Relias Specialized Care and Population-Specific Training 3 — Questions and Answers
Question 1: When working with older adults, polypharmacy is a concern primarily because it increases the risk of:
- Improved medication adherence through routine
- Adverse drug interactions, falls, and cognitive impairment (Correct answer)
- Faster recovery from acute illness
- Reduced need for nursing assessments
Correct answer: Adverse drug interactions, falls, and cognitive impairment
Polypharmacy in elderly patients significantly raises the risk of drug-drug interactions, falls, delirium, and hospital readmission.
Question 2: A client with intellectual disabilities is being asked to consent to a medical procedure. The most appropriate action is to:
- Obtain consent only from the legal guardian without involving the client
- Use plain language and visual aids to support the client's understanding and involve the guardian as required (Correct answer)
- Proceed without consent if the client appears cooperative
- Defer the procedure until the client regains full decision-making capacity
Correct answer: Use plain language and visual aids to support the client's understanding and involve the guardian as required
Supported decision-making requires using accessible communication while involving legal representatives per the client's legal status.
Question 3: In pediatric care, which pain assessment tool is most appropriate for a 3-year-old child who cannot verbally rate pain?
- Numeric Rating Scale (NRS 0-10)
- FLACC Behavioral Pain Scale (Correct answer)
- McGill Pain Questionnaire
- Brief Pain Inventory
Correct answer: FLACC Behavioral Pain Scale
The FLACC scale assesses Face, Legs, Activity, Cry, and Consolability and is validated for preverbal and cognitively impaired children.
Question 4: Which scenario represents a boundary violation in a residential behavioral health setting?
- A staff member sets consistent limits on a client's requests
- A staff member accepts a gift of jewelry from a client and keeps it private (Correct answer)
- A staff member documents a client's refusal of medication
- A staff member reports a client's threatening statement to a supervisor
Correct answer: A staff member accepts a gift of jewelry from a client and keeps it private
Accepting personal gifts privately violates professional boundaries and may indicate an exploitative therapeutic relationship.
Question 5: During care of a patient with schizophrenia who is experiencing command hallucinations, the priority nursing action is to:
- Argue with the patient to dispute the hallucinations
- Assess whether the commands direct the patient toward self-harm or harm to others (Correct answer)
- Isolate the patient to prevent disturbing other residents
- Immediately administer antipsychotic medication without assessment
Correct answer: Assess whether the commands direct the patient toward self-harm or harm to others
Assessing content and safety implications of command hallucinations is the first step in protecting the patient and others.
Question 6: A nurse caring for a patient with end-stage renal disease notices increasing confusion and muscle twitching. These symptoms most likely indicate:
- Hypoglycemia requiring glucose administration
- Uremic encephalopathy from accumulation of metabolic waste products (Correct answer)
- An acute anxiety episode
- Side effects of antihypertensive medications
Correct answer: Uremic encephalopathy from accumulation of metabolic waste products
Uremic encephalopathy results from the buildup of urea and other toxins when kidney function is severely compromised.
Question 7: When providing culturally competent care to a Native American patient, which approach best demonstrates cultural humility?
- Assuming all Native American patients prefer traditional healing exclusively
- Asking the patient about their cultural preferences and incorporating them into the care plan (Correct answer)
- Avoiding discussion of culture to prevent stereotyping
- Applying standard Western protocols without modification
Correct answer: Asking the patient about their cultural preferences and incorporating them into the care plan
Cultural humility requires asking and listening rather than assuming, and integrating patient-identified cultural practices into individualized care.
Relias Specialized Care and Population-Specific Training 3
When working with older adults, polypharmacy is a concern primarily because it increases the risk of: