ENLEC questions

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

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? A. Duration B. Aggravating factors C. Alleviating factors D. Intensity

C. Alleviating factors

You are upset with the healthcare 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.

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. 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?

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? 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 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? A. I should not use the words death or dying in my conversations. B. I should assume that the patient and family has understood what I have told them. C. I need to be sure to fill in any uncomfortable gaps in conversation with more information. D. I should acknowledge the emotions that the patient and family are expressing.

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

You are caring for a patient who has just died. What is the goal of care for the body after death? A. Make sure the body is sent to the morgue within an hour after death. B. Insist that the family members participate in 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. Provide a clean, peaceful impression of the deceased for the family

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 diseaseT B. he 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.

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

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

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. What is your BEST response to her? 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.Can you explain to me what Joey looks like that makes you concerned he is in pain?

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 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.

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? 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 the treatment of this illness. C. Treatment will be difficult; you just have to be strong and get through it. D. This disease is terminal and there is nothing we can do for you.

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

Which of the following individuals would be at highest risk for the under-treatment of pain? A. A 40-year-old female with cancer B. An 87-year-old male with osteoarthritis C. A 54-year-old male with good prescription coverage D. A 29-year-old female with a history of GI bleed

B. An 87-year-old male with osteoarthritis

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? A. Support him in his decision to increase the medication to relieve his pain. B. Discuss this 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 this issue with the provider and the team for next steps.

You are assessing Mrs. Smith's husband's well-being during her recent hospitalization. Mr. Smith has had trouble with heart failure this past year. He tells you that all that matters to him is his wife. He states he does not have time to go to the doctor or get his own prescriptions filled. What is your BEST response? 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. 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 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? A. Patient will remain continent of urine and stool. B. Patient will have a bowel movement at least once every three days. C. Patient will not experience dyspnea. D. Patient will not use more than two doses of breakthrough pain medication per day.

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

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? 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.

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? 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

The family of a patient who is imminently dying asks you why the nurses always come in and look under the sheets at his legs when they are checking his blood pressure. Which of the following is your BEST explanation? A. They are checking for contractures and foot drop. B. They are checking for signs of decreased blood circulation. C. I don't know why they need to do this at this time since he is not having pain in his legs. D. They are just examining him all over to make sure he is comfortable.

B. They are checking for signs of decreased blood circulation.

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? 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.I D. will call both 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 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.

Which of the following patients should never be given an opioid medication? A. Ms. Jones a 27-year-old with a history of substance abuse B. Mr. Rich who reports 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 years old 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. T's wife tells the nurse she does not 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. What is your BEST response? 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. Breathing problems are rare when these medications are used as ordered.

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? A. Why not tell her John? She probably already suspects it since you have been so sick. B. It is your right not to tell her, it would probably just upset her anyway. C. Maybe we could have the doctor tell her so you don't have to. D. Can you tell me what it is about your wife knowing about the cancer that is bothering you?

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

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? A. Occupational therapy B. Social work C. Psychology D. Respiratory therapy

Occupational therapy

What type of pain are antidepressants and anticonvulsants most beneficial for? A. Acute pain B. Somatic nociceptive pain c. Neuropathic pain D.Visceral nociceptive pain

c. Neuropathic pain

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? A. Find out if the patient feels like talking. B. Sit close to the patient to demonstrate empathy. C. Move the patient to a setting that ensures privacy. D. Discuss medical issues first to relax the patient.

A. Find out if the patient feels like talking.

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, what is the BEST intervention to complete FIRST? A. Educate about signs and symptoms of disease progression. B. Foster hope by stressing that prognosis is difficult to predict. C. Provide active listening and therapeutic presence. D. Advise the daughter to focus more on the present time with her mother rather than the future.

C. Provide active listening and therapeutic presence.

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 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.

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? A. She sleeps quite a bit, so she shouldn't be as tired as she is. B. She's lost some weight. I know she'll feel better if she eats more. C. She's been in pain. If we control that maybe she'll have more energy. D. She seems moody, so her fatigue will improve if we make her laugh.

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

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. The ex-wife of the patient who lives nearby

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? A. Be careful with these medications because they can cause addiction. B. Only take this medication if you are really suffering. C. This medication causes constipation, so you need to take a laxative to prevent that. D. This is the medication they prescribe when you are getting near the end of life.

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

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? A. Oh don't worry, Mr. Tate, that was a long time ago. B. Some people have pain at the end of life, but we can help you manage the pain. C. Would you like me to contact our chaplain? He's very good at helping people who have concerns like yours. D. I know that God does not make people suffer and I am sure that you will not suffer at end of life for your past.

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

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? A. Normal thyroid function B. Normal hemoglobin and hematocrit levels C. Sedating medications D. Adequate muscle strength and tone

. Sedating medications

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 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? A. He needs to be assessed carefully so that he gets enough pain medication. B. He may require less analgesia since he has limited memory of the pain. C. He is at risk for addiction due to his early exposure to pain medications. D. He does not have full pain sensitivity due to an underdeveloped nervous system.

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

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? 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.

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.

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? A. Normal grief after his wife died two months ago B. Depression because he does not want to go out with his buddies C. Complicated grief because his wife died in the hospital D. A psychiatric disorder since he is not cooking for himself

A. Normal grief after his wife died two months ago

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? 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.

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 will not dwell on the future D. Suggest she go to an exercise class to preserve her balance and strength

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

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 preferences. B. Personal grief of the professional will make communication about grief easier. I may not always know the answers to questions that the patient or family may ask. My lack of personal experience with death can make me reluctant to discuss death and dying.

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

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

Ms. H is very ill and her family has been told she will probably die during this hospital admission. You are walking by the waiting room and you see her family members seated together, crying. What is your BEST response? A. Leave them alone to give them private time to do their grieving. B. Find a social worker to go into the waiting room to see if they need anything C. .Call the hospital chaplain to visit them and offer prayers. D. Go into the waiting room, sit next to them, and allow them the opportunity to talk if they want to.

D. Go into the waiting room, sit next to them, and allow them the opportunity to talk if they want to.

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.

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. 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 one month ago. The daughter reports she is experiencing mild breathlessness, loss of appetite, and difficulty concentrating. What is the daughter likely experiencing? A. A normal grief reaction B. A complicated grief reaction C. An abnormal grief reaction D. A dysfunctional grief reaction

A. A normal grief reaction

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. Today you recognize that she is getting very close to death. Which of the following is the BEST way to approach Mrs. K's wish with her family? A. Can I help you call a priest to come and honor her wishes? B. I am sorry, we don't have a priest available. 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. Can I help you call a priest to come and honor her wishes?

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 too severe for this type of pain.

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