Nursing Elites

1. 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.

2. 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.

3. 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.

4. A nurse is working in an assisted living facility that has a culturally diverse older adult population. Which statement by the nurse best demonstrates cultural sensitivity?

• A. We need to ensure that both the minority population and the majority population have their health needs met.
• B. It's important to remember that minority groups do not usually express their pain explicitly.
• C. We need to build our knowledge of clients who belong to cultural and ethnic groups that we're not familiar with.
• D. We need to teach all clients that their health problems are not necessarily the result of punishment.

Correct answer: C

Rationale: The best demonstration of cultural sensitivity by the nurse is reflected in choice C. Building a knowledge base around cultural and ethnic groups is a crucial component of providing culturally sensitive care. Choice A creates an inaccurate dichotomy between 'minority' and 'majority' populations, which is not a culturally sensitive approach. Choice B incorrectly generalizes that minority groups do not usually express their pain explicitly, which is not true for all cultural groups. Choice D suggests imposing a different belief system on clients, which is not culturally sensitive and can undermine trust and rapport with older adult clients.

5. 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.

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