ELNEC
Which of the following demonstrates the impact serious illness has on the social domain of quality of life?
Financial burdens resulting form the high costs of medical care
What type of pain are antidepressants and anticonvulsants most beneficial for?
Neuropathic pain
The parents of a 2-year-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 he is very worried about dying. He knows his disease is terminal and he only has 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.
You are caring for the following four patients. Which patient is at highest risk for developing constipation?
A 48-year-old with metastatic cancer of the breast on high doses of opioids for pain.
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
Yolanda has osteoarthritis of the left knee for which she is receiving acetaminophen 1000 mg every 6 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 level is for her.
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 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/facial grimacing.
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 knowledgable of the benefits of palliative and hospice care
Mrs. K's family has informed you that she is Roman Catholic and that her wishes were to have a priest administer a sacrament since she is getting close to death. You should ask
Can I call you a priest
Joey is a 3-month-old who has a serious chronic 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 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?
A colleague comes to talk to you 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 or getting your own way.
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.
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 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 assessing Mrs. Smith's husband 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 will not leave until you are ready for me to.
Which of the following patient statements suggests that the patient is experiencing an existential crisis?
I am so afraid that God has abandoned me in my time of need.
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 reason?
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 shared this information with him. He is staring out the window, looking sad. How do you start your conversation?
I saw the team was just here, can you tell me about their conversation with you?
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 we understand what your hopes are for your treatment of this illness.
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 goal of care.
Which disease and dying trajectory best represents the course for a person with Alzheimer's disease?
Progressive deterioration
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 oxycodone/acetaminophen 5/325 mg tablets every four hours for bone pain related to metastatic cancer. His pain is a constant 6 on a 0-10 scale. Since the current regimen is not meeting his goals, and is keeping him from moving, you decide to call the 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.
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 severe 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 group.
You are entering a room to administer a medication to your patient and as you come in you find that 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. 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 the end of the 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?
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 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.
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
Which of the following statements is true about serious, chronic illnesses?
The majority of annual U.S. healthcare spending goes toward chronic illnesses.
The family of a patient who is dying asks 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.
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 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 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?
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.
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 honor his service?
Find out if he would like you to see if the local veterans group could visit him.
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.
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. 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 this is part of the dying process.
Symptom management in older adults with serious illness is complicated because
Many have multiple comorbidities.
Which of the following patients should never be given opioid medication?
Mr. Smith who reports developing a rash, hives, and shortness of breath after taking an opioid for dental work.
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 why the team doesn't feed her with a tube. They state, "it seems like you all are 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.
Mr. Rodriguez 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
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. 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 an elderly woman who is dying from Parkinson's disease. Her husband died years ago and all of her friends are also past. You are sitting with her and she tells you how lonely she feels. Your best response is.
It must feel lonely
John is admitted to the hospital for a pain crisis from his sickle cell disease. He usually takes morphine 30 mg 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 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 your appropriate response?
Pain is whatever the patient says it is. Let's assess her further.
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
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.