Nursing Elites

1. When in doubt about using restraints on an agitated patient, it is prudent for nurses to:

• A. Restrain the patient for their own safety
• B. Use minor restraints such as a bed side rail or a tray on a wheelchair
• C. Use alternatives such as a bed alarm with increased staff supervision
• D. Avoid using any device or procedure to limit liability

Correct answer: C

Rationale: The correct answer is C: 'Use alternatives such as a bed alarm with increased staff supervision.' The Omnibus Budget Reconciliation Act (OBRA) established strict standards on restraint use in long-term care facilities. Restraints can be considered a form of false imprisonment and neglect, leading to potential litigation. Therefore, it is advisable to avoid restraints whenever possible. A bed alarm coupled with enhanced staff supervision provides an effective and non-restrictive approach for managing an agitated patient. Choices A, B, and D are incorrect because restraining the patient, using minor restraints, or avoiding all devices without providing an alternative can pose risks to patient safety, violate regulations, or increase liability concerns.

2. A nurse has been providing care for a 69-year-old female client who has recently had her right foot amputated as a result of a chronic diabetic foot ulcer. The nurse undertook to perform debridement of the wound despite her lack of relevant education and experience. The client experienced permanent nerve damage as a result of the nurse's misguided efforts. Which category of legal liability is most likely relevant in this case?

• A. Larceny
• B. Assault
• C. Invasion of privacy
• D. Negligence

Correct answer: D

Rationale: In this case, the most likely relevant category of legal liability is negligence. Negligence involves the commission of an improper act, as exemplified by the nurse's actions of performing a procedure without the necessary education and experience, leading to permanent nerve damage for the client. Larceny refers to theft, assault involves a deliberate threat to harm, and invasion of privacy pertains to the violation of a person's right to privacy. Therefore, in this scenario, the nurse's actions align more closely with negligence.

3. A nurse who works in an inner-city clinic provides care for a large number of older black clients. Which health promotion activity best reflects the specific health needs of this population?

• A. A blood sugar and blood pressure monitoring program
• B. An education session on the positive health effects of good nutrition
• C. A screening mammography campaign for older black women
• D. A program that teaches black men the importance of prostate health screening

Correct answer: A

Rationale: The correct answer is A. Diabetes and hypertension are prevalent among older black adults. Regular blood sugar and blood pressure monitoring are crucial in managing these conditions. While education on good nutrition, screening mammography, and prostate health screening are important health promotion activities, they do not directly address the specific health needs of this population. Therefore, a blood sugar and blood pressure monitoring program would best reflect the health needs of the older black clients in this inner-city clinic.

4. A discharge planning nurse works with a wide variety of families when organizing care for older adults after their discharge from the hospital. Which of the following relationship structures would the nurse consider to be a family? Select all that apply.

• A. Mr. E and his partner, Mr. S, who live together in an apartment
• B. Mr. R and his new 'lady friend,' who began cohabiting 2 months ago
• C. Mrs. B and her daughter, son-in-law, and widowed sister, all of whom share a house
• D. Mr. R, who is estranged from his children and has lived with his brother, a bachelor, for several years

Correct answer: A

Rationale: The correct answer is A. While not traditional nuclear family structures, all of the given relationships and living arrangements constitute family units. Mr. E and his partner, Mr. S, who live together in an apartment, form a family unit. Choice B is not considered a family as it describes a relatively new and non-committal relationship. Choice C describes a traditional family structure with Mrs. B, her daughter, son-in-law, and widowed sister sharing a house, which also constitutes a family unit. Choice D describes a situation where Mr. R is estranged from his children and living with his bachelor brother, which can also be considered a family unit but is not as inclusive as the relationship described in choice A.

5. As a daughter and mother are extremely close emotionally, they made a pact years ago never to put the mother in a nursing home. Now, the physical demands of caregiving are becoming too great. What is the best way a nurse can help the daughter?

• A. Persuade her to admit her mother to a nursing home
• B. Aid her in finding help with in-home care
• C. Praise her success in being a good daughter and keeping her promise
• D. Point out her mistaken altruism

Correct answer: B

Rationale: In this situation, the best course of action for the nurse is to aid the daughter in finding help with in-home care. Persuading her to admit her mother to a nursing home would likely cause guilt and emotional distress due to their pact. Praise alone may not address the current physical caregiving challenges. Pointing out her 'mistaken altruism' could be seen as insensitive and unhelpful. Providing practical assistance in finding in-home care can alleviate the physical demands on the daughter while still honoring the emotional commitment they made.

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