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. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite her lack of relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case?

• A. Larceny
• B. Assault
• C. Invasion of privacy
• D. Negligence

Correct answer: D

Rationale: In this case, the most likely relevant category of legal liability is negligence. Negligence involves the commission of an improper act, as exemplified by the nurse's actions of performing a procedure without the necessary education and experience, leading to permanent nerve damage for the client. Larceny refers to theft, assault involves a deliberate threat to harm, and invasion of privacy pertains to the violation of a person's right to privacy. Therefore, in this scenario, the nurse's actions align more closely with negligence.

3. 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.

4. A newly hired nurse is being orientated in a community health center that provides care to the adjacent large Native American reservation/Canadian aboriginal reserve. Which statement by the nurse indicates a sound understanding of the Native American/First Nations population?

• A. I suppose that we will see a disproportionately high number of clients with lung and oral cancers.
• B. The high prevalence of diabetes and hypertension mean that strokes are likely to be relatively frequent in the area.
• C. It is unfortunate that many of the older Native Americans/First Nations people are unlikely to have family members involved in their care.
• D. The unique skin pigmentation of Native Americans/First Nations people means that I will have to modify my assessment techniques.

Correct answer: B

Rationale: Diabetes, hypertension, and stroke are all higher than average in Native American/First Nations adults. Lung and oral cancers are not noted to have a higher prevalence and family is likely to be involved in the care of these older adults. The skin tone of Native American/First Nations people is not noted to require specific assessment techniques. The Native American population may have close family bonds.

5. In which of the following situations would the use of physical restraints most likely be justified?

• A. Mr. Y is agitated and aggressive while experiencing severe alcohol withdrawal and is not responding to chemical sedation.
• B. Mrs. U, diagnosed with dementia, was found wandering outside the hospital, and nurses have been unable to redirect her to stay on the unit.
• C. Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously.
• D. Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds.

Correct answer: A

Rationale: Answer A is the correct choice because it describes a situation where the client poses a risk due to agitation and aggression during severe alcohol withdrawal, and chemical sedation has not been effective. In such cases, physical restraints may be justified as a last resort to ensure the safety of the client and others. Choices B, C, and D present scenarios where alternative strategies like redirection, addressing delirium, or implementing behavioral interventions should be attempted before considering physical restraints.

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