Nursing Elites

1. 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.

2. 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.

3. A nurse at a rehabilitation center is preparing a care plan for a 71-year-old post-stroke patient who has shown significant improvement in function and who is ready to return to the community. In the nurse's efforts to mobilize family caregiving, which of the following statements provides the most accurate criterion for inclusion in the category of 'family'?

• A. The patient's spouse, biological children, and closest friends
• B. Any unpaid person who has expressed sincere interest in the patient's condition and provided hands-on care since his admission to the facility
• C. Anyone who self-identifies as being a member of the patient's family
• D. Any individual who fulfills the patient's family functions

Correct answer: D

Rationale: The most accurate criterion for inclusion in the category of 'family' when mobilizing family caregiving is identifying individuals who fulfill family functions. Choice D is the correct answer as it emphasizes the importance of individuals who perform essential family functions for the patient. This criterion is crucial as it prioritizes the practical support and care provided by individuals over biological relationships (Choice A), self-identification (Choice C), or willingness to provide care (Choice B), which may not always translate to fulfilling necessary family functions.

4. Why might nurses not be the best choice to obtain informed consent from patients?

• A. Nurses may be tempted to influence the patient's decision in subtle ways.
• B. Nurses may not be able to answer some of the medical questions the patient asks.
• C. A signature obtained by anyone other than a physician will not stand up in court.
• D. Under the law, nurses are only allowed to act as witnesses to informed consent signatures.

Correct answer: B

Rationale: Nurses may not have the medical expertise to answer all the questions that patients may have regarding their treatment, which is a crucial aspect of obtaining informed consent. While nurses should not influence a patient's decision, it is not a major reason why they should not obtain informed consent. Signatures obtained by nurses are legally binding, and although nurses often act as witnesses, there is no legal restriction preventing them from obtaining informed consent itself.

5. Nurse B arrives for his regular night shift at a care facility for the aged. Due to a family emergency, he has only slept for 3 hours since his last shift. One of Nurse B's aides calls in sick, and there is no one available to replace the aide that night. With no help accessible, Nurse B lifts an obese patient from a wheelchair into a bed alone. Short on time and assistance, Nurse B decides to forgo the patient's evening bath. Legally, what does Nurse B most likely face?

• A. Little risk of liability because he is doing his best under difficult circumstances
• B. Immediate termination for dereliction of duty
• C. Liability if a pattern of negligence is identified in his performance evaluation
• D. A high risk of liability for his actions

Correct answer: D

Rationale: In this scenario, Nurse B faces a high risk of liability for his actions due to several factors. Working with insufficient resources, failing to adhere to policies and procedures, taking shortcuts, and working while highly stressed are all situations that increase the risk of liability. Nurse B's decision to lift an obese patient without assistance and skip the patient's evening bath due to time constraints and lack of help are clear examples of actions that can lead to legal consequences. Choices A, B, and C are incorrect because the circumstances described in the scenario indicate a higher likelihood of liability due to the factors mentioned above.

Similar Questions