Nokea
Nurse R works on the geriatric medicine unit of the university hospital and provides care for numerous older adult clients nearing the end of life, many of whom have no-code orders. Which of the following situations is incompatible with the legal requirements for a no-code order?
- A. A client who is mentally competent has declared his wish to have a no-code order despite the availability of treatment options for his condition.
- B. A client has expressed her desire to have a no-code order but her daughter is adamantly opposed to it.
- C. A client clearly tells the nurse her desire to have a no-code order, which the nurse documents at the bedside.
- D. A client has been in a coma and the family has decided to put in place a no-code order.
Correct Answer: C
Rationale: The correct answer is C. No-code orders require a written and signed order by a physician. Therefore, a client expressing the desire for a no-code order to a nurse, without a documented physician's order, is incompatible with legal requirements. Choices A and B are not incompatible as competent clients can make their own decisions, regardless of treatment options or family opposition. Choice D is also not incompatible as family decisions can be made on behalf of incompetent clients.
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A nurse is providing care for an older adult client who has been admitted to the hospital with liver cirrhosis. The client has expressed to the nurse his concerns that the details of his condition and treatment remain confidential, and that written documentation not 'get out there.' How can the nurse best respond to the client's concerns?
- A. Anything that is discussed between us is confidential and will not be shared with anyone else.
- B. The Health Insurance Portability and Accountability Act ensures that your medical records will not leave this hospital.
- C. Provided you signed a directive on admission, your records will not be made public.
- D. The law protects your right to confidentiality and protects your health information from being released into unintended hands.
Correct Answer: D
Rationale: The correct answer is D. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that protects individuals' right to confidentiality and safeguards health information from being accessed by unauthorized individuals. Assuring the client that the law protects their right to confidentiality and prevents their health information from being released into unintended hands is the best response. Choice A is too broad and may not cover all aspects of confidentiality. Choice B only mentions medical records staying within the hospital, which does not address the client's concern about written documentation. Choice C incorrectly implies that a signed directive is needed for confidentiality, which is not true under HIPAA regulations.
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.
During a busy shift, a registered nurse directed an unlicensed care provider to change the dressing and perform wound care on an older adult client's surgical incision, an act that exists outside of the unlicensed care provider's scope of practice. Which of the following statements best captures the legal context of this event?
- A. The unlicensed care provider is solely responsible for the inappropriate practice.
- B. The nurse can be held liable for the actions of the unlicensed care provider.
- C. Liability rests with the nurse manager of the unit.
- D. In the absence of documented harm to the client, the action is legally permissible.
Correct Answer: B
Rationale: The correct answer is B. Under the doctrine of respondent superior, nurses can be held liable for the actions of individuals under their supervision. In this scenario, the registered nurse directed the unlicensed care provider to perform a task outside their scope of practice, making the nurse accountable for the consequences. Choice A is incorrect because the responsibility is shared between the nurse and the unlicensed care provider. Choice C is incorrect as the nurse manager may not be directly responsible for the actions of the registered nurse. Choice D is incorrect because legality is not determined solely by the absence of harm; acting within one's legal scope of practice is essential to ensure patient safety.
An older adult client tells the nurse that blockage of qi in one of the body's meridians is causing severe headaches. The health care provider has diagnosed migraines and has prescribed a triptan drug. Which action would be most appropriate for the nurse to implement?
- A. Suggest that the prescribed medicine may stimulate the flow of qi
- B. Explain the vasoconstrictive and serotonin-moderating action of triptan
- C. Instruct the client to take as many doses as needed for relief
- D. Caution the client that the headaches will grow worse if the client fails to take the medication
Correct Answer: A
Rationale: Qi is the life force that circulates through the body in invisible pathways called meridians. In this scenario, the client believes that the blockage of qi is causing severe headaches. While explaining the scientific principles underlying the drug action could be valuable, it's crucial to consider the client's belief system. Therefore, the most appropriate response is to suggest that the prescribed medicine may stimulate the flow of qi, aligning with the client's perspective. Choice B, explaining the vasoconstrictive and serotonin-moderating action of triptan, does not address the client's concerns about qi blockage. Choice C, instructing the client to take as many doses as needed, can lead to potential medication misuse. Choice D, cautioning the client about worsening headaches without medication, may induce fear and hinder effective communication with the client.
A nurse is providing end-of-life care to an older female client who practices Judaism. Which intervention would the nurse identify as potentially problematic for this client and her family?
- A. The client requires transfusions of packed red blood cells during care.
- B. Assessment by a male health care provider was required.
- C. An autopsy was ordered due to the client's unique disease etiology.
- D. A do-not-resuscitate (DNR) order was recommended by the care team.
Correct Answer: C
Rationale: The correct answer is C. Autopsy is often opposed in the context of Jewish religious and cultural beliefs, as it is seen as desecration of the body. While a person who is a Jehovah's Witness would be opposed to blood transfusions (choice A), a Muslim client may prefer to be cared for by someone of the same gender (choice B). A DNR order (choice D) is not noted to be a particular issue in the context of Jewish culture.