Nursing Elites

1. A gerontological nurse is providing care at a local community health center that serves large black American and white American older adult populations. The nurse is working to develop culturally appropriate programs to meet each group's health needs and notes differences in health status between the groups. Which reason would the nurse most likely identify as accounting for the differences between the populations?

• A. High incidence of violent crime and sexually transmitted diseases in the black population
• B. Reliance on family for health care advice and rejection of formal service agencies in the white population
• C. Cultural preference for unconventional medical treatments like herbal remedies in the white population
• D. Lower standard of living and less access to health care services in the black population

Correct answer: D

Rationale: The correct answer is D. Black older adults historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Option A is incorrect because it presents stereotypes about the black population that are not supported by evidence. Option B is incorrect because it generalizes the behavior of the white population without a strong basis. Option C is incorrect as it also generalizes the white population and does not address the disparities in health status between the two groups.

2. As a daughter and mother are extremely close emotionally, they made a pact years ago never to put the mother in a nursing home. Now, the physical demands of caregiving are becoming too great. What is the best way a nurse can help the daughter?

• A. Persuade her to admit her mother to a nursing home
• B. Aid her in finding help with in-home care
• C. Praise her success in being a good daughter and keeping her promise
• D. Point out her mistaken altruism

Correct answer: B

Rationale: In this situation, the best course of action for the nurse is to aid the daughter in finding help with in-home care. Persuading her to admit her mother to a nursing home would likely cause guilt and emotional distress due to their pact. Praise alone may not address the current physical caregiving challenges. Pointing out her 'mistaken altruism' could be seen as insensitive and unhelpful. Providing practical assistance in finding in-home care can alleviate the physical demands on the daughter while still honoring the emotional commitment they made.

3. An 81-year-old female client has presented to the emergency department accompanied by her daughter with whom she lives. The daughter states that her mother has experienced a recent series of falls, which have resulted in her facial and arm bruises. The client smells of urine and is noticeably emaciated, unkempt, and anxious while the daughter berates her during the nurse's assessment. What is the nurse's responsibility in this situation?

• A. Determine the daughter's legal status with regard to her mother's financial affairs
• B. Report suspected elder abuse
• C. Establish whether the client has a durable power of attorney in place
• D. Obtain medical records regarding prior admissions for similar problems

Correct answer: B

Rationale: In cases of suspected elder abuse, the nurse is responsible for reporting his or her suspicions to the relevant authorities. In this scenario, the signs of elder abuse are evident, such as the client's bruises, unkempt appearance, and the daughter's behavior. Determining the daughter's legal status or the client's power of attorney are not immediate priorities when abuse is suspected. Obtaining medical records for prior admissions is also not the primary concern in this situation.

4. Based on the information provided, what can be inferred about the nurse who has been working for several years in a long-term care facility with many Middle Eastern residents?

• A. The nurse's knowledge and skills provide expected care for clients in this demographic.
• B. The nurse is knowledgeable about Middle Eastern culture and respects and values providing culturally competent care.
• C. The nurse is attempting to overcompensate for cultural blindness and ethnocentrism within the community.
• D. This employment has allowed the nurse to demonstrate ethnic identity and cultural bias to a specific group of people.

Correct answer: B

Rationale: The nurse in the scenario is likely knowledgeable about Middle Eastern culture and values providing culturally competent care to the residents. This inference can be made based on the nurse being well-respected and effective in providing care to this population. Choice A is incorrect because it only focuses on the nurse's knowledge and skills, not specifically about cultural competence. Choice C is incorrect as there is no indication of overcompensation; the nurse is described as effective and well-respected. Choice D is incorrect as there is no evidence to suggest that the nurse is demonstrating ethnic identity or cultural bias, but rather respecting and providing care tailored to the cultural needs of the residents.

5. An 81-year-old female client was diagnosed one year ago with Alzheimer's disease following a noticeable increase in confusion. She now possesses a durable power of attorney. Which of the following statements most accurately conveys an aspect of this legal arrangement?

• A. The parameters of the arrangement must be revisited if the client's condition declines.
• B. The arrangement was most likely initiated by court order.
• C. The client appointed someone to take care of her affairs in the event that she becomes incompetent.
• D. The family has control of logistical arrangements for the client but must gain court permission around financial affairs.

Correct answer: C

Rationale: The correct answer is C. Usually, a power of attorney becomes invalid if the individual granting it becomes incompetent, except in the case of a durable power of attorney. A durable power of attorney allows competent individuals to appoint someone to make decisions on their behalf in the event that they become incompetent. This legal arrangement is recommended for individuals with conditions like Alzheimer's disease where competency decline can be anticipated. It is not initiated by the court, unlike guardianship. A durable power of attorney encompasses both logistical and financial affairs, providing authority to the appointed person to act on behalf of the individual should they become incapacitated. Choices A, B, and D are incorrect because they do not accurately describe the purpose and nature of a durable power of attorney in the context of planning for incompetency due to conditions like Alzheimer's disease.

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