Question 1

A person requires assistance with bathing, feeding, ambulation, and skin care. Which inpatient care setting is most appropriate for this person?&#10;A) An elder day care center&#10;B) A hospice care center&#10;C) A nursing home&#10;D) An assisted living center&#10;

Accepted Answer

Rationale 1: Elder day care centers provide care to adults who are unable to stay home by themselves, but go home in the evening to be cared for in the home, many times by adult children or other relatives.
Rationale 2: Hospice care centers are for persons who are terminally ill. There is no indication that this patient is terminally ill.
Rationale 3: A person who requires assistance with three or more activities of daily living is best served by the nursing home environment.
Rationale 4: Assisted living residents may need assistance with two activities. The patient in this question likely needs more care than is traditionally available in an assisted living center.

Question 2

A long-term care resident has limited use of the right side of his body, but is coherent at intervals. If this patient develops decubiti, which factor might the facility plead to prevent liability?&#10;A) The resident is unable to obtain proper nutrition because of his refusal to eat.&#10;B) The resident must be confined to bed for prolonged periods of time because of his condition.&#10;C) Nursing notes reveal that the patient is repositioned frequently, but somehow manages to return to the back-lying position.&#10;D) Understaffing prevents the nurses from performing necessary passive range of motion exercises to the patient's affected side.&#10;

Accepted Answer

Rationale 1: Inadequate nutrition is a circumstance that should be addressed to reduce the incident of decubiti. Not addressing this situation could be considered substandard care.
Rationale 2: Being confined to bed for long periods of time must be addressed to reduce the incident of decubiti. Alternate forms of movement and exercise should be implemented. Not addressing these could be considered substandard care.
Rationale 3: The fact that nurses are turning this patient indicates the staff is attempting to prevent the occurrence of decubiti in this patient and could help in the defense of a lawsuit.
Rationale 4: Understaffing is never a valid reason for a resident not receiving adequate care.

Question 3

Nurses providing care in a long term care settings should be very aware of the potential for which patient incident that is one of the primary causes of action in lawsuits against these facilities?&#10;A) Medication errors&#10;B) Abuse of residents&#10;C) Resident falls&#10;D) Inadequate resident nutrition&#10;

Accepted Answer

Rationale 1: Medication errors are certainly important and should be avoided. However, a different type of incident is more prevalent in this setting.
Rationale 2: Abuse of residents does occur unfortunately. However, a different type of incident is more common.
Rationale 3: Similar to acute care settings, falls are one of the primary reasons that lawsuits are filed against long-term care facilities. Statistics show an average of 2.6 falls per person per year. In this setting, falls are frequently more preventable than in an acute care facility and thus are less able to be defended.
Rationale 4: Unfortunately cases in which residents do not receive adequate nutrition do occur. They are not as common as another incident.

Question 4

A nursing assistant suspects that another staff member is abusing residents in a nursing home. Is there a duty for this nursing assistant to report this suspicion?&#10;A) Yes, but not until the nursing assistant has proof of the abuse.&#10;B) Yes, older patients are members of a vulnerable population and there is a duty for anyone to report suspected abuse.&#10;C) Only if another nursing assistant has the same suspicions and is also willing to report the suspicion of abuse&#10;D) No, since the nursing assistant does not have a state license, there is not a duty to report.&#10;

Accepted Answer

Rationale 1: Proof of abuse is not necessary.
Rationale 2: Older patients are members of a vulnerable population and there is a duty for anyone who suspects abuse to report it.
Rationale 3: A single person can and has a duty to report suspected abuse.
Rationale 4: All persons, regardless of licensure, have a duty to report suspected elder abuse.

Question 5

The nurse manager of a long-term care facility is planning to hire additional nursing staff. What should this manager consider about how the need to assess resident/patient changes and potential problems differ between the long-term care facility and an acute care facility?

A) There is a need for greater assessment skills in acute care because patients are so sick.
B) There is a need for greater assessment skills in long-term care because of the lack of direct physician contact with residents.
C) There is a lesser need for good assessment in long-term care because the residents are generally stable.
D) They are the same.

Accepted Answer

Rationale 1: While it is true that acute care patients are sicker, there is also availability of consults both with other nurses and with physicians.
Rationale 2: The long-term care nurse does not have ready consult available and the physician may not have as good a working knowledge of the resident. This difference requires the nurse to have astute assessment, monitoring, and communication skills.
Rationale 3: Long-term care residents often have multiple chronic illnesses complicated with changes associated with aging. This makes good assessment and intervention skills essential.
Rationale 4: The need for assessment, monitoring, and communicating about long-term care facility residents is somewhat different than that for acute care patients.

Question 6

In which scenarios could the elderly wife of a homebound patient likely be guilty of elder abuse?&#10;A) The wife restrains the patient in bed while she goes to the grocery store.&#10;B) The wife only bathes the patient three times a week.&#10;C) The wife tries to &#34;stretch&#34; the patient's medications by giving one half doses twice a week.&#10;D) The wife reports being afraid to intervene when the home health nursing assistant strikes the patient for soiling the bed.&#10;E) The wife cries while telling the nurse that her husband often &#34;yells and screams&#34; when he doesn't feel well.&#10;

Accepted Answer

Rationale 1: The wife may feel she is protecting the patient by this action, but it is actually abuse.
Rationale 2: In many cases this is an adequate bathing schedule. There is no evidence abuse is occurring.
Rationale 3: If the wife is not aware that this is an unwise practice this is unintentional abuse.
Rationale 4: Striking a person or allowing a person to be struck is battery. It is apparent that the wife knows this is abuse, but is fearful.
Rationale 5: In this case the wife may be the victim of abuse, not the abuser.

