class to preserve her balance and strenght

B. active listening and presence as she talks about her fears and concerns

Which of the following statements BEST describes hospice care? -A. it can only be provided in the patient's home -B. hospice supports the patient and family through the dying process -C. hospice care focuses on continued disease-modifying treatment -D. it is not covered financially by Medicare, Medicaid, or most private insurance companies

B. hospice supports the patient and family through the dying process

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 an understanding of the BEST method to assess for dyspnea? -A. I will auscultate my patient's chest -B. I will take my patient's respiratory rate -C. I will ask my patient about their breathing -D. I will check my patient's oxygen saturation

C. I will ask my patient about their breathing

Ms. P is offered hospice care for her end-stage cardiac disease. Which statement by Ms. P reflects a need for the nurse to provide further education? -A. I know i am close to the end of my life -B. my family would really benefit from hospice just as much as i would -C. my friend had hospice care and her only wish was that she'd had hospice care longer than two months -D. why would I get hospice? I thought hospice is really for patients with cancer

D. why would I get hospice? I thought hospice is really for patients with cancer

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 MOST indicate he is close to death? -A. Mottling of his sacrum -B. Increase in urine output -C. Slow but regular respirations -D. Warm extremities and cold face

A. Mottling of his sacrum

Jack is a 6yo who just died at home with hospice from an aggressive type of brain cancer. His parents and his 12 yo 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? -A. hospice bereavement care -B. the American Cancer Society -C. the hospital's child life worker -D. the pediatric oncologist

A. hospice bereavement care

You are caring for an 85yo man who is dying. He has been comatose for several days. His respirations are now shallow and rattling. His adult children at the bedside are concerned their father is suffocating. Which action should you take? -A. Use a suction machine to suction secretions from the mouth and the throat -B. Percuss the patient's back to facilitate loosening of congestion -C. Reassure the family that terminal secretions are normal and try repositioning the patient -D. Request an order for humidified oxygen to decrease the patient's air hunger

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

Your patient, who has end-stage renal disease, has been asked by the hospitalist if he would like to have all available treatments, including CPR. The patient asks you if CPR is a good thing to do. What is your BEST response? -A. CPR saves lives; of course you want everything possible done -B. What do you know about CPR? Have you ever heard about it before? -C. That is really your decision to make; I cannot tell you what to do -D. I have seen it done and it is really violent; you should not have it

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

Mr. Lopez is the partner of the 50 yo woman you have been caring for who has just died following a long struggle with breast cancer. He is crying at the bedside and lying across the patient. What is your BEST initial response? -A. Tell him that it is not appropriate to be lying with the deceased patient -B. Support his privacy but offer to stay in the room if he would like you to -C. call his family to tell them that the patient has died and Mr. Lopez is not doing well -D. get help from your staff as he is not acting appropriately

B. Support his privacy but offer to stay in the room if he would like you to

You are teaching your colleagues about myths and realities of communication in palliative care. Which is a correct statement about communications? -A. we can never give someone too much information -B. we communicate only when we choose to communicate -C. the majority of messages we send are non-verbal -D. communication is primarily words and their meanings

C. the majority of messages we send re non-verbal

Mr. T is taking an NSAID for bone pain. Which of the following statements suggest he may be experiencing a worrisome side effect from the NSAID? -A. I am having muscle twitching -B. I noticed that my skin has gotten very dry -C. Yesterday I had an episode of black, tarry stools -D. my eyes have been very itchy and irritated lately

C. yesterday I had an episode of black, tarry stools

Joey is a 3 mo who had a serious illness and will probably die in the next few months. His mother is concerned that he looks like he is pain whenever she has to change his diaper. What is you BEST response to her? -A. Don't worry, Joey is too young to feel real pain -B. all 3mo babies hate to have their diaper changed; he is just responding normally -C. I will ask the doctor if it is possible for him to have pain with this illness -D. can you explain to me what Joey looks like that makes you concerned he is in pain?

