Chapter 07: Economic and Legal Issues
Touhy & Jett: Ebersole and Hess’ Gerontological Nursing & Healthy Aging, 5th Edition
MULTIPLE
... [Show More] CHOICE
1. Which of the following statements is true about health care costs for older adults in the United States?
U S N T O
2. Managed care systems are most effective for an older adult who does which of the following?
3. When an older adult is considering long-term care insurance (LTCI), which is an important consideration?
4. A health care provider asks the nurse about an older man’s durable power of attorney (DPA) because consent is needed for a medically necessary invasive procedure. The patient has
end-stage disease, is intubated, and is on mechanical ventilation. Which steps should the nurse implement?
5. An older woman is brain dead, and the attorney in fact or surrogate named in her le power of attorney (DPA) is opposed to organ donation; the law in the state allows a surrogate with a DPA to make end-of-life decisions. Although she failed to document it, her family states that she wanted to donate her organs. Given the law about a DPA, what does the nurse expect the
6. An older adult wants to appoint an attorney in fact with le power of attorney (DPA) for a specific period around a forthcoming surgery. Which should the nurse implement?
7. Which is the fundamental difference between Medicare Parts A and B?
8. Which of the following statements is true about conservators?
a. Whereas a conservatorship entails control over property, a guardianship entails control over the person.
b. The most legally restricting way individuals and property can be handled are through conservatorships and guardianships.
c. Conservators cannot be members of the conservatee’s (patient’s) family.
d. Because a conservatorship is the least restrictive alternative, a court hearing is not required.
ANS: B
A conservator can be responsible for the conservatee’s property, person, or both. The conservatee is a ward of the conservator or guardian and has no decision-making rights and, in many states, has no legal right to sue to terminate the conservatorship or guardianship. The conservator is the individual appointed by the court; this person can be a family member or someone who has a conflict of interest. Conservatorship is a most restrictive alternative and requires a court hearing.
PTS: 1 DIF: Understand REF: p. 89-90
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
9. An older patient with type II diabetes mellitus tells a nurse: “I don’t know how I am going to continue with this blood sugar testing. I know it is important, but the strips are so expensive.”
The nurse formulates a response based on the knowledge that
a. diabetic testing supplies are covered by Medicare Part A.
b. diabetic testing supplies are covered by Medicare Part B.
c. diabetic testing supplies are covered by Medicare Part D.
d. diabetic testing supplies are not covered by Medicare.
ANS: B
NURSINGTB.COM
Diabetic supplies are covered by Medicare Part B.
PTS: 1 DIF: Understand REF: p. 82-86
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
10. The principle of substituted judgment is defined as
a. a surrogate makes a decision based on the surrogate’s personal choice in a similar situation.
b. a surrogate makes a decision based on what he or she believes the person would have made if he or she were able to do so.
c. a surrogate finds an alternate individual to make the decision if he or she is uncomfortable with the situation.
d. a surrogate refuses to make any decisions that he or she is personally not in agreement with.
ANS: B
Substituted judgment is defined as making a decision based on what he or she believes the person would have made if he or she were able to do so. The personal beliefs and comfort level of the surrogate are irrelevant.
PTS: 1 DIF: Understand REF: p. 89
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
11. An older person who is cognitively intact and has decision-making capacity makes a decision to stop chemotherapy for breast cancer after being told of further spread of the cancer. The patient’s daughter is upset at her mother’s decision and approaches the nurse, stating: “I don’t agree with my mother’s decision to stop treatments. I am her health care proxy. I want to override her decision.” The best response by the nurse is:
a. “I understand why you are so upset. I don’t think she is doing the right thing either. Let us think together how we can change her mind.”
b. “Health care proxies only come into play when the individual can no longer make her or his own decisions. Your mother is able to make her own decisions. I suggest you talk with her.”
c. “As the health care proxy, you are the one who makes the decisions. Let’s call your mom’s doctor.”
d. “You will need to go to court and be declared a guardian.”
ANS: B
Health care proxies only come into play when the individual can no longer make her or his own decisions. In this situation, the patient can make her own decisions, so the daughter’s personal feelings are not relevant. The nurse’s feelings about what is right are also irrelevant in this situation. A guardian will not be appointed in the situation when the individual has the capacity to make her or his own decisions.
