Gerontologic Nursing 5th Edition by Sue E. Meiner – Test Bank
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Sample
Test
Chapter 03: Legal and Ethical Issues
Meiner: Gerontologic Nursing, 5th Edition
MULTIPLE CHOICE
1. A
nurse caring for older adult patients shows an understanding of the implementation
of standards of care when:
|
a. |
dialing the telephone when
the patient wants to call his daughter. |
|
b. |
requesting the patient’s
favorite dessert on his birthday. |
|
c. |
closing the patient’s door
when he is praying. |
|
d. |
reminding the patient to
call for assistance before getting out of bed. |
ANS: D
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.
DIF: Applying
(Application)
REF:
N/A
OBJ: 3-1
TOP: Nursing Process: Implementation
MSC: Safe and Effective Care Environment
2. 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:
|
a. |
“I’ll show you where you
can find this state’s reporting requirements.” |
|
b. |
“As a nurse you are
considered a ‘mandated reporter’ of elder abuse.” |
|
c. |
“As long as you are
reasonably sure abuse has occurred, report it.” |
|
d. |
“You need to report any
such claims directly to me.” |
ANS: A
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.
DIF: Applying
(Application)
REF:
N/A
OBJ: 3-8
TOP: Nursing Process: Implementation
MSC: Safe and Effective Care Environment
3. The
nurse recognizes that a nursing aide likely to abuse an older patient is one
who has:
|
a. |
ineffective verbal
communication skills. |
|
b. |
little experience working
with the older population. |
|
c. |
poor stress management
skills. |
|
d. |
been a victim of abuse. |
ANS: C
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.
DIF: Remembering
(Knowledge)
REF: Page 32
OBJ: 3-8
TOP: Nursing Process:
Assessment MSC:
Safe and Effective Care Environment
4. 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:
|
a. |
the patient’s right to
self-determination and to be free to get out of bed. |
|
b. |
an understanding that
nondrug interventions must be tried before medications. |
|
c. |
the knowledge that
application of a vest restraint requires a physician’s order. |
|
d. |
the patient’s cognitive
ability to understand and follow directions. |
ANS: B
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.
DIF: Remembering (Knowledge)
REF: Page 35-6 OBJ:
3-7
TOP: Nursing Process: Implementation
MSC: Safe and Effective Care Environment
5. 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:
|
a. |
a review of the situation
by the state board of nursing. |
|
b. |
termination of employment
from the facility. |
|
c. |
mandatory remediation
related to the suspect care issues. |
|
d. |
unannounced reevaluation of
performance within the next 3 months. |
ANS: A
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.
DIF: Understanding (Comprehension)
REF: Page 37
OBJ: 3-1
TOP: Communication and Documentation
MSC: Safe and Effective Care Environment
6. An
87-year-old patient is unsure of the purpose of a living will. The nurse
describes its purpose best when stating:
|
a. |
“It’s a legal document that
Social Services can help you create.” |
|
b. |
“It designates a family
member to make decisions if you become incompetent.” |
|
c. |
“It provides a written
description of your wishes in the event you become terminally ill.” |
|
d. |
“It assures you won’t be
subjected to treatments you don’t want.” |
ANS: C
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.
DIF: Understanding
(Comprehension) REF: Page
39 OBJ: 3-10
TOP:
Teaching-Learning
MSC: Safe and Effective Care Environment
7. 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:
|
a. |
legal immunity granted when
acting according to the patient’s expressed wishes. |
|
b. |
the legal view that the
duty to put into effect the patient’s wishes falls to the physician. |
|
c. |
knowledge of and compliance
with facility policies and procedures regarding end-of-life care. |
|
d. |
implementing interventions
that preserve the patient’s right to self-determination. |
ANS: C
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.
DIF: Understanding
(Comprehension) REF: Page
42 OBJ: 3-10
TOP: Nursing Process: Implementation
MSC: Safe and Effective Care Environment
8. 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:
|
a. |
“The nursing staff will
watch her very closely for any indication she has changed her mind.” |
|
b. |
“We will discuss her wishes
with her regularly.” |
|
c. |
“She can change her mind
about any provision in the document at any time.” |
|
d. |
“Your mother was very clear
about her wishes when she signed the document.” |
ANS: A
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.
DIF: Applying
(Application)
REF:
N/A
OBJ: 3-7
TOP: Nursing Process:
Assessment MSC:
Safe and Effective Care Environment
9. 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:
|
a. |
an appropriate intervention
to help assure his safety. |
|
b. |
an option to be used only
when all other nondrug interventions prove ineffective. |
|
c. |
inappropriate unless the
physician is notified and approves its use. |
|
d. |
not an option because it
should not be used to manage behaviors of this type. |
ANS: D
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.
