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During a family meeting that the nurse organized during an older adult's discharge planning from the hospital, there is visible animosity between the son and daughter of the patient. What should the nurse's initial response be to the apparent family dysfunction?
- A. Teach the patient's children alternative methods of interaction.
- B. Encourage the family to choose one spokesperson to represent all the children.
- C. Organize separate meetings with the son and with the daughter.
- D. Assess the family history and the nature of the son and daughter's relationship.
Correct Answer: D
Rationale: The correct initial response for the nurse in this situation is to assess the family history and the nature of the son and daughter's relationship. By gathering data and identifying factors contributing to the dysfunction, the nurse can better understand the underlying issues and dynamics at play. Teaching alternative methods of interaction (Choice A) may not address the root cause of the animosity. Encouraging one spokesperson for the family (Choice B) may overlook individual concerns. Organizing separate meetings (Choice C) may not provide a holistic view of the family dynamics and may not address the issues affecting the family unit as a whole. Therefore, assessing the family history and relationship dynamics is essential for effective intervention and resolution of the family dysfunction.
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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.
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 81-year-old female client was diagnosed one year ago with Alzheimer's disease following a noticeable increase in confusion. She now possesses a durable power of attorney. Which of the following statements most accurately conveys an aspect of this legal arrangement?
- A. The parameters of the arrangement must be revisited if the client's condition declines.
- B. The arrangement was most likely initiated by court order.
- C. The client appointed someone to take care of her affairs in the event that she becomes incompetent.
- D. The family has control of logistical arrangements for the client but must gain court permission around financial affairs.
Correct Answer: C
Rationale: The correct answer is C. Usually, a power of attorney becomes invalid if the individual granting it becomes incompetent, except in the case of a durable power of attorney. A durable power of attorney allows competent individuals to appoint someone to make decisions on their behalf in the event that they become incompetent. This legal arrangement is recommended for individuals with conditions like Alzheimer's disease where competency decline can be anticipated. It is not initiated by the court, unlike guardianship. A durable power of attorney encompasses both logistical and financial affairs, providing authority to the appointed person to act on behalf of the individual should they become incapacitated. Choices A, B, and D are incorrect because they do not accurately describe the purpose and nature of a durable power of attorney in the context of planning for incompetency due to conditions like Alzheimer's disease.
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.
A nurse is performing a health history on a client who identifies as Native American/First Nations. Based on familial history and racial disparities, for which health issue should the nurse prepare to monitor in this client?
- A. autoimmune disorders
- B. heart disease
- C. Alzheimer's disease
- D. lung cancer
Correct Answer: B
Rationale: The correct answer is B: heart disease. Heart disease is a major health issue among Native American/First Nations populations, along with diabetes, malignant neoplasm, and unintentional injuries, contributing to a decreased lifespan. Autoimmune disorders, Alzheimer's disease, and lung cancer are not the primary health concerns that the nurse should monitor for in this client. By understanding the prevalent health issues in this population, the nurse can provide targeted care and interventions to promote better health outcomes.