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. 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.

3. 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.

4. A nurse cares for an Asian American client with a fractured femur. During shift report, which statement by the nurse will another nurse challenge?

• A. The client has requested to wait to receive pain medication.
• B. The client does not want family to visit the room.
• C. The client is a recent immigrant to this country.
• D. The client is stoic and will not complain at all.

Correct answer: D

Rationale: The correct answer is D. Stereotyping the client as stoic and unlikely to complain about pain is incorrect and can lead to inadequate pain management. It is essential for the nurse to assess and address the client's pain regardless of cultural background. Choices A, B, and C are not as critical as they respect the client's autonomy, cultural preferences regarding family visits, and provide relevant background information about the client's immigrant status.

5. An elderly man has relied on one of his sons for his care. Now the son has become very involved with a religion other than the one in which he was raised. As a result, he now refuses to help his father. What can a nurse do to help in this family situation?

• A. Set up a family conference that includes the son
• B. Bring in help from other family members or outside
• C. Insist that the son help, along with other family members
• D. Ask the family's own spiritual adviser to intervene

Correct answer: A

Rationale: In this complex family situation, it is essential to approach the issue with sensitivity and understanding. Setting up a family conference that includes the son is the most appropriate action for the nurse to take. While it may seem challenging, there is a possibility that involving the son in a family discussion can help him understand the impact of his actions on his father and the rest of the family. By including him in the conversation, the son may realize the importance of his role in caring for his father. Insisting that the son help, along with other family members, could lead to resistance and further alienation. Asking the family's spiritual adviser to intervene may not be effective if the son is rebelling against the family's religion. If the family conference does not yield positive results, then bringing in help from other family members or an outside caregiver may become necessary to ensure the elderly man receives the care he needs.

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