D. can you explain to me what Joey looks like that makes you concerned he is in pain

You and your colleagues in ICU have been talking about how hard it is to readmit patients who have stated that they do not want aggressive treatments. Today, you find one of your colleagues crying in the bathroom. The state that they just admitted another patient to ICU who told them last week, at discharge, they never wanted to come back to ICU. What is your BEST response? -A. Comfort her and tell her you all feel that way but it will be okay -B. Suggest you both talk with the ICU manager about the unit needing the chaplain or psychiatric nurse liaison for emotional support -C. Tell her you are here for her and the two of you will get through this a day at a time -D. Suggest that if she really cannot stand it anymore, maybe she should consider changing jobs

B. Suggest you both talk with the ICU manager about the unit needing the chaplain or psychiatric nurse liaison for emotional support

You are caring for a 65 yo male patient who has just died. In planning for follow-up bereavement care, which person is at risk for disenfranchised grief? -A. The daughter who lives in a different state -B. The son who was with the patient when he died -C. the ex-wife of the patient who lives nearby -D. the 16 yo grandchild of the patient

C. the ex-wife of the patient who lives nearby

Mr. G has just been told he has a serious illness. which of the following statements by the healthcare team reflects respectful communication with hi about his treatment and illness? -A. we will decide which treatment options are best for you Mr. G -B. it is important that we understand what your hopes are for treatment of this illness -C. treatment will be difficult, you just have to be strong and get through it -D. the disease is terminal and there is nothing we can do for you

B. it is important that we understand what your hops are for treatment of this illness

Which of the following patients should never be given an opioid medication? -A. Ms. Jones a 27 yo with a history of substance abuse -B. Mr. Rich who supports severe nausea and vomiting with previous use of opioids for pain -C. Mrs. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work -D. Mr. Hanover who is 72 yo and has end-stage heart failure

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

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 10-14 seconds without a breath. The family asks you to please call respiratory therapy to see what they can do to help his breathing. What is your BEST response? -A. I can call them, but I don't think there is anything they can do to make this better -B. We don't need to do that; I am sure his breathing is not bothersome to him -C. His breathing pattern is difficult to watch, but the irregularity is a normal part of the dying process -D. I will call bother the doctor and respiratory therapy to see if he needs more oxygen

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

You are speaking with the family of a patient recently diagnosed with end-stage heart failure. How can you best demonstrate attentive listening? -A. interrupt the conversation to clarify what the family member means -B. use yes and no questions to enhance the flow of conversation -C. begin by telling the family the facts about end-stage heart failure -D. stay silent and when it is your turn to talk, repeat back a 2-3 word phrase

D. stay silent and when it is your turn to talk, repeat back a 2-3 word phrase

Which of the following demonstrates the impact serious illness has on social domain of quality of life? -A. financial burden resulting from the high costs of medical care -B. depression related to the possibility of dying -C. severe nausea and vomiting -D. a loss of hope

A. financial burden resulting from the high costs of medical care

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? -A. the physician -B. the chaplain -C. the advanced practice nurse -D. the occupational therapist

B. the chaplain

Which of the following is an important way nurses can improve palliative care access for those who should receive it? -A. Being knowledgeable of the benefits of palliative and hospice care -B. remembering that palliative care is for any patient who is in the hospital -C. discouraging the use of palliative care in the seriously ill pediatric population -D. advocating for palliative care only when the pt is close to end of life

A. being knowledgable of the benefits of palliative and hospice care

Which of the following is the MAIN reason symptom management in older adults with serious illness is complicated? -A. they never take their medications correctly -B. they have multiple comorbidities -C. most older adults like the use a variety of over-the-counter medications -D. most older adults like to over-report the severity of their symptoms

