Nursing Elites

1. A nurse who works in an inner-city clinic provides care for a large number of older black clients. Which health promotion activity best reflects the specific health needs of this population?

• A. A blood sugar and blood pressure monitoring program
• B. An education session on the positive health effects of good nutrition
• C. A screening mammography campaign for older black women
• D. A program that teaches black men the importance of prostate health screening

Correct answer: A

Rationale: The correct answer is A. Diabetes and hypertension are prevalent among older black adults. Regular blood sugar and blood pressure monitoring are crucial in managing these conditions. While education on good nutrition, screening mammography, and prostate health screening are important health promotion activities, they do not directly address the specific health needs of this population. Therefore, a blood sugar and blood pressure monitoring program would best reflect the health needs of the older black clients in this inner-city clinic.

2. An 81-year-old female client was diagnosed one year ago with Alzheimer's disease following a noticeable increase in confusion. She now possesses a durable power of attorney. Which of the following statements most accurately conveys an aspect of this legal arrangement?

• A. The parameters of the arrangement must be revisited if the client's condition declines.
• B. The arrangement was most likely initiated by court order.
• C. The client appointed someone to take care of her affairs in the event that she becomes incompetent.
• D. The family has control of logistical arrangements for the client but must gain court permission around financial affairs.

Correct answer: C

Rationale: The correct answer is C. Usually, a power of attorney becomes invalid if the individual granting it becomes incompetent, except in the case of a durable power of attorney. A durable power of attorney allows competent individuals to appoint someone to make decisions on their behalf in the event that they become incompetent. This legal arrangement is recommended for individuals with conditions like Alzheimer's disease where competency decline can be anticipated. It is not initiated by the court, unlike guardianship. A durable power of attorney encompasses both logistical and financial affairs, providing authority to the appointed person to act on behalf of the individual should they become incapacitated. Choices A, B, and D are incorrect because they do not accurately describe the purpose and nature of a durable power of attorney in the context of planning for incompetency due to conditions like Alzheimer's disease.

3. During a home visit, a nurse notes that an 80-year-old female patient's blood pressure is 166/99 despite the recent introduction of a diuretic to her medication regimen. The patient admits that her son refuses to give her the diuretic because it has precipitated incontinence episodes and states, 'He gets so furious when I soil myself.' What action should the nurse prioritize in this potential case of elder abuse?

• A. Improving or salvaging the family dynamics
• B. Teaching the son why his actions are inappropriate
• C. Initiating legal action
• D. Taking measures to protect the patient's safety

Correct answer: D

Rationale: In this potential case of elder abuse, the nurse's priority should be taking measures to protect the patient's safety. The patient's health and well-being are at risk due to the son's refusal to administer the diuretic, which can lead to serious health complications. While improving family dynamics (choice A), educating the son (choice B), and legal actions (choice C) may be necessary in the long run, the immediate concern is ensuring the patient's safety and well-being.

4. To minimize liability, what action should nurses take when accepting telephone orders from physicians?

• A. Ask the physician to follow up with a faxed, written order
• B. Clearly communicate the most likely diagnosis to the physician
• C. Have another staff member talk with the physician and audiotape the conversation
• D. Accept only written orders or those communicated orally, in person

Correct answer: A

Rationale: The best action for nurses to take when accepting telephone orders from physicians to minimize liability is to ask the physician to follow up with a faxed, written order and ensure it is signed within 24 hours. This approach helps ensure clarity, accuracy, and documentation of the physician's orders, reducing the risk of misinterpretation or errors. Choices B, C, and D are incorrect. Communicating a diagnosis is outside the nurse's scope of practice and should be done by the physician. Involving another staff member to audiotape the conversation can introduce legal and practical issues. Accepting only written or orally communicated orders in person may not always be practical or feasible in urgent situations where telephone orders are necessary.

5. Which of the following family interactions would the nurse most likely interpret as being atypical?

• A. Mr. R states that he and his brother always had a cordial, though somewhat distant, relationship but that they are now quite close.
• B. Mrs. D describes being a grandparent as 'having all the benefits of having children without the headaches and responsibilities.'
• C. Mr. and Mrs. N had a tumultuous relationship for decades but now appear more at ease with one another.
• D. Mr. A states that his ideal living situation would be himself and his adult son and daughter all under the same roof.

Correct answer: D

Rationale: The correct answer is D. While marital reconciliation, rekindled relationships with siblings, and satisfaction in the role of grandparent are common phenomena among older adults, it is less common for parents and children to see cohabitation as an ideal situation or first preference. Choices A, B, and C reflect common positive family dynamics experienced by older adults, such as improved relationships with siblings, contentment in the grandparent role, and easing of marital tensions over time. On the other hand, choice D stands out as atypical as it suggests an unconventional living arrangement where adult children live with their parent, which is less commonly preferred by older adults.

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