Nursing Elites

1. Following a recent lawsuit that implicated one of their colleagues, the nursing staff at an assisted-living facility are especially aware of the need to safeguard themselves legally. Which of the following measures should the nurses take? Select one that does not apply.

• A. Investigate whether their liability insurance is sufficient
• B. Ensure that work performed by unlicensed care staff under their supervision is adequate
• C. Avoid admitting residents who have living wills or advance directives
• D. Assess the competence of employees under their supervision

Correct answer: C

Rationale: Denying admission to residents with living wills or advance directives is not a legal safeguard measure and may be considered discriminatory. Measures like investigating liability insurance adequacy, ensuring adequate work by unlicensed staff, and assessing employee competence are all valid ways for nurses to protect themselves legally. These measures help in ensuring proper care, reducing risks, and maintaining a high standard of practice.

2. Which of the following family interactions would the nurse most likely interpret as being atypical?

• A. Mr. R states that he and his brother always had a cordial, though somewhat distant, relationship but that they are now quite close.
• B. Mrs. D describes being a grandparent as 'having all the benefits of having children without the headaches and responsibilities.'
• C. Mr. and Mrs. N had a tumultuous relationship for decades but now appear more at ease with one another.
• D. Mr. A states that his ideal living situation would be himself and his adult son and daughter all under the same roof.

Correct answer: D

Rationale: The correct answer is D. While marital reconciliation, rekindled relationships with siblings, and satisfaction in the role of grandparent are common phenomena among older adults, it is less common for parents and children to see cohabitation as an ideal situation or first preference. Choices A, B, and C reflect common positive family dynamics experienced by older adults, such as improved relationships with siblings, contentment in the grandparent role, and easing of marital tensions over time. On the other hand, choice D stands out as atypical as it suggests an unconventional living arrangement where adult children live with their parent, which is less commonly preferred by older adults.

3. For which of the following is informed consent required?

• A. Ordering a liquid diet for a post-surgical patient
• B. Listening to a patient reveal his or her private, personal secrets
• C. Giving a patient saline solution to relieve dry nasal passages
• D. Asking a patient to complete a questionnaire for a research study on hospital practices

Correct answer: D

Rationale: Informed consent is required when asking a patient to participate in a research study, as mentioned in choice D. Choices A, B, and C involve routine care measures that do not require specific informed consent. Ordering a liquid diet, providing saline solution for dry nasal passages, or listening to a patient's personal secrets are part of standard care and do not typically necessitate formal consent beyond general consent for treatment.

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. A nurse at a rehabilitation center is preparing a care plan for a 71-year-old post-stroke patient who has shown significant improvement in function and who is ready to return to the community. In the nurse's efforts to mobilize family caregiving, which of the following statements provides the most accurate criterion for inclusion in the category of 'family'?

• A. The patient's spouse, biological children, and closest friends
• B. Any unpaid person who has expressed sincere interest in the patient's condition and provided hands-on care since his admission to the facility
• C. Anyone who self-identifies as being a member of the patient's family
• D. Any individual who fulfills the patient's family functions

Correct answer: D

Rationale: The most accurate criterion for inclusion in the category of 'family' when mobilizing family caregiving is identifying individuals who fulfill family functions. Choice D is the correct answer as it emphasizes the importance of individuals who perform essential family functions for the patient. This criterion is crucial as it prioritizes the practical support and care provided by individuals over biological relationships (Choice A), self-identification (Choice C), or willingness to provide care (Choice B), which may not always translate to fulfilling necessary family functions.

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