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. How does a durable power of attorney differ from a power of attorney?

• A. It is granted by the court on behalf of an incompetent individual.
• B. It stays in effect if the individual granting it becomes incompetent.
• C. It goes into effect only after an individual becomes incompetent.
• D. It includes responsibility for managing an individual's financial assets.

Correct answer: B

Rationale: A durable power of attorney allows competent individuals to appoint someone else to make decisions on their behalf in the event they become incompetent. Choice A is incorrect because a durable power of attorney is typically granted by the individual themselves, not the court. Choice C is incorrect as a durable power of attorney can be effective both before and after incompetency. Choice D is incorrect because managing financial assets is just one aspect of the authority granted by a power of attorney, not specifically for a durable power of attorney.

3. How does the doctrine of respondent superior affect nurses?

• A. Liable for injury resulting from advice given to a member of a patient's family
• B. Responsible for double-checking the doses of medication ordered by a physician
• C. Responsible for the actions of the staff they supervise
• D. Obligated to obtain informed consent for any diagnostic procedure

Correct answer: C

Rationale: The correct answer is C. The doctrine of respondent superior holds that supervisors are accountable not only for their own actions but also for the actions of the staff they oversee. This means that nurses, as supervisors, are responsible for ensuring that the actions of their staff comply with established protocols and standards of care. Choices A, B, and D are incorrect because they do not directly relate to the principle of respondent superior. Nurses may have other responsibilities related to giving advice, medication administration, and obtaining consent, but the doctrine of respondent superior specifically pertains to the accountability of supervisors for the actions of their subordinates.

4. 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.

5. 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.

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