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. Why might nurses not be the best choice to obtain informed consent from patients?

• A. Nurses may be tempted to influence the patient's decision in subtle ways.
• B. Nurses may not be able to answer some of the medical questions the patient asks.
• C. A signature obtained by anyone other than a physician will not stand up in court.
• D. Under the law, nurses are only allowed to act as witnesses to informed consent signatures.

Correct answer: B

Rationale: Nurses may not have the medical expertise to answer all the questions that patients may have regarding their treatment, which is a crucial aspect of obtaining informed consent. While nurses should not influence a patient's decision, it is not a major reason why they should not obtain informed consent. Signatures obtained by nurses are legally binding, and although nurses often act as witnesses, there is no legal restriction preventing them from obtaining informed consent itself.

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. 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.

5. A gerontological nurse is conducting an in-service program for a group of nurses who work with a wide range of culturally diverse older adults. After teaching the group about the impact of culture on health and illness, the nurse determines that the teaching was successful when the group identifies which reason as underlying the need to understand culture?

• A. Ensure that clients receive the respect customary in their own ethnic group
• B. Provide individualized and culturally sensitive care
• C. Ensure that medical treatments align with cultural expectations
• D. Increase compliance among minority clients

Correct answer: B

Rationale: The correct answer is B because understanding the impact of culture on health and illness enables nurses to provide individualized and culturally sensitive care to older adults from diverse backgrounds. This approach ensures that the cultural, religious, and sexual orientation differences of older adults are acknowledged, respected, and factored into their care. Choice A is not as comprehensive as B, as the goal goes beyond just respecting customary practices. Choice C, while important, is more focused on medical treatments rather than holistic care. Choice D is not the primary reason for understanding culture; the main goal is to provide personalized care that respects individual differences.

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