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. 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. Based on the information provided, what can be inferred about the nurse who has been working for several years in a long-term care facility with many Middle Eastern residents?

• A. The nurse's knowledge and skills provide expected care for clients in this demographic.
• B. The nurse is knowledgeable about Middle Eastern culture and respects and values providing culturally competent care.
• C. The nurse is attempting to overcompensate for cultural blindness and ethnocentrism within the community.
• D. This employment has allowed the nurse to demonstrate ethnic identity and cultural bias to a specific group of people.

Correct answer: B

Rationale: The nurse in the scenario is likely knowledgeable about Middle Eastern culture and values providing culturally competent care to the residents. This inference can be made based on the nurse being well-respected and effective in providing care to this population. Choice A is incorrect because it only focuses on the nurse's knowledge and skills, not specifically about cultural competence. Choice C is incorrect as there is no indication of overcompensation; the nurse is described as effective and well-respected. Choice D is incorrect as there is no evidence to suggest that the nurse is demonstrating ethnic identity or cultural bias, but rather respecting and providing care tailored to the cultural needs of the residents.

4. A nurse is providing end-of-life care to an older female client who practices Judaism. Which intervention would the nurse identify as potentially problematic for this client and her family?

• A. The client requires transfusions of packed red blood cells during care.
• B. Assessment by a male health care provider was required.
• C. An autopsy was ordered due to the client's unique disease etiology.
• D. A do-not-resuscitate (DNR) order was recommended by the care team.

Correct answer: C

Rationale: The correct answer is C. Autopsy is often opposed in the context of Jewish religious and cultural beliefs, as it is seen as desecration of the body. While a person who is a Jehovah's Witness would be opposed to blood transfusions (choice A), a Muslim client may prefer to be cared for by someone of the same gender (choice B). A DNR order (choice D) is not noted to be a particular issue in the context of Jewish culture.

5. An older adult client from a minority culture refuses to eat at the nursing home, stating, 'I just do not like the food here.' What factor should the staff assess for this problem?

• A. The client does not like eating with other residents of the home.
• B. The client is using this as an excuse to go home.
• C. The food served may not be culturally appropriate.
• D. The food served may violate religious beliefs.

Correct answer: C

Rationale: The correct answer is C. Residents in long-term care settings often have limited food choices, which may not align with their cultural preferences. When assessing why a client is refusing to eat, it is essential to consider if the food served is culturally appropriate. Choices A, B, and D are incorrect. There is no indication in the scenario that the client's refusal to eat is due to not liking to eat with other residents, using it as an excuse to go home, or violating religious beliefs.

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