NURSING 3325 (NURS 3325) HOLISTIC CARE OLDER ADULT TEST FIVE

, NURS 3325 Holistic Care Older Adult
Test #5

1. A nurse discusses the future with an older adult who has had surgery for a fractured hip
and who has been diagnosed with depression. The client wavers between wanting to
give up or go to rehabilitation. Which question should the nurse ask to assist the client
toward values clarification?
 “How can we best assist you with your activities of daily living?
 “Which pain medication works best for you?”
 “Do you prefer to bathe in the morning or in the evening?”
 What goals do you have for the next year?”
Rationale: In holistic nursing ethics, the process of values clarification can be
used to guide nurses. Values clarification is an ongoing process in which an
individual becomes increasingly aware of what is important and just-and why.
The nurse can facilitate this process for clients by listing several health behaviors
or values, such as health, happiness, independence, and good relationships, and
ask clients to rank them or identify how and why they incorporate them into their
lives.

2. An older adult with heart failure and mild dementia states: “It is important to me to live
free, without restrictions on what I eat.” The family is supportive. Which action by the
nurse takes priority?
 Assure that the client understands the consequences of this decision
 Discuss this decision with the client’s family to plan for the future
 Notify the primary health care provider of the client’s wishes
 Document the client’s wishes in the plan of care
Rationale: All of these actions are appropriate; however, the primary concern is
that the nurse assess the client’s understanding of the consequences. During
mild-to-moderate stages of dementia, assessment of decision-making ability is
based upon the person’s ability to describe the importance or implications of the
choice on his or her future health. Medical decision making is a complex process
in which information is shared between client and clinicals and among family and
other who are affected by the outcomes.


3. An older adult client has become nonresponsive. The nurse is to identify the appropriate
person to sign the consent forms for an invasive medical procedure. Which action by the
nurse is appropriate?
 Move forward with guardianship as the client is incompetent
 Find the older adult’s family member to sing the consent
 Inform the health care provider that the nurse is unable to obtain a consent
 Review the chart for a health care power of attorney
Rationale: The client, at this time, does not have the decision-making capacity to
sign consents. Guardianship is a permanent option used only when a person has

, been declared incompetent. When the client does not have the decision-making
capacity to sign consents, the durable power of attorney for health care should
do so. If there is no power of attorney, the nurse needs to follow the institutionall
protocol for obtaining consent.

4. A nurse manager of a long-term care facility reviews potential health and safety
interventions and outcomes with the nursing staff. Which intervention places emphasis
on quality of life with the best possible health and safety outcomes?
 Discouraging the resident who states the resident is tires from participating in
activities
 Allowing the resident with a history of falls to walk with the help of an assistant
 Telling the resident about his or her schedule for the day
 Advising the resident not to attend church because the resident is not catholic
Rationale: Allowing the resident with a history of falls to walk with the help of an
assistant places emphasis on quality of life with the best possible health and
safety outcomes. Telling the resident about his or her schedule for the day does
not address safety or autonomy. It is not quality of life to discourage the resident
from participating in activities (even if tired). Advising the resident not to attend
church because the resident is not Catholic is unethical.

5. An older adult client suffered an ischemic stroke 6 days ago and remains unconscious.
The care team has approached the client’s family to discuss a feeding tube. Which will
allow the family to make a decision?
 A living will
 A will
 A do not resuscitate (DNR) order
 A durable power of attorney for health care
Rationale: A durable power of attorney for health care is an advance directive
that takes effect whenever someone cannot, for any reason, provide informed
consent for health care treatment decisions. A will, a DNR order, or a living will
do not confer this authority on the client’s family member.

6. A series of transient ischemic attacks have caused an older adult to become dysphagic.
The client is opposed to eating minced and pureed foods and wishes to eat a regular
diet. How should the care tea respond to this request?
 Defer responsibility for feeding to the client’s friends and family
 Provide the client’s requested diet after ensuring the client understands the risks
 Continue providing a minced and pureed diet to the client in order to ensure
safety
 Insert a feeding tube to provide nutrition while eliminating the risk of aspiration
Rationale: A common ethical dilemma is a desire by the client or the client’s
family to continue an activity at risk. In general, an individual has the autonomy
to choose this unless the client is declared incompetent.