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An investigation into reports of substandard care on the subacute geriatric unit of a hospital has been undertaken. Which of the following events is representative of malpractice on the part of the nursing staff?
- A. A client with a documented history of seizures was left with his bed raised and with bedrails not in place, resulting in a fall and head injury
- B. A client was sent for a colonoscopy, after which it was learned that the client had never given written consent for the procedure
- C. A client with a diagnosis of vascular dementia was found wandering in the hall outside the unit
- D. An immobile client was not turned over the course of a night shift and developed a pressure ulcer on her coccyx
Correct Answer: A
Rationale: Answer A is correct as it includes all the components of malpractice: duty, negligence, and injury. The nursing staff failed in their duty by leaving a client with a documented history of seizures unattended with bedrails not in place, resulting in a fall and head injury. Answer B involves an issue related to consent, which is the responsibility of the physician, not the nursing staff. Answer C does not demonstrate negligence or harm caused by the nursing staff. Answer D also shows negligence by failing to turn an immobile client, leading to a pressure ulcer, but it lacks a direct connection to the duty of the nursing staff in preventing harm.
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A local community has a small budget for community health programs aimed specifically toward its black population. Which type of community health program will the nurse recommend as the best use of the budget?
- A. depression screening
- B. meal planning
- C. blood pressure screening
- D. sleep disorder information
Correct Answer: C
Rationale: The best use of the budget for the black population in the local community would be blood pressure screening. Hypertension is a prevalent health issue among black Americans, occurring at a higher rate than in the white population. Therefore, focusing on blood pressure screening would help in early detection and management of hypertension within this community. Depression screening and sleep disorder information are not the priority as there is not a higher incidence of these conditions in older black clients. Meal planning could be beneficial for clients with diabetes, but it may not be the most critical focus considering the higher prevalence of hypertension among the black population.
A nurse is reviewing the client population of a local community health center and identifying the health care needs of the group. The nurse decides to develop a screening program for hypertension. Which client population would the nurse most likely be working with?
- A. A seniors' group based at a Jewish community center.
- B. A Native American reservation/Canadian aboriginal reserve.
- C. A predominantly Chinese-American neighborhood.
- D. A minimum-security prison serving young, rehabilitating offenders.
Correct Answer: B
Rationale: Hypertension is disproportionately high among Native American/First Nations clients. This condition is not noted to be a major health problem among Jewish Americans, prisoners, or Americans of Chinese ancestry. Developing a screening program for hypertension in a Native American reservation/Canadian aboriginal reserve would be most appropriate based on the prevalence of the condition in this population.
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.
What is a standard of care?
- A. A relationship in which a nurse has assumed responsibility for the care of a patient
- B. A policy or procedure established by a health care agency or professional association
- C. The norm for what a reasonable individual would do in a similar circumstance
- D. A public law that, if violated, can result in liability for the nurse
Correct Answer: C
Rationale: A standard of care is the level of care that a reasonably prudent person with similar training and experience would provide in a similar circumstance. Choice A is incorrect because it describes the nurse-patient relationship. Choice B is incorrect as it refers to specific policies or procedures. Choice D is incorrect as it describes a law rather than the expected level of care.
A gerontological nurse is providing care at a local community health center that serves large black American and white American older adult populations. The nurse is working to develop culturally appropriate programs to meet each group's health needs and notes differences in health status between the groups. Which reason would the nurse most likely identify as accounting for the differences between the populations?
- A. High incidence of violent crime and sexually transmitted diseases in the black population
- B. Reliance on family for health care advice and rejection of formal service agencies in the white population
- C. Cultural preference for unconventional medical treatments like herbal remedies in the white population
- D. Lower standard of living and less access to health care services in the black population
Correct Answer: D
Rationale: The correct answer is D. Black older adults historically possess many health problems that have accumulated over a lifetime due to a poor standard of living and limited access to health care services. Option A is incorrect because it presents stereotypes about the black population that are not supported by evidence. Option B is incorrect because it generalizes the behavior of the white population without a strong basis. Option C is incorrect as it also generalizes the white population and does not address the disparities in health status between the two groups.