Nursing Elites

1. Nurse B arrives for his regular night shift at a care facility for the aged. Due to a family emergency, he has only slept for 3 hours since his last shift. One of Nurse B's aides calls in sick, and there is no one available to replace the aide that night. With no help accessible, Nurse B lifts an obese patient from a wheelchair into a bed alone. Short on time and assistance, Nurse B decides to forgo the patient's evening bath. Legally, what does Nurse B most likely face?

• A. Little risk of liability because he is doing his best under difficult circumstances
• B. Immediate termination for dereliction of duty
• C. Liability if a pattern of negligence is identified in his performance evaluation
• D. A high risk of liability for his actions

Correct answer: D

Rationale: In this scenario, Nurse B faces a high risk of liability for his actions due to several factors. Working with insufficient resources, failing to adhere to policies and procedures, taking shortcuts, and working while highly stressed are all situations that increase the risk of liability. Nurse B's decision to lift an obese patient without assistance and skip the patient's evening bath due to time constraints and lack of help are clear examples of actions that can lead to legal consequences. Choices A, B, and C are incorrect because the circumstances described in the scenario indicate a higher likelihood of liability due to the factors mentioned above.

2. A nurse cares for an Asian American client with a fractured femur. During shift report, which statement by the nurse will another nurse challenge?

• A. The client has requested to wait to receive pain medication.
• B. The client does not want family to visit the room.
• C. The client is a recent immigrant to this country.
• D. The client is stoic and will not complain at all.

Correct answer: D

Rationale: The correct answer is D. Stereotyping the client as stoic and unlikely to complain about pain is incorrect and can lead to inadequate pain management. It is essential for the nurse to assess and address the client's pain regardless of cultural background. Choices A, B, and C are not as critical as they respect the client's autonomy, cultural preferences regarding family visits, and provide relevant background information about the client's immigrant status.

3. Which of the following statements by family caregivers would the nurse consider most indicative of elder abuse?

• A. Mom can't handle her own money anymore, so I've had to take over her banking.
• B. When my dad starts wandering around the house, I give him sleeping pills until he calms down and falls asleep in his chair.
• C. My mother says she wants me to do everything for her, but I think it's better if she keeps on doing everything she's still capable of.
• D. I get so frustrated because my father used to be so competent, and now he can't even use a toilet.

Correct answer: B

Rationale: The correct answer is B. The statement 'When my dad starts wandering around the house, I give him sleeping pills until he calms down and falls asleep in his chair' is most indicative of elder abuse as it involves the inappropriate use of chemical restraints. This practice can harm the elderly and is considered a form of abuse. Choices A, C, and D do not demonstrate elder abuse. Choice A may be a responsible action depending on the circumstances, choice C reflects a positive philosophy of care, and choice D expresses frustration but does not constitute abuse.

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. 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.

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