A. Assist with obtaining informed consent from the client.
Explanation: Informed consent is a critical aspect of healthcare procedures, but it requires the patient to have the capacity to understand and make decisions. In this scenario, the client is intubated and on mechanical ventilation, which might compromise their ability to communicate effectively. If the client lacks capacity, obtaining consent from the durable power of attorney (POA) is more appropriate.

B. Refer to the client's advance directive for a name.
Explanation: Advance directives, including the durable POA, provide guidance on a person's wishes for healthcare decisions when they are unable to communicate. However, the advance directive may not always specify a particular person's name for decisions related to specific medical interventions. The key consideration in this situation is to determine the current decision-making capacity and involve the appropriate decision-maker if needed.

C. Determine the client's inability to make reasonable decisions.
Explanation: This is the correct answer. In this scenario, the nurse should assess the client's capacity to make decisions. If the client lacks capacity, the durable POA can be activated to make healthcare decisions on behalf of the client. Capacity involves the ability to understand relevant information, appreciate the consequences of decisions, and communicate a choice.

D. Use the oral trail-making test to measure cognitive function.
Explanation: The oral trail-making test is a cognitive screening tool, but it may not be suitable in this critical care scenario with an intubated and mechanically ventilated patient. Moreover, the primary concern in this situation is determining the capacity to make healthcare decisions, which requires a more comprehensive evaluation than a specific cognitive function test. The focus should be on decision-making capacity rather than a cognitive assessment.

A. Transportation can be a critical factor in nutritional insufficiency in older adults.
Explanation: Limited access to transportation can be a barrier for older adults in obtaining nutritious food. This can lead to challenges in grocery shopping and accessing fresh, healthy food options. Lack of transportation may contribute to nutritional insufficiency in older individuals.

B. Soul food is a concern primarily for the African-American culture.
Explanation: This statement is not accurate. Dietary concerns and considerations, including those related to health, are not exclusive to any particular culture. Soul food, like any cuisine, can be enjoyed in moderation, but it's important to focus on a balanced and nutritious diet.

C. No government programs promote congregate dining among older adults.
Explanation: This statement is not true. There are government programs, such as the Older Americans Act Nutrition Program, that support congregate dining among older adults. These programs aim to provide nutritious meals to older individuals and foster social interactions by offering group dining opportunities.

D. The older person should be encouraged to practice strict controls on cholesterol intake to ensure protection against heart disease.
Explanation: While monitoring cholesterol intake is important for heart health, the term "strict controls" might not be universally applicable. Recommendations for cholesterol intake can vary based on an individual's overall health status, medical history, and specific dietary needs. It's advisable to consult with a healthcare professional for personalized advice on cholesterol management for older adults.

A. Because a conservatorship is the least restrictive alternative, a court hearing is not required.

Explanation: This statement is not accurate. Conservatorships are legal arrangements that involve the appointment of a conservator to manage the financial affairs and assets of an individual who is unable to do so themselves. While conservatorships may be necessary for the protection of the individual, they are not automatically considered the least restrictive alternative, and a court hearing is typically required to establish one.

B. The most legally restricting way individuals and property can be handled are through conservatorships and guardianships.

Explanation: This statement is partially true. Conservatorships and guardianships are legal mechanisms that grant authority to individuals (conservators and guardians, respectively) to manage the affairs of someone who is unable to do so themselves. While they involve legal restrictions, whether they are the most restrictive or not can depend on the specific details of the arrangement and the jurisdiction.

C. A conservatorship entails control over property, whereas a guardianship entails control over the person.

Explanation: This statement is true. In general, a conservatorship focuses on managing the financial affairs and assets of an individual, while a guardianship involves decision-making authority over personal and healthcare matters. The roles and responsibilities of conservators and guardians may vary by jurisdiction, but the distinction between control over property and control over the person is a common principle.

D. Conservators cannot be members of the conservatee's (client's) family.

Explanation: This statement is not universally true. In many cases, family members can be appointed as conservators. The court will typically consider the best interests of the individual in need of protection when appointing a conservator, and a family member may be deemed suitable if they can fulfill the responsibilities of the role. The specific rules regarding who can be a conservator may vary by jurisdiction.