DIF: Analysis (Analyze)
REF:
N/A
OBJ: 3-7
TOP: Nursing Process:
Planning
MSC: Safe and Effective Care Environment
10. 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:
|
a. |
a family member stating,
“It’s hard being a caregiver.” |
|
b. |
assessment showing bruises
in the genital area. |
|
c. |
observation of mild changes
in orientation. |
|
d. |
patient’s report of always
being hungry. |
ANS: B
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.
DIF: Application
(Apply)
REF: N/A
OBJ: 3-8
TOP: Nursing Process:
Assessment MSC:
Safe and Effective Care Environment
11. 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:
|
a. |
evaluating the patient’s
cognitive ability to understand the consequence of the study. |
|
b. |
determining what risks to
the patient are involved. |
|
c. |
discussing the importance
of the study with the patient and his family. |
|
d. |
encouraging the patient to
discuss the decision with trusted family or friends. |
ANS: A
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)
REF:
N/A
OBJ:
3-7
TOP: Communication and Documentation
MSC: Safe and Effective Care Environment
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:
|
a. |
physician’s medical orders. |
|
b. |
stated requests of the
individual patient. |
|
c. |
care that a responsible
geriatric nurse would provide. |
|
d. |
implementation of the
nursing process. |
ANS: C
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.
DIF: Remembering
(Knowledge)
REF: Page 30
OBJ: 3-1
TOP: Nursing Process: Implementation
MSC: Safe and Effective Care Environment
13. 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:
|
a. |
“I will, because such a
document is so valuable to the patient’s plan of care.” |
|
b. |
“I’ll ask the patient’s
family if they agree that the patient should sign the document.” |
|
c. |
“First I need to discuss
the purpose of this document with the patient.” |
|
d. |
“I’m sorry but I cannot
ethically do that.” |
ANS: D
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.
DIF: Application
(Apply)
REF: N/A
OBJ: 3-9
TOP: Nursing Process: Implementation
MSC: Safe and Effective Care Environment
14. A
graduate nurse learns about the provisions of the Health Insurance Portability and
Accountability Act (HIPAA), which include which of the following?
|
a. |
Requires employers to offer
health care insurance |
|
b. |
Regulates the amount
employers can charge for insurance |
|
c. |
Mandates that employers
provide specific benefits |
|
d. |
Helps maintain coverage
when a person changes jobs |
ANS: D
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.
DIF: Remembering
(Knowledge)
REF: Page 31
OBJ: 3-5
TOP:
Teaching-Learning
MSC: Safe Effective Care Environment
15. The
nurse manager in a long-term care facility reviews resident care plans at what interval?
|
a. |
Quarterly |
|
b. |
Every 60 days |
|
c. |
Annually |
|
d. |
When changes occur |
ANS: A
The resident care plan is routinely reviewed quarterly.
DIF: Remembering
(Knowledge)
REF: Page 33
OBJ: 3-1
TOP: Nursing Process:
Assessment MSC:
Safe Effective Care Environment
16. 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?
|
a. |
On anxiolytics; now able to
participate in group activities |
|
b. |
Given a benzodiazepine at
night; roommate now sleeps well |
|
c. |
Given sedatives; eats 100%
of meals if resident is fed |
|
d. |
Taking an antipsychotic; no
longer wanders at night |
ANS: A
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.
DIF: Applying
(Application)
REF:
N/A
OBJ: 3-7
TOP: Nursing Process:
Assessment MSC:
Safe Effective Care Environment
17. To meet
current guidelines regarding incontinence in a long-term care facility, what
action by the director of nursing is best?
|
a. |
Assess residents for the
ability to participate in a bladder training program. |
|
b. |
Take all residents to the
toilet every 2 hours and after meals. |
|
c. |
Ensure all residents wear
incontinence briefs, which are changed routinely. |
|
d. |
Ask physicians and other
providers to prescribe medications for bladder control. |
ANS: A
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.
DIF: Applying
(Application)
REF:
N/A
OBJ: 3-4
TOP: Nursing Process:
Assessment MSC:
Physiologic Integrity: Reduction of Risk Potential
18. The
director of nursing at a long-term care facility is getting ready for the
annual inspection. What information guides the director?
|
a. |
Visits cannot be
unannounced. |
|
b. |
The director must be off
site during the inspection. |
|
c. |
Nurses must answer
questions from the inspectors. |
|
d. |
Results will be shared only
through the mail. |
ANS: C
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.
DIF: Remembering
(Knowledge)
REF: Page 36
OBJ: 3-4
TOP: Communication and Documentation
MSC: Safe Effective Care Environment
19. The
nursing student learns about the Patient Self-Determination Act. What is a key
provision of this act?
|
a. |
It establishes new rights
for patients in medical facilities. |
|
b. |
It requires facilities to
educate patients on their rights. |
|
c. |
It allows families to be
approached for organ donation. |
|
d. |
It spells out the
procedures for creating an advance directive. |
ANS: B
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.
