Nursing Elites

1. A nurse is determining ways to address ethnic diversity among clients being provided care. Which action would be the most direct way for the nurse to do this?

• A. Explain how cultural backgrounds influence health beliefs and practices.
• B. Provide culturally sensitive care that respects clients' traditions.
• C. Listen to the life stories of clients to understand their cultural influences.
• D. Participate in cultural competency training and workshops.

Correct answer: C

Rationale: Listening to the life stories of clients is an effective way for nurses to understand the cultural influences that shape their beliefs and practices. By actively listening, nurses can gain insight into the clients' backgrounds, values, and preferences, allowing them to provide more personalized and culturally sensitive care. Choices A, B, and D are not as direct as listening to the life stories of clients. While explaining how cultural backgrounds influence health beliefs and practices is important, directly listening to clients' life stories provides a deeper understanding of their individual cultural influences.

2. During a busy shift, a registered nurse directed an unlicensed care provider to change the dressing and perform wound care on an older adult client's surgical incision, an act that exists outside of the unlicensed care provider's scope of practice. Which of the following statements best captures the legal context of this event?

• A. The unlicensed care provider is solely responsible for the inappropriate practice.
• B. The nurse can be held liable for the actions of the unlicensed care provider.
• C. Liability rests with the nurse manager of the unit.
• D. In the absence of documented harm to the client, the action is legally permissible.

Correct answer: B

Rationale: The correct answer is B. Under the doctrine of respondent superior, nurses can be held liable for the actions of individuals under their supervision. In this scenario, the registered nurse directed the unlicensed care provider to perform a task outside their scope of practice, making the nurse accountable for the consequences. Choice A is incorrect because the responsibility is shared between the nurse and the unlicensed care provider. Choice C is incorrect as the nurse manager may not be directly responsible for the actions of the registered nurse. Choice D is incorrect because legality is not determined solely by the absence of harm; acting within one's legal scope of practice is essential to ensure patient safety.

3. What is the most important advantage of an advance directive?

• A. Such a directive indicates how medical decisions are to be made in case a patient is unable to communicate their wishes.
• B. It spares the family the burden of making significant decisions for a patient regarding terminal care.
• C. It ensures that a person's property is distributed according to their wishes after death, avoiding legal complications.
• D. It allows individuals to appoint a guardian for themselves in case of incapacity, without involving the court system.

Correct answer: B

Rationale: An advance directive, or living will, is a legal document that specifies an individual's preferences for medical treatment if they are unable to communicate their wishes. The most important advantage of an advance directive is that it spares the family from having to make challenging decisions about terminal care on behalf of the patient. Choice A is incorrect because advance directives pertain to healthcare decisions, not property matters. Choice C is incorrect as it refers to a will for property distribution, which is a different legal document. Choice D is incorrect as advance directives are not related to appointing guardians but rather focus on healthcare decision-making.

4. To receive government funding, a county hospital must provide demographic statistics on its client population. When selecting the box labeled Hispanic on the forms, what characteristic of the client population would a worker consider?

• A. immigrant workers who entered the United States and their descendants
• B. immigrants who have a Spanish accent
• C. native Spanish-speaking people living in the United States
• D. persons with brown skin and dark hair

Correct answer: C

Rationale: The correct answer is C because the term 'Hispanic' includes Spanish-speaking individuals from various countries like Spain, Cuba, Mexico, and Puerto Rico. It is essential to understand that Hispanic does not solely refer to individuals with brown skin, dark hair, or those with a Spanish accent. Therefore, choices A, B, and D do not accurately represent the characteristic of the client population that would be classified as Hispanic.

5. A nurse is providing care for an older adult client who has been admitted to the hospital with liver cirrhosis. The client has expressed to the nurse his concerns that the details of his condition and treatment remain confidential, and that written documentation not 'get out there.' How can the nurse best respond to the client's concerns?

• A. Anything that is discussed between us is confidential and will not be shared with anyone else.
• B. The Health Insurance Portability and Accountability Act ensures that your medical records will not leave this hospital.
• C. Provided you signed a directive on admission, your records will not be made public.
• D. The law protects your right to confidentiality and protects your health information from being released into unintended hands.

Correct answer: D

Rationale: The correct answer is D. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects individuals' right to confidentiality and safeguards health information from being accessed by unauthorized individuals. Assuring the client that the law protects their right to confidentiality and prevents their health information from being released into unintended hands is the best response. Choice A is too broad and may not cover all aspects of confidentiality. Choice B only mentions medical records staying within the hospital, which does not address the client's concern about written documentation. Choice C incorrectly implies that a signed directive is needed for confidentiality, which is not true under HIPAA regulations.

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