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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.
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During a home visit, a nurse notes that an 80-year-old female patient's blood pressure is 166/99 despite the recent introduction of a diuretic to her medication regimen. The patient admits that her son refuses to give her the diuretic because it has precipitated incontinence episodes and states, 'He gets so furious when I soil myself.' What action should the nurse prioritize in this potential case of elder abuse?
- A. Improving or salvaging the family dynamics
- B. Teaching the son why his actions are inappropriate
- C. Initiating legal action
- D. Taking measures to protect the patient's safety
Correct Answer: D
Rationale: In this potential case of elder abuse, the nurse's priority should be taking measures to protect the patient's safety. The patient's health and well-being are at risk due to the son's refusal to administer the diuretic, which can lead to serious health complications. While improving family dynamics (choice A), educating the son (choice B), and legal actions (choice C) may be necessary in the long run, the immediate concern is ensuring the patient's safety and well-being.
Based on the information provided, what can be inferred about the nurse who has been working for several years in a long-term care facility with many Middle Eastern residents?
- A. The nurse's knowledge and skills provide expected care for clients in this demographic.
- B. The nurse is knowledgeable about Middle Eastern culture and respects and values providing culturally competent care.
- C. The nurse is attempting to overcompensate for cultural blindness and ethnocentrism within the community.
- D. This employment has allowed the nurse to demonstrate ethnic identity and cultural bias to a specific group of people.
Correct Answer: B
Rationale: The nurse in the scenario is likely knowledgeable about Middle Eastern culture and values providing culturally competent care to the residents. This inference can be made based on the nurse being well-respected and effective in providing care to this population. Choice A is incorrect because it only focuses on the nurse's knowledge and skills, not specifically about cultural competence. Choice C is incorrect as there is no indication of overcompensation; the nurse is described as effective and well-respected. Choice D is incorrect as there is no evidence to suggest that the nurse is demonstrating ethnic identity or cultural bias, but rather respecting and providing care tailored to the cultural needs of the residents.
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.
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.
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.