Nokea
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.
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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.
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.
In which of the following situations would the use of physical restraints most likely be justified?
- A. Mr. Y is agitated and aggressive while experiencing severe alcohol withdrawal and is not responding to chemical sedation.
- B. Mrs. U, diagnosed with dementia, was found wandering outside the hospital, and nurses have been unable to redirect her to stay on the unit.
- C. Mr. I is delirious during the acute stage of his urinary tract infection and is ringing the call bell nearly continuously.
- D. Mrs. T is frequently entering other patients' rooms and attempting to crawl into others' beds.
Correct Answer: A
Rationale: Answer A is the correct choice because it describes a situation where the client poses a risk due to agitation and aggression during severe alcohol withdrawal, and chemical sedation has not been effective. In such cases, physical restraints may be justified as a last resort to ensure the safety of the client and others. Choices B, C, and D present scenarios where alternative strategies like redirection, addressing delirium, or implementing behavioral interventions should be attempted before considering physical restraints.
Which of the following aspects of gerontological nursing would be most likely classified under private law?
- A. The regulation of who may call himself or herself a 'nurse'
- B. The contract between an older adult resident of a care facility and the owners of the facility
- C. The legal criteria for declaring an individual mentally incompetent
- D. The criminal consequences for instances of elder abuse
Correct Answer: B
Rationale: The correct answer is B because private law deals with relationships between individuals and organizations, such as the contract between an individual and the care facility. Choices A, C, and D are not classified under private law. Choice A pertains to professional regulation and is a matter of public law. Choice C involves legal criteria and decision-making related to mental competence, falling under public law. Choice D concerns criminal consequences, which are also part of public law.
A nurse cares for an Asian American client with a fractured femur. During shift report, which statement by the nurse will another nurse challenge?
- A. The client has requested to wait to receive pain medication.
- B. The client does not want family to visit the room.
- C. The client is a recent immigrant to this country.
- D. The client is stoic and will not complain at all.
Correct Answer: D
Rationale: The correct answer is D. Stereotyping the client as stoic and unlikely to complain about pain is incorrect and can lead to inadequate pain management. It is essential for the nurse to assess and address the client's pain regardless of cultural background. Choices A, B, and C are not as critical as they respect the client's autonomy, cultural preferences regarding family visits, and provide relevant background information about the client's immigrant status.