An older adult with Alzheimer's disease lives with family. During the week, the person attends a day care center while the family is at work. In the evenings, members of the family provide care. Which factor makes this patient most vulnerable to abuse?
a. Dementia
b. Living in a rural area
c. Being part of a busy family
d. Being home only in the evening
ANS: A
Older adults, particularly those with cognitive impairments, are at high risk for abuse. The other characteristics are not identified as placing an individual at high risk for abuse.
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A nurse teaches a client who is recovering from a urography. Which instruction should the nurse include in this client's discharge teaching?
a. "Avoid direct contact with your urine for 24 hours until the radioisotope clears." b. "You may have some dribbling of urine for several weeks after this procedure." c. "Be sure to drink at least 3 liters of fluids today to help eliminate the dye faster." d. "Your skin may become slightly yellow from the dye used in this procedure."
What will the nurse keep in mind when documenting the suspected abuse of an older patient?
1. Photo documentation is not usually included as part of the documentation. 2. Documentation should include objective data of the older patient's reaction when the suspected abuser is present. 3. It is important to include the nurse's personal opinion of the suspected abuser and the nurse's prior experience in similar cases. 4. The details of the documentation should not be reported to the adult protective services; it is important that they come to an independent conclusion about the issue of abuse.
The patient who has osteomyelitis following multiple fractures inquires what the physician meant when he said that surgery would follow the antibiotic therapy. The nurse's most helpful reply is to explain that the surgery will be done to:
1. remove dead bone. 2. close the open draining wound. 3. close the area with casting material. 4. amputate.
When documenting client care, the nurse recognizes that which of the following is true about documentation of care?
a. Every nurse should anticipate having clients' records subpoenaed at some time during his or her nursing career. b. There is a need for quicker documentation that does not reflect the nursing process. c. The legal assumption is that care was given even if it is not documented. d. Any method of documentation that provides comprehensive, factual information is legally unacceptable.