Question 1

A nurse caring for older adult patients shows an understanding of the implementation of standards of care when:

Accepted Answer

A standard of care is a guideline for nursing practice and establishes an expectation for the nurse to provide safe and appropriate care,such as reminding the patient to call for assistance before getting out of bed.Standards of care may be established on national or regional levels.Dialing the phone for the patient,closing the patient's door,and requesting a special dessert are not actions that conform to standards of care.

Question 2

The nurse manager in a long-term care facility reviews resident care plans at what interval?

Accepted Answer

The resident care plan is routinely reviewed quarterly.

Question 3

The manager of a long-term care facility is evaluating patients' use of drugs.The resident on which of the following medications would be allowed to continue taking medications to control behavior?

Accepted Answer

Drugs should not be used to control behavior.If used to manage health conditions,the patient should show improvement.The patient who is now able to participate in activities shows an increase in functional ability,so this medication is therapeutic for this patient.The other patients are given drugs to control behavior.

Question 4

The nurse is caring for an unresponsive patient who has terminal cancer with a Do Not Resuscitate order in effect.A family member tells the nurse,"I'll sue you and every other nurse here if you don't do everything possible to keep her alive." The nurse understands that protection from legal prosecution in this situation is provided by:

Accepted Answer

In this case,immunity applies only to the physician and not to the nurse because the physician is given the legal duty to put into effect the patient's wishes.Consequently,the nurse must rely on effective communication with the physician,patient,and family,and on the quality of the facility's policies and procedures,to be sure that his or her actions are consistent with the legally required steps.

Question 5

A nurse new to geriatric nursing asks the nurse manager to clarify how to handle a patient's claim that she has been physically abused.The nurse manager responds most appropriately when stating:

Accepted Answer

To be responsive to the legal obligation to report reasonably suspicious acts of abuse and because there is great variation among the states,nurses should determine the specific reporting requirements of their jurisdictions,including where reports and complaints are received and in what form they must be made.The statements that the nurse is a mandatory reporter and that abuse should be reported if suspected are true,but they do not help the nurse learn to handle the complaint.The manager may want to know about claims of abuse and it may be facility policy to report up the chain of command,but the nurse is responsible for filing the formal complaint.

Question 6

To meet current guidelines regarding incontinence in a long-term care facility,what action by the director of nursing is best?

Accepted Answer

Urinary incontinence is a common problem that can lead to several complications.The extent to which residents participate in bladder training programs is an area of focus for facility inspectors.Some residents may need routine toileting,wearing briefs,and medications,but they should all be assessed for the ability to participate in bladder training.

Question 7

An older adult patient has been approached to participate in a research study.The nurse best advocates for the patient's right of self-determination by:

Accepted Answer

The right to self-determination has its basis in the doctrine of informed consent.Informed consent is the process by which competent individuals are provided with information that enables them to make a reasonable decision about any treatment or intervention that is to be performed on them.The other options do not address autonomy and self-determination.
DIF Applying (Application)

Question 8

An 87-year-old patient is unsure of the purpose of a living will.The nurse describes its purpose best when stating:

Accepted Answer

Living wills are intended to provide written expressions of a patient's wishes regarding the use of medical treatments in the event of a terminal illness or condition.

Question 9

During the state inspection of a skilled nursing facility,a surveyor notes suspicion that a particular nurse may not be providing the proper standard of care.The nurse manager informs the nurse to expect:

Accepted Answer

In such cases,the surveyor may forward the record showing the relevant findings to the appropriate state agency or board for review of the nurse's practice,requesting a determination of whether the nurse may have violated the state's nurse practice act.Regulations do not specify that the nurse be terminated,have remediation,or have an unannounced reevaluation.

Question 10

The nursing student learns about the Patient Self-Determination Act.What is a key provision of this act?

Accepted Answer

The intent of this law is to ensure that patients are given information about the extent to which their rights are protected under state law.It does not establish new rights,is not related to organ donation,and does not specify procedures for advance directives.