DIF: Remembering
(Knowledge)
REF: Page 42
OBJ: 3-7
TOP:
Teaching-Learning
MSC: Safe Effective Care Environment
MULTIPLE RESPONSE
1. 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.)
|
a. |
“Do you understand what a
living will and durable power of attorney are?” |
|
b. |
“If you have already
prepared an advance care directive, can you provide it now?” |
|
c. |
“Are you prepared to
discuss your end-of-life choices with the nursing staff?” |
|
d. |
“Have you discussed your
end-of-life choices with your family or designated surrogate?” |
|
e. |
“Would you like help with
preparing a living will or a durable power of attorney?” |
ANS: A, B, D, E
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.
DIF: Application
(Apply)
REF:
N/A
OBJ: 3-7
TOP: Integrated Process: Teaching-Learning
MSC: Safe and Effective Care Environment
2. What
provisions for nursing service are part of the Omnibus Budget Reconciliation
Act (OBRA) as it pertains to long-term care facilities? (Select all that apply.)
|
a. |
Resident assessments |
|
b. |
Annual screenings |
|
c. |
Minimum staffing |
|
d. |
Ensuring resident rights |
|
e. |
Registered nurse
educational requirements |
ANS: A, B, C, D
OBRA’s service requirements include resident assessments and
screenings, minimum staffing requirements, and ensuring resident rights.
Educational requirements for nurses are not part of this mandate.
DIF: Remembering
(Knowledge)
REF: Page 33
OBJ: 3-4
TOP: Nursing Process: Implementation
MSC: Safe Effective Care Environment
3. The
director of nursing at a certified long-term care facility overhauls the
nursing assistant training program to include which features? (Select all that apply.)
|
a. |
12 hours of classroom content |
|
b. |
Training in infection
control measures |
|
c. |
Instruction on resident
rights |
|
d. |
6 hours of quarterly
in-service education |
|
e. |
Education on safety
measures |
ANS: B, C, D, E
Requirements for a nursing assistant’s education includes training
in infection control and interpersonal skills, instruction on resident rights
and safety procedures, and 6 hours of education through in-services quarterly.
Nursing assistants must have classroom training before working with residents,
but the amount of time is not specified.
DIF: Applying
(Application)
REF:
N/A
OBJ: 3-3
TOP:
Teaching-Learning
MSC: Safe Effective Care Environment
4. The
adult child of a long-term care facility resident receives a phone call from
the director of nursing stating that her parent has 30 days to move out of the
home. Under what conditions can a facility require a resident to move? (Select all that apply.)
|
a. |
Nonpayment for services
received |
|
b. |
Needs exceeding what the
facility can provide |
|
c. |
Stay is no longer required
based on the resident’s medical condition |
|
d. |
Facility is going out of
business |
|
e. |
Frequent disruptive
behavior during the night |
ANS: A, B, C, D
A facility can require a resident to leave in four situations:
nonpayment for services, needs that exceed what the facility can provide, the
patient’s medical condition no longer warrants long-term care, or the facility
is going out of business. Being disruptive is not a cause for expelling a
resident.
DIF: Remembering
(Knowledge)
REF: Page 34
OBJ: 3-2
TOP: Communication and Documentation
MSC: Safe Effective Care Environment
Chapter 04: Gerontologic Assessment
Meiner: Gerontologic Nursing, 5th Edition
MULTIPLE CHOICE
1. The
geriatric nurse recognizes that the body’s homeostatic mechanisms may be
compromised in the:
|
a. |
79-year-old with moderate
Alzheimer disease who requires assistance with all activities of daily living
(ADLs). |
|
b. |
73-year-old with a history
of chronic bronchitis who lives with family. |
|
c. |
86-year-old who lost a
spouse and is moving into an assisted living facility. |
|
d. |
69-year-old with peripheral
vascular disease who is visited by home health care weekly. |
ANS: C
Declining physiologic function and increased prevalence of
disease, particularly in the old-old (age 85 or older), are in part a result of
a reduction in the body’s ability to respond to stress through all of its
homeostatic mechanisms. The important point is that older adults often
encounter profound and repeated losses; the time between the occurrences of
these losses is often short, resulting in an inadequate period for resolution
and return to a baseline state, thus putting them at risk for illness. Although
the other patients may have compromised homeostatic mechanisms, the 86-year-old
patient is most likely to exhibit this phenomenon.
DIF: Analyzing
(Analysis)
REF:
N/A OBJ: 4-2
TOP: Nursing Process:
Diagnosis
MSC: Physiologic Integrity
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