Nursing Elites

1. Which of the following statements most accurately captures an aspect of contemporary family caregiving in the United States?

• A. Women typically spend more time caring for aging parents than they did for their own children.
• B. The most common pattern of care involves an older man providing in-home care for his wife.
• C. The majority of care is now provided by public and private agencies rather than family members.
• D. A residential or institutional environment is now the most common venue for caregiving.

Correct answer: A

Rationale: The correct answer is A. Today, on average, women spend more time providing care for their aging parents than they did for their own children. While some men provide care for their wives, it is not the most common pattern. Family members, rather than public or private agencies, still provide the majority of care in a non-institutional environment, making option C incorrect. Also, caregiving in a residential or institutional environment is not the most common venue, thus choice D is inaccurate.

2. An elderly man has relied on one of his sons for his care. Now the son has become very involved with a religion other than the one in which he was raised. As a result, he now refuses to help his father. What can a nurse do to help in this family situation?

• A. Set up a family conference that includes the son
• B. Bring in help from other family members or outside
• C. Insist that the son help, along with other family members
• D. Ask the family's own spiritual adviser to intervene

Correct answer: A

Rationale: In this complex family situation, it is essential to approach the issue with sensitivity and understanding. Setting up a family conference that includes the son is the most appropriate action for the nurse to take. While it may seem challenging, there is a possibility that involving the son in a family discussion can help him understand the impact of his actions on his father and the rest of the family. By including him in the conversation, the son may realize the importance of his role in caring for his father. Insisting that the son help, along with other family members, could lead to resistance and further alienation. Asking the family's spiritual adviser to intervene may not be effective if the son is rebelling against the family's religion. If the family conference does not yield positive results, then bringing in help from other family members or an outside caregiver may become necessary to ensure the elderly man receives the care he needs.

3. 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.

4. A nurse is determining ways to address ethnic diversity among clients being provided care. Which action would be the most direct way for the nurse to do this?

• A. Explain how cultural backgrounds influence health beliefs and practices.
• B. Provide culturally sensitive care that respects clients' traditions.
• C. Listen to the life stories of clients to understand their cultural influences.
• D. Participate in cultural competency training and workshops.

Correct answer: C

Rationale: Listening to the life stories of clients is an effective way for nurses to understand the cultural influences that shape their beliefs and practices. By actively listening, nurses can gain insight into the clients' backgrounds, values, and preferences, allowing them to provide more personalized and culturally sensitive care. Choices A, B, and D are not as direct as listening to the life stories of clients. While explaining how cultural backgrounds influence health beliefs and practices is important, directly listening to clients' life stories provides a deeper understanding of their individual cultural influences.

5. As a daughter and mother are extremely close emotionally, they made a pact years ago never to put the mother in a nursing home. Now, the physical demands of caregiving are becoming too great. What is the best way a nurse can help the daughter?

• A. Persuade her to admit her mother to a nursing home
• B. Aid her in finding help with in-home care
• C. Praise her success in being a good daughter and keeping her promise
• D. Point out her mistaken altruism

Correct answer: B

Rationale: In this situation, the best course of action for the nurse is to aid the daughter in finding help with in-home care. Persuading her to admit her mother to a nursing home would likely cause guilt and emotional distress due to their pact. Praise alone may not address the current physical caregiving challenges. Pointing out her 'mistaken altruism' could be seen as insensitive and unhelpful. Providing practical assistance in finding in-home care can alleviate the physical demands on the daughter while still honoring the emotional commitment they made.

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