Nursing Elites

1. A visiting nurse becomes concerned about a caregiver daughter. Although she does not seem overburdened, she may be drinking too much. The recycling bin contains many wine bottles, and visitors come to the home. What action should the nurse take?

• A. Direct the daughter to a local Alcoholics Anonymous chapter
• B. Ignore the signs unless they interfere with caregiving
• C. Find a new caregiver in the family or outside of it
• D. Assess the daughter's motivation and ability to provide care

Correct answer: D

Rationale: The correct action for the nurse to take in this situation is to assess the daughter's motivation and ability to provide care. The nurse should not jump to conclusions based solely on the presence of wine bottles in the recycling bin. It is important to understand the daughter's overall capacity for caregiving and if her potential alcohol consumption is affecting her ability to provide care. Directing the daughter to Alcoholics Anonymous without a thorough assessment may not be appropriate at this stage. Ignoring the signs or immediately finding a new caregiver without understanding the daughter's situation may not address the underlying issue. Therefore, assessing the daughter's motivation and caregiving capabilities is the most appropriate initial step for the nurse.

2. A nurse at a rehabilitation center is preparing a care plan for a 71-year-old post-stroke patient who has shown significant improvement in function and who is ready to return to the community. In the nurse's efforts to mobilize family caregiving, which of the following statements provides the most accurate criterion for inclusion in the category of 'family'?

• A. The patient's spouse, biological children, and closest friends
• B. Any unpaid person who has expressed sincere interest in the patient's condition and provided hands-on care since his admission to the facility
• C. Anyone who self-identifies as being a member of the patient's family
• D. Any individual who fulfills the patient's family functions

Correct answer: D

Rationale: The most accurate criterion for inclusion in the category of 'family' when mobilizing family caregiving is identifying individuals who fulfill family functions. Choice D is the correct answer as it emphasizes the importance of individuals who perform essential family functions for the patient. This criterion is crucial as it prioritizes the practical support and care provided by individuals over biological relationships (Choice A), self-identification (Choice C), or willingness to provide care (Choice B), which may not always translate to fulfilling necessary family functions.

3. 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.

4. A gerontological nurse is conducting an in-service program for a group of nurses who work with a wide range of culturally diverse older adults. After teaching the group about the impact of culture on health and illness, the nurse determines that the teaching was successful when the group identifies which reason as underlying the need to understand culture?

• A. Ensure that clients receive the respect customary in their own ethnic group
• B. Provide individualized and culturally sensitive care
• C. Ensure that medical treatments align with cultural expectations
• D. Increase compliance among minority clients

Correct answer: B

Rationale: The correct answer is B because understanding the impact of culture on health and illness enables nurses to provide individualized and culturally sensitive care to older adults from diverse backgrounds. This approach ensures that the cultural, religious, and sexual orientation differences of older adults are acknowledged, respected, and factored into their care. Choice A is not as comprehensive as B, as the goal goes beyond just respecting customary practices. Choice C, while important, is more focused on medical treatments rather than holistic care. Choice D is not the primary reason for understanding culture; the main goal is to provide personalized care that respects individual differences.

5. For which of the following is informed consent required?

• A. Ordering a liquid diet for a post-surgical patient
• B. Listening to a patient reveal his or her private, personal secrets
• C. Giving a patient saline solution to relieve dry nasal passages
• D. Asking a patient to complete a questionnaire for a research study on hospital practices

Correct answer: D

Rationale: Informed consent is required when asking a patient to participate in a research study, as mentioned in choice D. Choices A, B, and C involve routine care measures that do not require specific informed consent. Ordering a liquid diet, providing saline solution for dry nasal passages, or listening to a patient's personal secrets are part of standard care and do not typically necessitate formal consent beyond general consent for treatment.

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