ELNEC Questions

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? A. Nociceptive pain B. Acute pain C. Neuropathic pain D. Psychological pain

A

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

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: A. Don't worry, Joey is too young to feel real pain. B. All 3-month-old 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

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

During your pain assessment, Randall describes his pain as a burning pain in his lower extremities. What type of pain does this describe? A. Nociceptive pain B. Acute pain C. Neuropathic pain D. Spiritual pain

C

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? A. "I will auscultate my patient's chest." B. "I will take my patient's respiratory rate." C. "I will ask my patient about his breathing." D. "I will check my patient's oxygen saturation."

C

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

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? 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-year-old grandchild of the patient

C

Mr. Johnson tells you that although the oral morphine prescription he just started for his cancer pain says to take one tablet every 12 hours, he has found that if he takes it every 6 hours, his pain is much less. What behavior does this represent? A. Addiction B. Physical dependence C. Tolerance D. Substance misuse

D

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? 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 change. C. Accept the orders but tell Mr. Jones to continue taking the medication every four hours. D. Tell the physician that this medication is not appropriate for this type of pain.

A

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: A. "Can I help you call a priest to come and honor her wishes?" B. "We don't have a priest, but I can see if the hospital chaplain on call can visit her." C. "There is no need for a sacrament of the sick because Mrs. K is close to end of life." D. "Mrs. K is actively dying so you had better contact your local priest soon."

A

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? 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

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? A. "If that is not possible, what else might you hope for? B. "Keep praying for that and maybe it will happen." C. "You shouldn't hope for things that won't happen." D. "You don't seem to understand the severity of your daughter's condition."

A

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: 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 hope you will be here; no one ever 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

You are caring for the following four patients. Which patient is at the highest risk for developing constipation? A. A 48-year-old with metastatic cancer of the breast on high doses of opioids for pain. B. A 76-year-old who has had a recent history of diarrhea associated with a C-difficile infection. C. An 85-year-old with hepatic encephalopathy who is receiving lactulose to manage high ammonia levels. D. A 62 year-old with ulcerative colitis.

A

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. A normal grief reaction B. A complicated grief reaction C. An abnormal grief reaction D. A dysfunctional grief reaction

A

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? 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

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? 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 won't dwell on the future D. Suggest she go to an exercise class to preserve her balance and strength

B

John's lung cancer is causing him severe shortness of breath. Which pharmacologic intervention would be of most benefit for his dyspnea? A. A benzodiazepine like lorazepam B. An opioid like morphine sulfate C. A cough syrup containing a cough suppressant D. A diuretic like furosemide.

B

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: A. Comfort her and tell her you all feel that way but it will be ok. B. 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. C. Tell her you are here for her and the two of you will get through this together. D. Suggest that if she really can't stand it anymore, maybe she should consider changing jobs.

B

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: A. "I understand. Your wife certainly requires a lot of care and it is so hard to keep track of all her medications, let alone your own." B. "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." C. "That is nonsense; don't you know that not taking your heart failure medications could put you in the hospital?" D. "Later on may never come if you don't take care of yourself now; you have to take better care of yourself and get your medications filled."

B

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? A. Foul-smelling diarrhea B. Sudden onset of liquid stool C. Fatty-looking stools D. Blood and mucous strands in stool

B

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? A. Suggest her family bring her in a fiber supplement, since she has used these in the past. B. Recommend a physician order for a scheduled laxative and stool softener. C. Just assess her regularly for constipation as she is not eating much. D. Insist that she increase her fluids to three liters per day as an intervention.

B

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? A. Hold a unit party to celebrate the great care everyone gives. B. Recommend starting a reflection ritual to honor patients who die on the unit. C. Suggest that the staff get together after work to go to a local bar. D. Ask the unit manager if the staff could have a feel-good pizza lunch day.

