Nokea
An 81-year-old female client has presented to the emergency department accompanied by her daughter with whom she lives. The daughter states that her mother has experienced a recent series of falls, which have resulted in her facial and arm bruises. The client smells of urine and is noticeably emaciated, unkempt, and anxious while the daughter berates her during the nurse's assessment. What is the nurse's responsibility in this situation?
- A. Determine the daughter's legal status with regard to her mother's financial affairs
- B. Report suspected elder abuse
- C. Establish whether the client has a durable power of attorney in place
- D. Obtain medical records regarding prior admissions for similar problems
Correct Answer: B
Rationale: In cases of suspected elder abuse, the nurse is responsible for reporting his or her suspicions to the relevant authorities. In this scenario, the signs of elder abuse are evident, such as the client's bruises, unkempt appearance, and the daughter's behavior. Determining the daughter's legal status or the client's power of attorney are not immediate priorities when abuse is suspected. Obtaining medical records for prior admissions is also not the primary concern in this situation.
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How does guardianship differ from power of attorney?
- A. The court appoints a guardian; an individual grants a power of attorney to someone else to make decisions on his or her behalf.
- B. Guardianship is legally binding whether or not an individual is competent; power of attorney applies only to the incompetent.
- C. Courts monitor the actions of those executing a power of attorney, but guardians are free to act on behalf of another as long as standards of 'reasonable prudence' are met.
- D. Guardianship stays in effect for one calendar year and must be renewed annually; power of attorney stays in effect until one or both parties choose to revoke it.
Correct Answer: A
Rationale: The correct answer is A. The key difference between guardianship and power of attorney is that the court appoints a guardian to make decisions on behalf of an individual who is deemed incompetent, while an individual grants a power of attorney to someone else to make decisions on their behalf when they are competent. Choice B is incorrect because both guardianship and power of attorney can apply to individuals who are competent or incompetent. Choice C is incorrect as guardians, like those with power of attorney, must act in the best interest of the individual they represent, and the level of oversight can vary. Choice D is incorrect as guardianship and power of attorney do not have fixed time limits; they remain in effect until revoked or ended by the appropriate legal process.
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.
A nurse manager works in a setting where projections for the future include a more diverse ethnic mix of older adults. Which action will the nurse manager take?
- A. Recruit multilingual nurses.
- B. Request volunteers for the ethics committee.
- C. Develop nurses' cultural competence.
- D. Teach nurses about a variety of religious practices.
Correct Answer: C
Rationale: Nurses working in a setting with a diverse ethnic mix will need to exhibit cultural competence. Thus, the nurse manager should work to develop cultural competence in nursing staff. Developing nurses' cultural competence involves understanding and respecting the beliefs, values, and practices of different cultural groups, which is essential for providing effective care. Recruiting multilingual nurses could be beneficial, but cultural competence goes beyond language skills to encompass a deeper understanding of cultural nuances. Teaching nurses about a variety of religious practices is important for a holistic approach to care, but focusing solely on religious practices may not fully address the diverse cultural needs of older adults. Ethical dilemmas may not be directly related to the projected increase in diversity, so requesting volunteers for the ethics committee does not directly address the need for cultural competence in caring for a more diverse ethnic mix of older adults.
An elderly man has relied on one of his sons for his care. Now the son has become very involved with a religion other than the one in which he was raised. As a result, he now refuses to help his father. What can a nurse do to help in this family situation?
- A. Set up a family conference that includes the son
- B. Bring in help from other family members or outside
- C. Insist that the son help, along with other family members
- D. Ask the family's own spiritual adviser to intervene
Correct Answer: A
Rationale: In this complex family situation, it is essential to approach the issue with sensitivity and understanding. Setting up a family conference that includes the son is the most appropriate action for the nurse to take. While it may seem challenging, there is a possibility that involving the son in a family discussion can help him understand the impact of his actions on his father and the rest of the family. By including him in the conversation, the son may realize the importance of his role in caring for his father. Insisting that the son help, along with other family members, could lead to resistance and further alienation. Asking the family's spiritual adviser to intervene may not be effective if the son is rebelling against the family's religion. If the family conference does not yield positive results, then bringing in help from other family members or an outside caregiver may become necessary to ensure the elderly man receives the care he needs.
Which of the following is required in order for a healthcare provider to be legally justified in not attempting to save a client's life?
- A. A 'Do Not Resuscitate' (DNR) statement on the patient's care plan
- B. A 'No-Code' sign or symbol placed at the patient's bedside
- C. A 'No-Code' order written and signed on the physician's order sheet
- D. The next of kin's request for 'Do Not Resuscitate' orally or in writing
Correct Answer: C
Rationale: To legally justify not attempting to save a client's life, a healthcare provider must have a 'No-Code' order written and signed on the physician's order sheet. Unless there is a specific order stating that resuscitation should not be performed, failure to do so can be considered negligence. A 'Do Not Resuscitate' statement on the care plan or a symbol at the bedside is not legally valid without the proper medical order. Additionally, a request from the next of kin, whether oral or written, is not a substitute for a signed physician's order.