Nursing Elites

1. 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.

2. During a family meeting that the nurse organized during an older adult's discharge planning from the hospital, there is visible animosity between the son and daughter of the patient. What should the nurse's initial response be to the apparent family dysfunction?

• A. Teach the patient's children alternative methods of interaction.
• B. Encourage the family to choose one spokesperson to represent all the children.
• C. Organize separate meetings with the son and with the daughter.
• D. Assess the family history and the nature of the son and daughter's relationship.

Correct answer: D

Rationale: The correct initial response for the nurse in this situation is to assess the family history and the nature of the son and daughter's relationship. By gathering data and identifying factors contributing to the dysfunction, the nurse can better understand the underlying issues and dynamics at play. Teaching alternative methods of interaction (Choice A) may not address the root cause of the animosity. Encouraging one spokesperson for the family (Choice B) may overlook individual concerns. Organizing separate meetings (Choice C) may not provide a holistic view of the family dynamics and may not address the issues affecting the family unit as a whole. Therefore, assessing the family history and relationship dynamics is essential for effective intervention and resolution of the family dysfunction.

3. How does the doctrine of respondent superior affect nurses?

• A. Liable for injury resulting from advice given to a member of a patient's family
• B. Responsible for double-checking the doses of medication ordered by a physician
• C. Responsible for the actions of the staff they supervise
• D. Obligated to obtain informed consent for any diagnostic procedure

Correct answer: C

Rationale: The correct answer is C. The doctrine of respondent superior holds that supervisors are accountable not only for their own actions but also for the actions of the staff they oversee. This means that nurses, as supervisors, are responsible for ensuring that the actions of their staff comply with established protocols and standards of care. Choices A, B, and D are incorrect because they do not directly relate to the principle of respondent superior. Nurses may have other responsibilities related to giving advice, medication administration, and obtaining consent, but the doctrine of respondent superior specifically pertains to the accountability of supervisors for the actions of their subordinates.

4. How does guardianship differ from power of attorney?

• A. The court appoints a guardian; an individual grants a power of attorney to someone else to make decisions on his or her behalf.
• B. Guardianship is legally binding whether or not an individual is competent; power of attorney applies only to the incompetent.
• C. Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of 'reasonable prudence' are met.
• D. Guardianship stays in effect for one calendar year and must be renewed annually; power of attorney stays in effect until one or both parties choose to revoke it.

Correct answer: A

Rationale: The correct answer is A. The key difference between guardianship and power of attorney is that the court appoints a guardian to make decisions on behalf of an individual who is deemed incompetent, while an individual grants a power of attorney to someone else to make decisions on their behalf when they are competent. Choice B is incorrect because both guardianship and power of attorney can apply to individuals who are competent or incompetent. Choice C is incorrect as guardians, like those with power of attorney, must act in the best interest of the individual they represent, and the level of oversight can vary. Choice D is incorrect as guardianship and power of attorney do not have fixed time limits; they remain in effect until revoked or ended by the appropriate legal process.

5. A discharge planning nurse works with a wide variety of families when organizing care for older adults after their discharge from the hospital. Which of the following relationship structures would the nurse consider to be a family? Select all that apply.

• A. Mr. E and his partner, Mr. S, who live together in an apartment
• B. Mr. R and his new 'lady friend,' who began cohabiting 2 months ago
• C. Mrs. B and her daughter, son-in-law, and widowed sister, all of whom share a house
• D. Mr. R, who is estranged from his children and has lived with his brother, a bachelor, for several years

Correct answer: A

Rationale: The correct answer is A. While not traditional nuclear family structures, all of the given relationships and living arrangements constitute family units. Mr. E and his partner, Mr. S, who live together in an apartment, form a family unit. Choice B is not considered a family as it describes a relatively new and non-committal relationship. Choice C describes a traditional family structure with Mrs. B, her daughter, son-in-law, and widowed sister sharing a house, which also constitutes a family unit. Choice D describes a situation where Mr. R is estranged from his children and living with his bachelor brother, which can also be considered a family unit but is not as inclusive as the relationship described in choice A.

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