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. A local community has a small budget for community health programs aimed specifically toward its black population. Which type of community health program will the nurse recommend as the best use of the budget?

• A. depression screening
• B. meal planning
• C. blood pressure screening
• D. sleep disorder information

Correct answer: C

Rationale: The best use of the budget for the black population in the local community would be blood pressure screening. Hypertension is a prevalent health issue among black Americans, occurring at a higher rate than in the white population. Therefore, focusing on blood pressure screening would help in early detection and management of hypertension within this community. Depression screening and sleep disorder information are not the priority as there is not a higher incidence of these conditions in older black clients. Meal planning could be beneficial for clients with diabetes, but it may not be the most critical focus considering the higher prevalence of hypertension among the black population.

3. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite her lack of relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case?

• A. Larceny
• B. Assault
• C. Invasion of privacy
• D. Negligence

Correct answer: D

Rationale: In this case, the most likely relevant category of legal liability is negligence. Negligence involves the commission of an improper act, as exemplified by the nurse's actions of performing a procedure without the necessary education and experience, leading to permanent nerve damage for the client. Larceny refers to theft, assault involves a deliberate threat to harm, and invasion of privacy pertains to the violation of a person's right to privacy. Therefore, in this scenario, the nurse's actions align more closely with negligence.

4. A nurse working with a population of black clients is cognizant that some health conditions are more prevalent in this population than in the white population and is working to address them. Which health assessment would be the priority for this client population?

• A. Mandating different lifestyle choices because of a lower life expectancy
• B. Monitoring their blood pressure because of a blunted nocturnal response
• C. Examining their buccal mucosa because black skin color can complicate the use of skin color for assessment
• D. Monitoring for HIV/AIDS as this is a leading cause of death among black clients

Correct answer: B

Rationale: Hypertension is the most prevalent health problem among black Americans. A blunted nocturnal response is one factor responsible for this problem.

5. Why might nurses not be the best choice to obtain informed consent from patients?

• A. Nurses may be tempted to influence the patient's decision in subtle ways.
• B. Nurses may not be able to answer some of the medical questions the patient asks.
• C. A signature obtained by anyone other than a physician will not stand up in court.
• D. Under the law, nurses are only allowed to act as witnesses to informed consent signatures.

Correct answer: B

Rationale: Nurses may not have the medical expertise to answer all the questions that patients may have regarding their treatment, which is a crucial aspect of obtaining informed consent. While nurses should not influence a patient's decision, it is not a major reason why they should not obtain informed consent. Signatures obtained by nurses are legally binding, and although nurses often act as witnesses, there is no legal restriction preventing them from obtaining informed consent itself.

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