Question 7

An elderly person, who lives with adult children, requires therapeutic and social services and cannot stay alone in the daytime. The person is alert and oriented, but needs a more structured setting during the day. Which care setting is likely the most appropriate for this person?

A) Adult day social care
B) Assisted living
C) Alzheimer's specific adult day care
D) Adult day health care

Accepted Answer

Rationale 1: Adult social care provides social activities, meals, recreation, and some limited health-related services, but not to the extent needed by this person.
Rationale 2: Adult day health care provides more intensive health, therapeutic, and social services. Adult social care provides social activities, meals, recreation, and some limited health-related services, but not to the extent needed by this person. Alzheimer's day care is specific for those with dementia. Assisted living centers become the resident's home.
Rationale 3: Alzheimer's day care is specific for those with dementia.
Rationale 4: Adult day health care provides more intensive health, therapeutic, and social services.

Question 8

Which option reflects financial exploitation?&#10;A) The caregiver allows the patient to pay for incidentals necessary for care.&#10;B) The caregiver encourages the elder person who wishes to continue to work in the family business.&#10;C) The caregiver takes the patient's Social Security check to the bank for deposit.&#10;D) The caregiver has the patient sign power of attorney papers by saying they are required by the government.&#10;

Accepted Answer

Rationale 1: This is an appropriate action by the care provider.
Rationale 2: It is not financial exploitation to support the older adult's wish to continue to be productive.
Rationale 3: There is no indication that the caregiver is not depositing these funds into the older adult's account. This is not exploitation.
Rationale 4: Fraudulently obtaining power of attorney is financial exploitation.

Question 9

The long-term care facility is considering the involuntary discharge of a resident. What should the facility provide the resident prior to making this decision?&#10;A) A referral to a different long-term care facility&#10;B) Return of the last month's fees&#10;C) Access to a psychiatric evaluation&#10;D) Social work counseling if requested&#10;E) Written notice&#10;

Accepted Answer

Rationale 1: The facility does not have to refer the resident to a different facility.
Rationale 2: There is no requirement for return of the last month's fees.
Rationale 3: There is no requirement that the facility provide access to a psychiatric evaluation.
Rationale 4: The resident has a right to social work counseling.
Rationale 5: To discharge a resident involuntarily, written notice must be given to the resident, a responsible party, a state agency, or an ombudsman.

Question 10

A nurse suspects that an elderly person has been physically abused. According to research, which person would be the most likely abuser?&#10;A) The person's paid caregiver&#10;B) Someone previously unknown to the person&#10;C) The individual's adult child&#10;D) The person's neighbor&#10;

Accepted Answer

Rationale 1: While paid caregivers can be abusers, they are not the most likely to abuse.
Rationale 2: Typically the abuser is someone well known to the abused elder.
Rationale 3: Studies have shown that the profile of the person most likely to be abused is an elderly woman and the abuser is frequently an adult child.
Rationale 4: Neighbors could become abusers, but this is not the most likely scenario.

Question 11

A frail 90-year-old resident of a long-term care facility refuses to sign an advanced directive and tells the nurse she "wants everything done" to save her life if she should go into cardiopulmonary arrest. What action by the nurse is ethically and legally indicated?

A) Discuss the situation with the resident's family and plan to follow their wishes.
B) Tell the resident that end of life interventions are generally up to the physician.
C) Tell the resident that everything will be done, but make a do not resuscitation note on the medical record.
D) Support the patient in her wishes but continue education about end-of-life care.

Accepted Answer

The answer of A frail 90-year-old resident of a long-term...

Question 12

Which options reflect a scenario that violates the Nursing Home Reform Act of 1987?&#10;A) If a resident attempts to get out of bed, a soft vest restraint is applied.&#10;B) The nursing staff routinely leave doors open when getting residents up to bedside commodes.&#10;C) The patient is not consulted prior to a change in medical treatment.&#10;D) The nursing assistant is overheard telling a resident, &#34;If you don't eat, I won't take you down to play dominoes this afternoon.&#34;&#10;E) The resident falls during a physical therapy session, despite being attended by two staff members.&#10;

Accepted Answer

The answer of Which options reflect a scenario that violates...

Question 13

The nurse executive wishes to change the culture of the long-term care facility to one in which restraints are seldom used. Which information would the nurse provide when discussing this change with the facility's ownership?

A) In facilities where restraints are seldom used the rate of falls has decreased.
B) Reducing restraint use increases fall rate and injury rate, but results in better patient satisfaction ratings.
C) Fall rates have increased, but the incidence of long-term injuries has remained unchanged.
D) Chemical restraints can be substituted for most physical restraints.

Accepted Answer

The answer of The nurse executive wishes to change the...

Question 14

Which actions could meet the definition of a quasi-intentional tort in a long-term care facility?&#10;A) A resident wanders away from the facility and is found 2 miles away.&#10;B) The resident is restrained to a chair in the day room to prevent wandering.&#10;C) The local newspaper publishes pictures of residents enjoying a holiday presentation by children.&#10;D) The nursing assistant slaps a resident's hand when the resident pinches another resident.&#10;E) The nursing home provides a list of names and clothing sizes to a local group who wishes to purchase birthday gifts for residents.&#10;

Accepted Answer

The answer of Which actions could meet the definition of...

Question 15

What is true of the use of restraints in long-term care facilities today?&#10;A) The least restrictive restraint possible should be used.&#10;B) Restraints should be used for all residents at risk for falls.&#10;C) They are expressly forbidden by federal laws.&#10;D) Use of restraints increases the need to monitor the resident.&#10;E) Chemical restraints are preferable to physical restraints.&#10;

Accepted Answer

The answer of What is true of the use of...

Deck 20: Nursing in Long-Term Care Settings