B. they have multiple comorbidities

An 85 yo patient with end-stage heart diseases arrived unconscious at the emergency department after sustaining her third myocardial infarction. The physical has told the daughter that without resuscitation, her mother could die today. You find the daughter crying at the bedside. Which intervention is most appropriate in communicating with this family member? -A. Ask the daughter if she would like more information about resuscitation -B. tell the daughter you are so sorry her mother is going to die -C. remain present with the daughter, using silence to impart comfort -D. assure the daughter than her mother may get better

C. remain present with the daughter, using silence to impart comfort

Which of the following patients' statements suggest that the patient is experiencing an existential crisis? -A. I am so afraid that God has abandoned me in my time of need -B. I am mad that my minister has not come by to see me in the hospital -C. I believe strongly that God never gives a person more than they can handle -D. I find great comfort when I spend time among my flowers in my garden

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

Your patient, Mr. W, has been unresponsive for the past day and is actively dying. His family is with im. He had appeared comfortable but has been showing some signs of restlessness and agitation over the past hour. What should you do FIRST? -A. assess for evidence of pain, constipation, urinary retention, or other possible physical cause -B. Educate his family that all patients die in their own way and this is probably his way -C. Suggest that maybe he is getting restless and agitated with everyone around him -D. Get an order for as needed medication for restlessness and agitation as it may continue

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

Which of the following demonstrates good self-care when taking care of the many patients with serious illness and their families? -A. Establish healthy eating, sleeping, and exercise habits especially when rotating shifts -B. Volunteer for extra shifts to cover your overworked colleagues -C. Ask to take care of all the very ill patients and families because you have the expertise many of your colleagues don't have -D. Make sure you go to every funeral and service for all the deceased patients you have cared for

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

You are caring for a patient who has just died. What should you do to assist the family in understanding what will occur next? -A. Explain how the body will be cared for immediately following the death -B. Request that the family leave the room in order for the body to be washed -C. Give information about the need to remove the body promptly for embalming -D. ask if they would like to have all the tubes, catheters, and IV lines removed

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

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 military service? -A. Find out if he would like you to see if the local veterans group could visit him -B. Ask the chaplain to come and pray with him -C. Encourage him to think about being buried in Arlington Cemetery in Washington, DC -D. Write a letter to the local congressman about this patient's great service

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

You have been the pediatric nurse of a young boy with malignant brain tumor who just died on your unit. The parents are in the room with their son and they ask you if you would stay with them. What is your BEST response? -A. I am here and I will not leave you until you are ready for me to -B. I have to take care of my other patients, but I will be back to check on you in a few minutes -C. I am so sorry this has happened to you -D. I know you are sad but your son is in a better place now and is no longer suffering

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

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 planning for the death of the patient, how much spiritual and cultural beliefs MOST affect the plan of care? -A. Rituals or rites after death -B. concerns about thirst -C. Fear of opioids hastening death -D. removing catheters from the body

A. Rituals or rites after death

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 will not be around to see his daughter graduate next year from college. After listening attentively, how should you respond? -A. Would it be helpful to write a letter to her or a card that can be given on that special day? -B. Let's hop you will be here; no one every really knows when the final days are near -C. I am so sad for you; I would hate if my dad couldn't come to my graduation -D. I am sure your daughter will understand that you wished you would be there

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

During your pain assessment, Lenora describes her pain as an aching and cramping pain in lower abdomen. What type of pain does this usually describe? -A. nociceptive pain -B. acute pain -C. neuropathic pain -D. psychological pain

A. nociceptive pain

Mr. Jones is struggling with fatigue from his advanced heart failure. Which of the following interdisciplinary team members would be most helpful in managing this debillitating symptoms? -A. occupational therapy -B. social work -C. psychology -D. respiratory therapy

A. occupational therapy

You are caring for an older adult 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. What is your BEST response? -A. At least you have lived a long life and were married to a wonderful husband -B. It must feel so lonely with your family and friends no longer with you -C. This could be a time of quiet reflection for you -D. I can't stay long. Can I call someone to come visit you?

