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. 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. As a daughter and mother are extremely close emotionally, they made a pact years ago never to put the mother in a nursing home. Now, the physical demands of caregiving are becoming too great. What is the best way a nurse can help the daughter?

• A. Persuade her to admit her mother to a nursing home
• B. Aid her in finding help with in-home care
• C. Praise her success in being a good daughter and keeping her promise
• D. Point out her mistaken altruism

Correct answer: B

Rationale: In this situation, the best course of action for the nurse is to aid the daughter in finding help with in-home care. Persuading her to admit her mother to a nursing home would likely cause guilt and emotional distress due to their pact. Praise alone may not address the current physical caregiving challenges. Pointing out her 'mistaken altruism' could be seen as insensitive and unhelpful. Providing practical assistance in finding in-home care can alleviate the physical demands on the daughter while still honoring the emotional commitment they made.

4. Which of the following is required in order for a healthcare provider to be legally justified in not attempting to save a client's life?

• A. A 'Do Not Resuscitate' (DNR) statement on the patient's care plan
• B. A 'No-Code' sign or symbol placed at the patient's bedside
• C. A 'No-Code' order written and signed on the physician's order sheet
• D. The next of kin's request for 'Do Not Resuscitate' orally or in writing

Correct answer: C

Rationale: To legally justify not attempting to save a client's life, a healthcare provider must have a 'No-Code' order written and signed on the physician's order sheet. Unless there is a specific order stating that resuscitation should not be performed, failure to do so can be considered negligence. A 'Do Not Resuscitate' statement on the care plan or a symbol at the bedside is not legally valid without the proper medical order. Additionally, a request from the next of kin, whether oral or written, is not a substitute for a signed physician's order.

5. During a busy shift, a registered nurse directed an unlicensed care provider to change the dressing and perform wound care on an older adult client's surgical incision, an act that exists outside of the unlicensed care provider's scope of practice. Which of the following statements best captures the legal context of this event?

• A. The unlicensed care provider is solely responsible for the inappropriate practice.
• B. The nurse can be held liable for the actions of the unlicensed care provider.
• C. Liability rests with the nurse manager of the unit.
• D. In the absence of documented harm to the client, the action is legally permissible.

Correct answer: B

Rationale: The correct answer is B. Under the doctrine of respondent superior, nurses can be held liable for the actions of individuals under their supervision. In this scenario, the registered nurse directed the unlicensed care provider to perform a task outside their scope of practice, making the nurse accountable for the consequences. Choice A is incorrect because the responsibility is shared between the nurse and the unlicensed care provider. Choice C is incorrect as the nurse manager may not be directly responsible for the actions of the registered nurse. Choice D is incorrect because legality is not determined solely by the absence of harm; acting within one's legal scope of practice is essential to ensure patient safety.

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