PTS: 1 DIF: Apply REF: p. 89
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
12. An older woman accompanies her husband to the geriatric clinic. The husband has
Alzheimer’s disease and needs maximum assistance with activities of daily living. The wife has made the decision to place her husband in a long-term care facility because she is no
longer able to care for him. ThUe wiSfe eNxprTesses coOncern about the cost of the long-term care
facility and the worry that all of their funds will be used to pay for the facility, leaving no funds for her own care. The nurse formulates a response based on the understanding that
a. all of the couple’s assets need to be exhausted before becoming eligible for Medicaid.
b. it is best for the wife to divorce her husband so she will not have to pay for his care.
c. only burial funds and half of the combined value of household goods are used to determine eligibility for Medicaid.
d. the woman should transfer all of the assets into her own name so her husband is eligible for Medicaid.
ANS: C
Only burial funds and half of the combined value of household goods are used to determine the eligibility for Medicaid; the remainder of the assets are reserved for the spouse to live on. Even if the wife were to transfer all the assets in to her own name, half of the combined vale would be used to determine eligibility for Medicaid.
PTS: 1 DIF: Understand REF: p. 86
TOP: Nursing Process: Implementation MSC: Safe, Effective Care Environment
13. An older patient is admitted to the hospital for treatment of pneumonia. The patient has a court-appointed conservator who manages her finances. The nurse understands that
a. the patient does not have the capacity to give informed consent for any procedures.
b. he or she needs to provide all educational materials to the conservator instead of the patient.
c. the presence of a conservator does not mean the patient cannot give informed consent.
d. the conservator will function in the same capacity as a health care proxy.
ANS: C
Guardians and conservators are individuals, agencies, or corporations that have been appointed by the court to have care, custody, and control of a disabled person (ward) and manage his or her personal or financial affairs (or both) when the person has been found (adjudicated) to lack capacity. A conservator is appointed specifically to control the finances of the ward. The presence of a conservator does not mean the individual cannot give consent. The conservator is not the same as a health care proxy. The nurse needs to care for the patient in the same manner regardless of the presence of a conservator.
PTS: 1 DIF: Understand REF: p. 89-90
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
MULTIPLE RESPONSE
1. The major sources of income for older adults include which of the following? (Select all that apply.)
a. Social Security
b. Income from assets
c. Earnings
d. Money given to them by children and other family members
e. Supplemental Security InNcoUmReS(SISNI)GTB.COM
ANS: A, B, C
Major sources of income reported by older persons include Social Security, income from assets, private pensions, government employee pensions, and earnings. SSI is not available to all older individuals; there is an income requirement to qualify.
PTS: 1 DIF: Remember REF: p. 79-81
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
2. An older patient is scheduled for an elective cataract extraction with a lens implant. The patient signed the informed consent. The nurse understands that informed consent entails which of the following? (Select all that apply.)
a. The capacity to understand the nature of the surgery
b. The cost of the surgery
c. The various alternative procedures to the surgery
d. The consequences of not having the surgery
e. Alternate providers who are skilled in performing the surgery
ANS: A, C, D
Informed consent is based on the principle of autonomy, which requires the capacity to understand the situation, the choices available, and the consequences of the decision. The cost of the surgery and alternate providers are not part of the informed consent process.
PTS: 1 DIF: Understand REF: p. 88
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
3. The Affordable Care Act (ACA) of the Obama administration has impacted the health of older adults in which of the following ways? (Select all that apply.)
a. Expanded access to preventative care
b. Institution of the Medicare annual wellness visit
c. Reduced medication costs
d. Elimination of all copayments for services
e. Provision of hospice services to all Medicare enrollees
ANS: A, C
The ACA has expanded access to preventative care and reduced medication costs. The Medicare annual wellness visit was in place before the ACS, as was hospice. The ACA did not eliminate all copays.
PTS: 1 DIF: Remember REF: p. 79
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment
4. The “Welcome to Medicare” exam includes which of the following? (Select all that apply.)
a. Height, weight, and blood pressure measurements
b. Simple vision testing
c. Hearing evaluation
d. Functional status assessment
e. Calculation of body mass index
ANS: A, B, E
The “Welcome to Medicare” exam includes height, weight, blood pressure measurements, simple vision testing, calculaNtionRof IbodGy mBas.s CindeMx, and a written preventive health plan
along with other evaluations that are individually determined for the patient.
PTS: 1 DIF: Remember REF: p. 82
TOP: Nursing Process: Assessment MSC: Safe, Effective Care Environment [Show Less]