Nursing Elites

1. How might the nursing home's social worker help Ms. O's friends in visiting her?

• A. The social worker should defer to the nursing staff
• B. Help her friends find easier transportation
• C. Tell her to make friends at the dialysis center
• D. Ask other residents' families to bring her friends with them

Correct answer: B

Rationale: The correct answer is B. Ms. O's friends, who are elderly and cannot drive, ride buses to visit her. The social worker can help by finding easier transportation options for them. Not having family around, friends' visits can significantly impact Ms. O's well-being. It may be challenging for the friends to ask for help themselves, so the social worker can reach out to volunteer groups for assistance. Making friends at the dialysis center might not be feasible due to the nature of treatments. Asking other residents' families to bring her friends could burden them further and might deter them from helping. It's important to consider the friends' convenience and emotional support for Ms. O.

2. What is the most important advantage of an advance directive?

• A. Such a directive indicates how medical decisions are to be made in case a patient is unable to communicate their wishes.
• B. It spares the family the burden of making significant decisions for a patient regarding terminal care.
• C. It ensures that a person's property is distributed according to their wishes after death, avoiding legal complications.
• D. It allows individuals to appoint a guardian for themselves in case of incapacity, without involving the court system.

Correct answer: B

Rationale: An advance directive, or living will, is a legal document that specifies an individual's preferences for medical treatment if they are unable to communicate their wishes. The most important advantage of an advance directive is that it spares the family from having to make challenging decisions about terminal care on behalf of the patient. Choice A is incorrect because advance directives pertain to healthcare decisions, not property matters. Choice C is incorrect as it refers to a will for property distribution, which is a different legal document. Choice D is incorrect as advance directives are not related to appointing guardians but rather focus on healthcare decision-making.

3. A nurse is working in an assisted living facility that has a culturally diverse older adult population. Which statement by the nurse best demonstrates cultural sensitivity?

• A. We need to ensure that both the minority population and the majority population have their health needs met.
• B. It's important to remember that minority groups do not usually express their pain explicitly.
• C. We need to build our knowledge of clients who belong to cultural and ethnic groups that we're not familiar with.
• D. We need to teach all clients that their health problems are not necessarily the result of punishment.

Correct answer: C

Rationale: The best demonstration of cultural sensitivity by the nurse is reflected in choice C. Building a knowledge base around cultural and ethnic groups is a crucial component of providing culturally sensitive care. Choice A creates an inaccurate dichotomy between 'minority' and 'majority' populations, which is not a culturally sensitive approach. Choice B incorrectly generalizes that minority groups do not usually express their pain explicitly, which is not true for all cultural groups. Choice D suggests imposing a different belief system on clients, which is not culturally sensitive and can undermine trust and rapport with older adult clients.

4. Nurse M obtains a signature on an informed consent form from Mr. Y, who is later shown to have a fluctuating level of mental competency. In this case, what is Nurse M's most likely legal position?

• A. Freedom from liability because Mr. Y signed the form
• B. Possibly liable for a violation of Mr. Y's rights
• C. Liable unless a malpractice insurance policy is in effect
• D. Not liable because no family member had a durable power of attorney

Correct answer: B

Rationale: An informed consent may be considered invalid if the patient does not fully understand what he or she is signing. Patients with a fluctuating level of mental function are incapable of granting legally sound consent. Nurse M could be held liable for a violation of Mr. Y's rights as he did not have the capacity to provide informed consent. The presence of an insurance policy and the legal status of family members are irrelevant in this context and do not absolve Nurse M of potential liability.

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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