B

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: A. "Your mom is fine. Why don't you take a long walk and get some dinner since you must be so tired and hungry?" B. "I don't think there is any more we can do to make her more comfortable. She is resting now." C. "Some patients relax when we give them a gentle foot massage. Would you like me to show you how?" D. "You don't need to worry. Your mom seems comfortable and the nurses are all giving her great care."

C

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? A. "Don't worry, this is probably just a phase she is going through because she sees you all are sad and upset. She will get over it with time." B. "I would recommend you schedule an appointment with the pediatrician as soon as possible; it sounds like something is seriously wrong with her since she is acting out like this." C. "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?" D. "It sounds like Mr. C's granddaughter is looking for attention and needs to be disciplined for her difficult behavior."

C

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: A. "I can call them, but I don't think there is anything they can do to make this better." B. "I know he looks uncomfortable breathing like this, but I can assure you, he is ok." C. "His breathing pattern is difficult to watch, but the irregularity is a normal part of the dying process." D. "I will call both the doctor and respiratory therapy to see if he needs more oxygen."

C

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? 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. Ask the IDT if Yolanda would benefit from an antidepressant for pain.

C

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: A. "Ms. F said she never wanted tube feedings in her advance directives so we are honoring her wishes." B. "Food or fluid will not help Ms. F get stronger. She is dying from lung cancer." C. "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." D. "That's a terrible thing to say; of course we are not starving her to death."

C

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? A. If he is not moaning, he's probably not experiencing pain. B. I'll have to guess when he is in pain since he can't tell me. C. Now that he's unable to communicate, we can stop his pain medication. D. Since he was in pain when he was conscious, I assume he's still in pain.

D

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? A. Call the physician to let her know that Mr. T is having hallucinations and needs medication. B. Tell Mr. T. that his father is dead and it is not possible that he is in the room with him. C. Ask the family if Mr. T has had a history of psychosis or other mental health issues. D. Find out from Mr. T how it feels to have his father visiting, is it frightening him?

D

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: A. That is just an old belief that you don't need to worry about. B. It could happen, but the most important thing is that he needs to take the medication for pain. C. The side effects of these strong narcotics are scary- you should watch his breathing carefully. D. Breathing problems are rare when these medications are used as ordered.

D

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? A. "I don't know why he wouldn't eat it. You have brought some to our unit and it is wonderful." B. "Don't take it personally Mrs. F - maybe you should stop pushing him to try to eat." C. "Maybe you should change your recipe and try making it a little blander for him." D. "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."

D

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? 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 wife 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

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? 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 won't 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

You are caring for a patient who has just died. In caring for the body after death, the goal of care is to: A. Make sure the body is sent to the morgue within an hour after death. B. Insist that the family members participate in the bathing and dressing the deceased. C. Notify all family members and team members regarding the patient's death. D. Provide a clean, peaceful impression of the deceased for the family.

D

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? A. Use the phrase "your father has gone away" rather than "your father has died." B. Tell him he will get over the loss of his father when he gets a little older. C. Let him know his father's death was peaceful and that he "just went to sleep." D. Let him know you wish that his father had not died.

D

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? A. Avoid talking about the recent deaths, focusing on the patients who have survived. B. Seek the support of the family of the dying patient to comfort the staff. C. Share with the staff that personal grief should not be expressed by healthcare professionals. D. Consult with the hospital chaplain or spiritual care counselor for staff support.

D

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? A. "Hospital policy states that we have to move the patient's body to the morgue within an hour." B. "I am so sorry but you cannot wait here. When the rest of the family gets here, we can go with them to see the body in the morgue." C. "The ER is full and we need the bed quickly for another patient, but you can view the body now." D. "We will do everything we can to give the other family members time to get to the ER."

D

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? A. Start looking on the jobs board for a transfer to another unit. B. Take up yoga and enroll in daily Pilates classes for more exercise. C. Acknowledge that these are normal feelings when you have only been working for eight months. D. Speak with your nurse manager about how you are feeling and ask for help.

D