A. Comprehensive assessment

Explanation: A comprehensive assessment involves a thorough evaluation of various cognitive functions, including memory, attention, language, problem-solving, and executive functions. This allows for a comprehensive understanding of an individual's cognitive abilities.

B. Assessing for atypical presentation of illness

Explanation: Assessing for atypical presentation of illness is relevant in a cognitive assessment because some medical conditions or illnesses can manifest with cognitive symptoms. Recognizing atypical presentations helps in identifying potential underlying causes of cognitive changes.

C. Complete blood count

Explanation: While laboratory tests like a complete blood count (CBC) may be useful in identifying certain medical conditions that could affect cognition, it is not a direct component of a cognitive assessment. Cognitive assessments typically involve clinical interviews, neuropsychological testing, and observation of cognitive functions. Blood tests and other diagnostic tools may be used to complement the cognitive assessment but are not considered components of it.

D. Differentiating delirium, dementia, and depression

Explanation: Distinguishing between delirium, dementia, and depression is crucial in a cognitive assessment. Each condition has distinct characteristics, and accurate differentiation is necessary for appropriate intervention and management.

A. Pointing to a grimacing face or crying

Explanation: This behavior may indicate pain or discomfort, and it's important to assess and address the underlying cause.

B. Staring off into space

Explanation: Staring off into space may suggest disorientation or confusion. It's essential to evaluate whether this behavior is a manifestation of the client's cognitive impairment or if there are other contributing factors.

C. Aggression

Explanation: Aggression can be a behavioral expression of distress or frustration in cognitively impaired individuals. Identifying triggers and employing appropriate interventions is crucial for the safety of the client and others.

D. Agitation

Explanation: Agitation, restlessness, or pacing may be signs of discomfort, anxiety, or frustration in cognitively impaired individuals. Identifying the cause and implementing strategies to reduce agitation are essential aspects of care.

E. Increased confusion

Explanation: A sudden increase in confusion may indicate an underlying issue, such as an infection, medication side effect, or environmental change. Regular assessment of cognitive status helps in detecting changes and addressing them promptly.

F. Decreased passivity

Explanation: Passivity, or a lack of activity or initiative, is not necessarily a specific symptom commonly associated with cognitive impairment. Observing for changes in behavior, mood, and cognitive status is important, but the term "decreased passivity" is not a standard indicator of cognitive impairment. Instead, it's essential to assess for changes in behavior that may indicate distress or unmet needs.

A. Participants in PACE programs must be able to perform their own ADLs independently.

Explanation: This statement is generally not true. PACE programs are designed to provide comprehensive and coordinated care for individuals who are frail and meet the criteria for nursing home admission. The emphasis is on maintaining participants in their homes and communities. Participants in PACE programs often have limitations in Activities of Daily Living (ADLs), and the program is designed to support them in these activities.

B. Participants in PACE programs must have been residents in a nursing home prior to enrollment in the PACE program.

Explanation: This statement is generally not true. PACE programs aim to keep individuals out of nursing homes by providing comprehensive healthcare services in a community setting. Participants in PACE programs are often those at risk of nursing home placement due to their health and functional status.

C. Participants in PACE programs must be eligible for either Medicare or Medicaid.

Explanation: This statement is generally true. PACE programs are funded through Medicare and Medicaid. Participants must be eligible for both Medicare and Medicaid to enroll in a PACE program. Medicaid eligibility may vary by state.

D. PACE programs only provide service to individuals who are age 55 and over.

Explanation: This statement is generally true. PACE programs typically serve individuals who are 55 years of age or older. However, the specific age eligibility may vary by state.

E. PACE programs provide services to individuals who meet the criteria for nursing home admission.

Explanation: This statement is generally true. PACE programs are designed for individuals who are at risk of nursing home placement due to their health and functional status. Participants must meet the criteria for nursing home admission to be eligible for PACE services.

A. Facilitates remote physical assessment and monitoring of chronic conditions

Explanation: Telehealth technology allows healthcare providers to remotely assess and monitor chronic conditions, enabling timely interventions and personalized care plans.

D. Promotes self-management of illness in rural and underserved areas

Explanation: Telehealth technology can help individuals in rural and underserved areas access healthcare services and information, promoting self-management of illnesses and improving overall health outcomes.

