An older adult client from a minority culture refuses to eat at the nursing home, stating, 'I just do not like the food here.' What factor should the staff assess for this problem?
- A. The client does not like eating with other residents of the home.
- B. The client is using this as an excuse to go home.
- C. The food served may not be culturally appropriate.
- D. The food served may violate religious beliefs.
Correct Answer: C
Rationale: The correct answer is C. Residents in long-term care settings often have limited food choices, which may not align with their cultural preferences. When assessing why a client is refusing to eat, it is essential to consider if the food served is culturally appropriate. Choices A, B, and D are incorrect. There is no indication in the scenario that the client's refusal to eat is due to not liking to eat with other residents, using it as an excuse to go home, or violating religious beliefs.
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What is the most important advantage of an advance directive?
- A. Such a directive indicates how medical decisions are to be made in case a patient is unable to communicate their wishes.
- B. It spares the family the burden of making significant decisions for a patient regarding terminal care.
- C. It ensures that a person's property is distributed according to their wishes after death, avoiding legal complications.
- D. It allows individuals to appoint a guardian for themselves in case of incapacity, without involving the court system.
Correct Answer: B
Rationale: An advance directive, or living will, is a legal document that specifies an individual's preferences for medical treatment if they are unable to communicate their wishes. The most important advantage of an advance directive is that it spares the family from having to make challenging decisions about terminal care on behalf of the patient. Choice A is incorrect because advance directives pertain to healthcare decisions, not property matters. Choice C is incorrect as it refers to a will for property distribution, which is a different legal document. Choice D is incorrect as advance directives are not related to appointing guardians but rather focus on healthcare decision-making.
For which of the following is informed consent required?
- A. Ordering a liquid diet for a post-surgical patient
- B. Listening to a patient reveal his or her private, personal secrets
- C. Giving a patient saline solution to relieve dry nasal passages
- D. Asking a patient to complete a questionnaire for a research study on hospital practices
Correct Answer: D
Rationale: Informed consent is required when asking a patient to participate in a research study, as mentioned in choice D. Choices A, B, and C involve routine care measures that do not require specific informed consent. Ordering a liquid diet, providing saline solution for dry nasal passages, or listening to a patient's personal secrets are part of standard care and do not typically necessitate formal consent beyond general consent for treatment.
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.
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.
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.
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