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. To receive government funding, a county hospital must provide demographic statistics on its client population. When selecting the box labeled Hispanic on the forms, what characteristic of the client population would a worker consider?

• A. immigrant workers who entered the United States and their descendants
• B. immigrants who have a Spanish accent
• C. native Spanish-speaking people living in the United States
• D. persons with brown skin and dark hair

Correct answer: C

Rationale: The correct answer is C because the term 'Hispanic' includes Spanish-speaking individuals from various countries like Spain, Cuba, Mexico, and Puerto Rico. It is essential to understand that Hispanic does not solely refer to individuals with brown skin, dark hair, or those with a Spanish accent. Therefore, choices A, B, and D do not accurately represent the characteristic of the client population that would be classified as Hispanic.

3. A nurse working with a population of black clients is cognizant that some health conditions are more prevalent in this population than in the white population and is working to address them. Which health assessment would be the priority for this client population?

• A. Mandating different lifestyle choices because of a lower life expectancy
• B. Monitoring their blood pressure because of a blunted nocturnal response
• C. Examining their buccal mucosa because black skin color can complicate the use of skin color for assessment
• D. Monitoring for HIV/AIDS as this is a leading cause of death among black clients

Correct answer: B

Rationale: Hypertension is the most prevalent health problem among black Americans. A blunted nocturnal response is one factor responsible for this problem.

4. 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.

5. Which of the following family interactions would the nurse most likely interpret as being atypical?

• A. Mr. R states that he and his brother always had a cordial, though somewhat distant, relationship but that they are now quite close.
• B. Mrs. D describes being a grandparent as 'having all the benefits of having children without the headaches and responsibilities.'
• C. Mr. and Mrs. N had a tumultuous relationship for decades but now appear more at ease with one another.
• D. Mr. A states that his ideal living situation would be himself and his adult son and daughter all under the same roof.

Correct answer: D

Rationale: The correct answer is D. While marital reconciliation, rekindled relationships with siblings, and satisfaction in the role of grandparent are common phenomena among older adults, it is less common for parents and children to see cohabitation as an ideal situation or first preference. Choices A, B, and C reflect common positive family dynamics experienced by older adults, such as improved relationships with siblings, contentment in the grandparent role, and easing of marital tensions over time. On the other hand, choice D stands out as atypical as it suggests an unconventional living arrangement where adult children live with their parent, which is less commonly preferred by older adults.

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