ELNEC FINAL EXAMS

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.

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 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

John tells you that he does not want his wife to know that he has cancer. You sit down to talk about this with him. How can you BEST begin this conversation with John?

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

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.

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. You are aware he has a past history of substance use disorder. What should be your next action?

Discuss this issue with the provider and the team for next steps.

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 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.

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 expresses that they wish all their suffering would end. Which action should you take FIRST?

Evaluate the patient further for depression and risk of suicide.

You are caring for a patient who has just died. What should you do to assist the family in understanding what will occur next?

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 planning to assess the emotional and spiritual needs of a patient in the advanced stages of HIV/AIDS. What should be your FIRST action to open the communication process?

Find out if the patient feels like talking.

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

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

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. What is your BEST response?

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

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.

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

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

Liver dysfunction

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?

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

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

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 debilitating symptom?

Occupational therapy

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. What is the goal of care for the body after death?

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

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.

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

. 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 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?

Tell me more about what you are most afraid of.

Jane, a 72-year-old woman with end-stage renal disease, tells you she does not 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?

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 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. What is MOST important for you to assess when planning for bereavement follow-up with the family?

The family support system

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

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

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.

What should be MOST important in driving decision-making in palliative care?

The patient's goals of care

Mr. C, whose wife of 14 years died five months ago, returns to your unit to thank you all for your great care. He tells you he still cannot get through a week without crying and states that he knows he should be moving on from the death. Which of the following is your BEST response?

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

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. 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.

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 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 they ask you if you would stay with them. What is your BEST response?

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

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

I should acknowledge the emotions that the patient and family are expressing.

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. He tells you he is struggling with eating since his wife was always the cook and he is just not ready to go out to dinner with his buddies, even though they keep asking him. What is John experiencing?

Normal grief after his wife died two months ago

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 tells you that Ms. P. cannot be hurting as much as she says she is. What is your most appropriate response?

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

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 at the bedside. Which intervention is most appropriate in communicating with this family member?

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

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.

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. What is your BEST response?

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

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

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

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 to determine if a fecal impaction is present?

Sudden onset of liquid stool

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. They 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?

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

Mr. Lopez is the partner of the 50-year-old 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?

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

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.

You are working in the emergency room and a patient came in with a massive heart attack and cannot be resuscitated. The physician has just informed the family that the patient is dead. While sitting with the family, they ask you if the body can stay in the emergency room until the other family members arrive. The remaining family live 2 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 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?

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

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?

You must have loved her very much; this has to be so hard for you.

What is one of the nurse's MOST important roles in caring for seriously ill patients and their families?

providing listening and presence

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

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

Mr. F has advanced prostate cancer with bone metastasis and is unresponsive. His daughter is caring for him at home. 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 responsive, I assume he's still in pain.

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 impacted for Mrs. Woodrow's mother?

physical

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.?

psychological

1 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