Nursing Elites

1. An 81-year-old female client has presented to the emergency department accompanied by her daughter with whom she lives. The daughter states that her mother has experienced a recent series of falls, which have resulted in her facial and arm bruises. The client smells of urine and is noticeably emaciated, unkempt, and anxious while the daughter berates her during the nurse's assessment. What is the nurse's responsibility in this situation?

• A. Determine the daughter's legal status with regard to her mother's financial affairs
• B. Report suspected elder abuse
• C. Establish whether the client has a durable power of attorney in place
• D. Obtain medical records regarding prior admissions for similar problems

Correct answer: B

Rationale: In cases of suspected elder abuse, the nurse is responsible for reporting his or her suspicions to the relevant authorities. In this scenario, the signs of elder abuse are evident, such as the client's bruises, unkempt appearance, and the daughter's behavior. Determining the daughter's legal status or the client's power of attorney are not immediate priorities when abuse is suspected. Obtaining medical records for prior admissions is also not the primary concern in this situation.

2. How does guardianship differ from power of attorney?

• A. The court appoints a guardian; an individual grants a power of attorney to someone else to make decisions on his or her behalf.
• B. Guardianship is legally binding whether or not an individual is competent; power of attorney applies only to the incompetent.
• C. Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of 'reasonable prudence' are met.
• D. Guardianship stays in effect for one calendar year and must be renewed annually; power of attorney stays in effect until one or both parties choose to revoke it.

Correct answer: A

Rationale: The correct answer is A. The key difference between guardianship and power of attorney is that the court appoints a guardian to make decisions on behalf of an individual who is deemed incompetent, while an individual grants a power of attorney to someone else to make decisions on their behalf when they are competent. Choice B is incorrect because both guardianship and power of attorney can apply to individuals who are competent or incompetent. Choice C is incorrect as guardians, like those with power of attorney, must act in the best interest of the individual they represent, and the level of oversight can vary. Choice D is incorrect as guardianship and power of attorney do not have fixed time limits; they remain in effect until revoked or ended by the appropriate legal process.

3. Based on the information provided, what can be inferred about the nurse who has been working for several years in a long-term care facility with many Middle Eastern residents?

• A. The nurse's knowledge and skills provide expected care for clients in this demographic.
• B. The nurse is knowledgeable about Middle Eastern culture and respects and values providing culturally competent care.
• C. The nurse is attempting to overcompensate for cultural blindness and ethnocentrism within the community.
• D. This employment has allowed the nurse to demonstrate ethnic identity and cultural bias to a specific group of people.

Correct answer: B

Rationale: The nurse in the scenario is likely knowledgeable about Middle Eastern culture and values providing culturally competent care to the residents. This inference can be made based on the nurse being well-respected and effective in providing care to this population. Choice A is incorrect because it only focuses on the nurse's knowledge and skills, not specifically about cultural competence. Choice C is incorrect as there is no indication of overcompensation; the nurse is described as effective and well-respected. Choice D is incorrect as there is no evidence to suggest that the nurse is demonstrating ethnic identity or cultural bias, but rather respecting and providing care tailored to the cultural needs of the residents.

4. 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.

5. A local community has a small budget for community health programs aimed specifically toward its black population. Which type of community health program will the nurse recommend as the best use of the budget?

• A. depression screening
• B. meal planning
• C. blood pressure screening
• D. sleep disorder information

Correct answer: C

Rationale: The best use of the budget for the black population in the local community would be blood pressure screening. Hypertension is a prevalent health issue among black Americans, occurring at a higher rate than in the white population. Therefore, focusing on blood pressure screening would help in early detection and management of hypertension within this community. Depression screening and sleep disorder information are not the priority as there is not a higher incidence of these conditions in older black clients. Meal planning could be beneficial for clients with diabetes, but it may not be the most critical focus considering the higher prevalence of hypertension among the black population.

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