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

You are caring for 76 yo 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? -A. ask her anyways and see if she can nod "yes" to your question -B. assume she continues to have pain and assess for evidence of wincing or facial grimacing -C. you do not need to assess this, as she is now unresponsive -D. ask the family to report a pain score for her using 0-10 numeric rating scale

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

Which of the following statements about dyspnea in patients at end of life is correct? -A. dyspnea is a rare problem in patients with advanced serious illness -B. dyspnea may be relieved by a cool fan blowing on the patient -C. dyspnea is best treated by putting the patient on oxygen -D. dyspnea is assess primarily by the patient's respiratory rate

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

You are helping a new nurse understand that some healthcare professionals' actions or behaviors can be a barrier to communication. which statement by the new nurse indicates the need for additional education on communication barriers? -A. I will complete a physical assessment in order to understand the patient's communication references -B. personal grief of the professional will make communication about grief easier -C. I may not always know the answers to questions that the patient or family may ask -D. my lack of personal experience with the death can make me reluctant to discuss death and dying

B. personal grief of the professional will make communication about grief easier

You are upset with the healthcaer provider who wants the patient you are caring for to continue chemotherapy when that is not what the patient wants to do. Which of the following actions would help you BEST handle this conflict? -A. walk away and avoid conflict because it is such a negative experience -B. make sure you display your own emotions during conversations with the healthcare provider so he knows how strongly you feel about this issue -C. help the healthcare professional understand that the most important outcome is honoring the patient's wishes -D. find another colleague who feels like you do and together tell the healthcare professional he is not an ethical provider

C. help the healthcare professional understand that the most important outcome is honoring the patient's wishes

You are providing bereavement support to an 8yo child whose father just died on your unit. Which of the following statements would be appropriate for you to use? -A. Tell the child that their father has gone away -B. Tell the child that he will get over the loss of his father when he gets older -C. Let the child know his father's death was peaceful and that he just went to sleep -D. Let the child know you wish that his father had not died

D. Let the child know you wish that his father had not died

Which of the following family members is at greatest risk for complicated grief? -A. The wife of 60 years who has provided care for three years to her husband with Alzheimer's disease -B. The son who lives out of town and has only been able to see his dad once a week for the past six months -C. The female partner of a woman whose family has embraced her as family -D. The daughter who has a long history of substance use and has just recently returned home to be at her dying mother's bedside

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

Which of the following patients are you MOST concerned may have undiagnosed depression? -A. the 52 yo with metastatic prostate cancer who now plays only nine holes of golf rather than 18 holes with his buddies every week -B. a 90 yo woman with early stage dementia who participates in the craft activities at the nursing facility -C. the 40 yo with end stage liver disease who has fatigue and does not feel like eating much when he attends his weekly men's church club meetings -D. a 71 yo grandmother with pancreatic cancer who reports trouble sleeping, fatigue, and does not care to see her grandchildren on the weekends anymore

D. a 71 yo grandmother with pancreatic cancer who reports trouble sleeping, fatigue, and does not care to see her grandchildren on the weekends anymore

Mrs. Smith has end-stage COPD and is admitted with sever dyspnea and is started on morphine sulfate. Which of the following statements by her husband demonstrated he understands the use of morphine in patients with COPD? -A. morphine is addictive and I am worried that she will become an addict -B. we have to be really careful with this drug because I have heard it could make her stop breathing -C. my life has a lung condition and morphine prevents her lungs from causing her pain -D. the morphine is being used to treat her shortness of breath

D. the morphine is being used to treat her shortness of breath

Mr. Lopez's partner just died and he has been unable to leave her side. He is grieving and tells you he will never be able to get over losing the love of his life. What is your BEST response? -A. Mr. Lopez, you have been in the room for over an hour, it's time to leave -B. Don't worry, you will get over it, it just takes time -C. It may be painful now, but you will find a new love someday -D. you must have loved her very much, this has to be so hard for you

D. you must have loved her very much, this has to be so hard for you