Nursing Elites

1. An elderly man has relied on one of his sons for his care. Now the son has become very involved with a religion other than the one in which he was raised. As a result, he now refuses to help his father. What can a nurse do to help in this family situation?

• A. Set up a family conference that includes the son
• B. Bring in help from other family members or outside
• C. Insist that the son help, along with other family members
• D. Ask the family's own spiritual adviser to intervene

Correct answer: A

Rationale: In this complex family situation, it is essential to approach the issue with sensitivity and understanding. Setting up a family conference that includes the son is the most appropriate action for the nurse to take. While it may seem challenging, there is a possibility that involving the son in a family discussion can help him understand the impact of his actions on his father and the rest of the family. By including him in the conversation, the son may realize the importance of his role in caring for his father. Insisting that the son help, along with other family members, could lead to resistance and further alienation. Asking the family's spiritual adviser to intervene may not be effective if the son is rebelling against the family's religion. If the family conference does not yield positive results, then bringing in help from other family members or an outside caregiver may become necessary to ensure the elderly man receives the care he needs.

2. Which of the following statements by family caregivers would the nurse consider most indicative of elder abuse?

• A. Mom can't handle her own money anymore, so I've had to take over her banking.
• B. When my dad starts wandering around the house, I give him sleeping pills until he calms down and falls asleep in his chair.
• C. My mother says she wants me to do everything for her, but I think it's better if she keeps on doing everything she's still capable of.
• D. I get so frustrated because my father used to be so competent, and now he can't even use a toilet.

Correct answer: B

Rationale: The correct answer is B. The statement 'When my dad starts wandering around the house, I give him sleeping pills until he calms down and falls asleep in his chair' is most indicative of elder abuse as it involves the inappropriate use of chemical restraints. This practice can harm the elderly and is considered a form of abuse. Choices A, C, and D do not demonstrate elder abuse. Choice A may be a responsible action depending on the circumstances, choice C reflects a positive philosophy of care, and choice D expresses frustration but does not constitute abuse.

3. An older adult client tells the nurse that blockage of qi in one of the body's meridians is causing severe headaches. The health care provider has diagnosed migraines and has prescribed a triptan drug. Which action would be most appropriate for the nurse to implement?

• A. Suggest that the prescribed medicine may stimulate the flow of qi
• B. Explain the vasoconstrictive and serotonin-moderating action of triptan
• C. Instruct the client to take as many doses as needed for relief
• D. Caution the client that the headaches will grow worse if the client fails to take the medication

Correct answer: A

Rationale: Qi is the life force that circulates through the body in invisible pathways called meridians. In this scenario, the client believes that the blockage of qi is causing severe headaches. While explaining the scientific principles underlying the drug action could be valuable, it's crucial to consider the client's belief system. Therefore, the most appropriate response is to suggest that the prescribed medicine may stimulate the flow of qi, aligning with the client's perspective. Choice B, explaining the vasoconstrictive and serotonin-moderating action of triptan, does not address the client's concerns about qi blockage. Choice C, instructing the client to take as many doses as needed, can lead to potential medication misuse. Choice D, cautioning the client about worsening headaches without medication, may induce fear and hinder effective communication with the client.

4. 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.

5. Mrs. W, aged 82, resides with her son and daughter-in-law who are finding it challenging to provide adequate care while maintaining their careers and home life. During a homecare visit, Mrs. W tells the nurse that, 'My children's generation doesn't know how good they've got it; when I was younger we all had to take care of our parents, and for a lot longer than most people do now.' Which of the following statements most accurately underlies the response that the nurse will provide to Mrs. W?

• A. The increasing prevalence of chronic illnesses means that there are indeed fewer old-old adults than there were in earlier generations.
• B. The increasing acceptance of long-term care means that the caregiving burden of the son and daughter-in-law's generation is lighter than that of Mrs. W's generation.
• C. More older people are living longer and receiving care in the community than when Mrs. W was in her middle-adult years.
• D. The caregiving needs of the old-old are increasing but these needs are more commonly met in institutional settings rather than in the community.

Correct answer: C

Rationale: The correct answer is C because people are living longer and receiving more of their care in the community than in years past. This reflects the current trend where older individuals tend to receive care in community settings rather than institutional ones. Choices A, B, and D are incorrect because they do not align with the reality that more older people today are living longer and being cared for in the community.

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