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. 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.

3. In which of the following situations would the use of physical restraints most likely be justified?

• A. Mr. Y is agitated and aggressive while experiencing severe alcohol withdrawal and is not responding to chemical sedation.
• B. Mrs. U, diagnosed with dementia, was found wandering outside the hospital, and nurses have been unable to redirect her to stay on the unit.
• C. Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously.
• D. Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds.

Correct answer: A

Rationale: Answer A is the correct choice because it describes a situation where the client poses a risk due to agitation and aggression during severe alcohol withdrawal, and chemical sedation has not been effective. In such cases, physical restraints may be justified as a last resort to ensure the safety of the client and others. Choices B, C, and D present scenarios where alternative strategies like redirection, addressing delirium, or implementing behavioral interventions should be attempted before considering physical restraints.

4. 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.

5. Nurse R works on the geriatric medicine unit of the university hospital and provides care for numerous older adult clients nearing the end of life, many of whom have no-code orders. Which of the following situations is incompatible with the legal requirements for a no-code order?

• A. A client who is mentally competent has declared his wish to have a no-code order despite the availability of treatment options for his condition.
• B. A client has expressed her desire to have a no-code order but her daughter is adamantly opposed to it.
• C. A client clearly tells the nurse her desire to have a no-code order, which the nurse documents at the bedside.
• D. A client has been in a coma and the family has decided to put in place a no-code order.

Correct answer: C

Rationale: The correct answer is C. No-code orders require a written and signed order by a physician. Therefore, a client expressing the desire for a no-code order to a nurse, without a documented physician's order, is incompatible with legal requirements. Choices A and B are not incompatible as competent clients can make their own decisions, regardless of treatment options or family opposition. Choice D is also not incompatible as family decisions can be made on behalf of incompetent clients.

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