Nursing Elites

1. During a home visit, a nurse notes that an 80-year-old female patient's blood pressure is 166/99 despite the recent introduction of a diuretic to her medication regimen. The patient admits that her son refuses to give her the diuretic because it has precipitated incontinence episodes and states, 'He gets so furious when I soil myself.' What action should the nurse prioritize in this potential case of elder abuse?

• A. Improving or salvaging the family dynamics
• B. Teaching the son why his actions are inappropriate
• C. Initiating legal action
• D. Taking measures to protect the patient's safety

Correct answer: D

Rationale: In this potential case of elder abuse, the nurse's priority should be taking measures to protect the patient's safety. The patient's health and well-being are at risk due to the son's refusal to administer the diuretic, which can lead to serious health complications. While improving family dynamics (choice A), educating the son (choice B), and legal actions (choice C) may be necessary in the long run, the immediate concern is ensuring the patient's safety and well-being.

2. A nurse manager works in a setting where projections for the future include a more diverse ethnic mix of older adults. Which action will the nurse manager take?

• A. Recruit multilingual nurses.
• B. Request volunteers for the ethics committee.
• C. Develop nurses' cultural competence.
• D. Teach nurses about a variety of religious practices.

Correct answer: C

Rationale: Nurses working in a setting with a diverse ethnic mix will need to exhibit cultural competence. Thus, the nurse manager should work to develop cultural competence in nursing staff. Developing nurses' cultural competence involves understanding and respecting the beliefs, values, and practices of different cultural groups, which is essential for providing effective care. Recruiting multilingual nurses could be beneficial, but cultural competence goes beyond language skills to encompass a deeper understanding of cultural nuances. Teaching nurses about a variety of religious practices is important for a holistic approach to care, but focusing solely on religious practices may not fully address the diverse cultural needs of older adults. Ethical dilemmas may not be directly related to the projected increase in diversity, so requesting volunteers for the ethics committee does not directly address the need for cultural competence in caring for a more diverse ethnic mix of older adults.

3. How can the nurse best respond to this situation?

• A. The nurse should accept that the relationship plays a positive role for the man.
• B. The nurse should organize a family meeting that includes both the children and the man's partner in an effort to facilitate reconciliation.
• C. The nurse should document the children's concerns and investigate the truth of their claims.
• D. The nurse should ask the partner to demonstrate that she is not a negative influence on the resident.

Correct answer: A

Rationale: In this scenario, the nurse should respect the father's perspective and accept that the relationship with his common-law partner may indeed be positive and beneficial for him. The nurse's role is to support the patient's autonomy and decisions, especially when there are no legal concerns or signs of abuse. Organizing a family meeting (Choice B) might be premature without first acknowledging the father's viewpoint. Documenting concerns and investigating (Choice C) may create unnecessary conflict and breach the father's trust. Asking the partner to prove herself (Choice D) could strain the relationship further and is not within the nurse's role unless there are clear signs of harm or abuse.

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. A nurse is performing a health history on a client who identifies as Native American/First Nations. Based on familial history and racial disparities, for which health issue should the nurse prepare to monitor in this client?

• A. autoimmune disorders
• B. heart disease
• C. Alzheimer's disease
• D. lung cancer

Correct answer: B

Rationale: The correct answer is B: heart disease. Heart disease is a major health issue among Native American/First Nations populations, along with diabetes, malignant neoplasm, and unintentional injuries, contributing to a decreased lifespan. Autoimmune disorders, Alzheimer's disease, and lung cancer are not the primary health concerns that the nurse should monitor for in this client. By understanding the prevalent health issues in this population, the nurse can provide targeted care and interventions to promote better health outcomes.

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