Question 11

A graduate nurse learns about the provisions of the Health Insurance Portability and Accountability Act (HIPAA),which include which of the following?

Accepted Answer

HIPAA has several provisions,one of which is that it helps people maintain health care insurance when they are changing jobs.The other statements are common misconceptions about HIPAA.

Question 12

A nurse responsible for the care of older adult patients shows the best understanding of the nursing standards of practice when basing nursing care on the:

Accepted Answer

Nursing standards of practice are measured according to the expected level of professional practice of those in similar roles and clinical fields.Nursing care is not judged against the physician's orders,stated requests of the patient,or implementation of the nursing process.

Question 13

An alert but disoriented older patient lives with family members.The home health nurse,being aware of the role of patient advocate,recognizes the obligation to report possible patient abuse based on:

Accepted Answer

Even when a patient exhibits disorientation,any report of mistreatment or neglect is to be considered reasonably suspicious and so should be reported.Bruises in the genital area raise suspicions of abuse.The family stating caregiving is hard does not mean they don't have enough support to cope.Mild changes in orientation may be expected in a disoriented patient.The patient who is always hungry should be followed up with a nutrition assessment,and this may or may not be a sign of abuse.

Question 14

The nurse recognizes that a nursing aide likely to abuse an older patient is one who has:

Accepted Answer

It has been shown that the primary abusers of nursing facility residents are nurse aides and orderlies who have never received training in stress management.

Question 15

The director of nursing at a long-term care facility is getting ready for the annual inspection.What information guides the director?

Accepted Answer

Nurses present during inspections must answer questions posed by the inspectors.Visits can be unannounced.The director should be present during the survey.Results are shared during a conference,then a report is mailed later.

Question 16

A patient residing in a long-term care facility has been experiencing restlessness and has often been found by nursing staff wandering in and out of other patients' rooms during the night.The nurse views the patient's PRN antipsychotic medication order as:

Accepted Answer

Reasons for the use of antipsychotic drugs do not include behaviors such as restlessness,insomnia,yelling or screaming,inability to manage the resident,or wandering.The staff must provide nondrug alternatives to help calm the patient.

Question 17

The nurse is caring for a terminally ill older patient who has a living will that excludes pulmonary and cardiac resuscitation.The family expresses a concern that the patient may "change her mind." The nurse best reassures the family by stating:

Accepted Answer

AMD provisions appropriately provide that people can change their minds at any time and by any means.Nurses need to be alert to any indications from a patient.Based on the person's medical condition,subtle signs such as a gesture or a nod of the head may be easily overlooked.The patient may or may not be able to discuss her condition.Stating that the mother was very clear in her wishes does not take into account the fact that patients can change their minds any time.

Question 18

To best address the patient's right to self-determination,which of the follow questions does the nurse ask at the time the patient is admitted to a nursing facility? (Select all that apply. )

Accepted Answer

All the correct options address the patient's right to make an informed decision regarding health care issues by using various advance directives.The patient does not need to discuss end-of-life choices with the staff in order to exercise the right to self-determination.

Question 19

An older adult resident of a long-term care nursing facility frequently attempts to get out of bed and is at risk of sustaining an injury.The nurse's planned intervention to minimize the patient's risk for injury is guided by:

Accepted Answer

The drug use guidelines are based on the principles that certain problems can be handled with nondrug interventions and that such forms of treatment must be ruled out before drug therapy is initiated.The patient does have the right to self-determination,but the staff must ensure the patient's safety.Vest restraints do require an order,but environmental measures must be tried before chemical or physical restraints.The patient's cognitive abilities do not allow for unjustified physical or chemical restraints.

Question 20

The nurse caring for an older patient who resides in an assisted living facility is asked to obtain and witness the patient's signature on a living will document.The nurse responds most appropriately when stating:

Accepted Answer

It is not permissible for the nurse to secure the patient's signature or to witness the patient's signature on a living will document.Generally speaking,an employee or owner of a facility in which the patient resides cannot witness this document.

Quiz 3: Legal and Ethical Issues