Nursing Elites

1. 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.

2. How might the nursing home's social worker help Ms. O's friends in visiting her?

• A. The social worker should defer to the nursing staff
• B. Help her friends find easier transportation
• C. Tell her to make friends at the dialysis center
• D. Ask other residents' families to bring her friends with them

Correct answer: B

Rationale: The correct answer is B. Ms. O's friends, who are elderly and cannot drive, ride buses to visit her. The social worker can help by finding easier transportation options for them. Not having family around, friends' visits can significantly impact Ms. O's well-being. It may be challenging for the friends to ask for help themselves, so the social worker can reach out to volunteer groups for assistance. Making friends at the dialysis center might not be feasible due to the nature of treatments. Asking other residents' families to bring her friends could burden them further and might deter them from helping. It's important to consider the friends' convenience and emotional support for Ms. O.

3. An investigation into reports of substandard care on the subacute geriatric unit of a hospital has been undertaken. Which of the following events is representative of malpractice on the part of the nursing staff?

• A. A client with a documented history of seizures was left with his bed raised and with bedrails not in place, resulting in a fall and head injury
• B. A client was sent for a colonoscopy, after which it was learned that the client had never given written consent for the procedure
• C. A client with a diagnosis of vascular dementia was found wandering in the hall outside the unit
• D. An immobile client was not turned over the course of a night shift and developed a pressure ulcer on her coccyx

Correct answer: A

Rationale: Answer A is correct as it includes all the components of malpractice: duty, negligence, and injury. The nursing staff failed in their duty by leaving a client with a documented history of seizures unattended with bedrails not in place, resulting in a fall and head injury. Answer B involves an issue related to consent, which is the responsibility of the physician, not the nursing staff. Answer C does not demonstrate negligence or harm caused by the nursing staff. Answer D also shows negligence by failing to turn an immobile client, leading to a pressure ulcer, but it lacks a direct connection to the duty of the nursing staff in preventing harm.

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. 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.

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