Nursing Elites

1. A nurse at a rehabilitation center is preparing a care plan for a 71-year-old post-stroke patient who has shown significant improvement in function and who is ready to return to the community. In the nurse's efforts to mobilize family caregiving, which of the following statements provides the most accurate criterion for inclusion in the category of 'family'?

• A. The patient's spouse, biological children, and closest friends
• B. Any unpaid person who has expressed sincere interest in the patient's condition and provided hands-on care since his admission to the facility
• C. Anyone who self-identifies as being a member of the patient's family
• D. Any individual who fulfills the patient's family functions

Correct answer: D

Rationale: The most accurate criterion for inclusion in the category of 'family' when mobilizing family caregiving is identifying individuals who fulfill family functions. Choice D is the correct answer as it emphasizes the importance of individuals who perform essential family functions for the patient. This criterion is crucial as it prioritizes the practical support and care provided by individuals over biological relationships (Choice A), self-identification (Choice C), or willingness to provide care (Choice B), which may not always translate to fulfilling necessary family functions.

2. A nurse is working in an assisted living facility that has a culturally diverse older adult population. Which statement by the nurse best demonstrates cultural sensitivity?

• A. We need to ensure that both the minority population and the majority population have their health needs met.
• B. It's important to remember that minority groups do not usually express their pain explicitly.
• C. We need to build our knowledge of clients who belong to cultural and ethnic groups that we're not familiar with.
• D. We need to teach all clients that their health problems are not necessarily the result of punishment.

Correct answer: C

Rationale: The best demonstration of cultural sensitivity by the nurse is reflected in choice C. Building a knowledge base around cultural and ethnic groups is a crucial component of providing culturally sensitive care. Choice A creates an inaccurate dichotomy between 'minority' and 'majority' populations, which is not a culturally sensitive approach. Choice B incorrectly generalizes that minority groups do not usually express their pain explicitly, which is not true for all cultural groups. Choice D suggests imposing a different belief system on clients, which is not culturally sensitive and can undermine trust and rapport with older adult clients.

3. How does a durable power of attorney differ from a power of attorney?

• A. It is granted by the court on behalf of an incompetent individual.
• B. It stays in effect if the individual granting it becomes incompetent.
• C. It goes into effect only after an individual becomes incompetent.
• D. It includes responsibility for managing an individual's financial assets.

Correct answer: B

Rationale: A durable power of attorney allows competent individuals to appoint someone else to make decisions on their behalf in the event they become incompetent. Choice A is incorrect because a durable power of attorney is typically granted by the individual themselves, not the court. Choice C is incorrect as a durable power of attorney can be effective both before and after incompetency. Choice D is incorrect because managing financial assets is just one aspect of the authority granted by a power of attorney, not specifically for a durable power of attorney.

4. A newly hired nurse is being orientated in a community health center that provides care to the adjacent large Native American reservation/Canadian aboriginal reserve. Which statement by the nurse indicates a sound understanding of the Native American/First Nations population?

• A. I suppose that we will see a disproportionately high number of clients with lung and oral cancers.
• B. The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area.
• C. It is unfortunate that many of the older Native Americans/First Nations people are unlikely to have family members involved in their care.
• D. The unique skin pigmentation of Native Americans/First Nations people means that I will have to modify my assessment techniques.

Correct answer: B

Rationale: Diabetes, hypertension, and stroke are all higher than average in Native American/First Nations adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these older adults. The skin tone of Native American/First Nations people is not noted to require specific assessment techniques. The Native American population may have close family bonds.

5. A gerontological nurse is conducting an in-service program for a group of nurses who work with a wide range of culturally diverse older adults. After teaching the group about the impact of culture on health and illness, the nurse determines that the teaching was successful when the group identifies which reason as underlying the need to understand culture?

• A. Ensure that clients receive the respect customary in their own ethnic group
• B. Provide individualized and culturally sensitive care
• C. Ensure that medical treatments align with cultural expectations
• D. Increase compliance among minority clients

Correct answer: B

Rationale: The correct answer is B because understanding the impact of culture on health and illness enables nurses to provide individualized and culturally sensitive care to older adults from diverse backgrounds. This approach ensures that the cultural, religious, and sexual orientation differences of older adults are acknowledged, respected, and factored into their care. Choice A is not as comprehensive as B, as the goal goes beyond just respecting customary practices. Choice C, while important, is more focused on medical treatments rather than holistic care. Choice D is not the primary reason for understanding culture; the main goal is to provide personalized care that respects individual differences.

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