E. Decreases costs by reducing hospital readmissions

Explanation: Telehealth technology can contribute to reducing hospital readmissions by enabling remote monitoring, early detection of issues, and timely interventions, ultimately lowering healthcare costs associated with avoidable hospitalizations.

The following options are not accurate in relation to the benefits of telehealth technology:

B. Decreases costs by replacing the role of the nurse with technology

Explanation: Telehealth technology is not meant to replace the role of healthcare professionals, including nurses. Instead, it enhances their ability to provide care by extending access to patients, facilitating communication, and improving monitoring. The goal is to complement healthcare services rather than replace them.

C. Reimbursed by all health care insurances

Explanation: While reimbursement for telehealth services has expanded, it is not universally covered by all healthcare insurances. Coverage varies depending on the payer, state regulations, and the type of telehealth service provided. Reimbursement policies continue to evolve, and not all services may be covered by every insurance plan.

Medicare supplemental insurance, commonly known as Medigap, does not have a Part 8. The options provided seem to be a combination of different parts of Medicare and supplementary insurance.

A. It covers the costs of outpatient services.

Explanation: This statement is generally true, but it is associated with Medicare Part B, which covers outpatient services. Medigap plans can help cover some of the out-of-pocket costs associated with Medicare Part B services.

B. It must be purchased and is a subsidized medical policy.

Explanation: This statement is partially true. Medigap policies must be purchased, but they are not subsidized. Individuals pay private insurance companies for Medigap coverage to help pay for certain costs not covered by Original Medicare (Parts A and B).

C. It covers the costs of speech therapy.

Explanation: This statement is generally true. Medigap plans may cover part or all of the costs associated with Medicare-approved services, including speech therapy.

D. It covers medication costs.

Explanation: This statement is not entirely accurate. Medigap plans do not cover prescription drugs. Coverage for prescription medications is typically provided through Medicare Part D, which is a separate prescription drug coverage plan.

B. Provide nutritious food according to the residents' expressed food preferences.

Explanation: Offering nutritious food based on residents' preferences can enhance their satisfaction with meals, making them more likely to eat and maintain adequate nutritional intake. Taking individual preferences into account helps create a more person-centered approach to nutrition.

D. Distribute "med-pass" nutritional supplements.

Explanation: Nutritional supplements may be beneficial for residents who have difficulty meeting their nutritional needs through regular meals. "Med-pass" supplements can be distributed with medications or as a separate supplement to enhance calorie and nutrient intake, especially for those with specific dietary requirements.

The other options are not recommended:

A. Develop a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery.

Explanation: While organization and efficiency are important, creating a seating chart based on the unit might not directly address the nutritional status of residents. Instead, focus should be on providing appetizing, nutritious meals and accommodating residents' preferences.

C. Replace the fluorescent lighting with candles at every table to create a cozy, restaurant-like atmosphere.

Explanation: While creating a pleasant dining environment is important, replacing fluorescent lighting with candles may not be practical or safe in a healthcare setting. Moreover, the emphasis should be on the nutritional content of the meals rather than the ambiance.

A. Sub-acute care is more intensive than traditional nursing home care.

Explanation: Sub-acute care is generally more intensive and focused on providing specialized, short-term medical care and rehabilitation services. It is designed for individuals who require a higher level of care than what is typically provided in traditional nursing home settings.

B. Sub-acute care and nursing home care are identical.

Explanation: This statement is incorrect. Sub-acute care and nursing home care serve different purposes. Sub-acute care is typically provided for individuals recovering from acute medical conditions or surgeries, while nursing homes often cater to individuals with chronic illnesses or long-term care needs.

C. Sub-acute care is reimbursed by either Medicaid or private pay.

Explanation: This statement is not entirely accurate. Sub-acute care may be reimbursed by a variety of sources, including Medicare, private insurance, and, in some cases, Medicaid. The reimbursement sources can vary based on the specific circumstances and the services provided.

D. Professional nursing staff levels are the same as those in traditional nursing home settings.

Explanation: This statement is generally incorrect. Sub-acute care settings often have a higher ratio of skilled healthcare professionals, including nurses and therapists, compared to traditional nursing homes. This higher level of staffing is necessary to meet the more intensive medical and rehabilitation needs of sub-acute care patients.