Community based PrepU
A group of nursing students are preparing for a class presentation that describes community-based nursing. Which of the following would they most likely include? Caring for the needs of individual clients as the primary focus Practice on all the three levels of preventive care Delivery of nursing care with direct on-site supervision Care delivered by nurses functioning in limited roles
Commmunity-based care involves nurses providing care at all three levels of prevention, that is, primary, secondary, and tertiary levels. There is a focus on community needs as well as on the needs of individual clients. Nurses often deliver care without direct on-site supervision or support of other health care personnel. Community health nurses assume many different roles such as epidemiologist, case manage, service coordinator, direct care provider, and educator.
Which level of prevention focuses on minimizing deterioration and improving quality of life? Primary Secondary Tertiary Outpatient
Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Primary prevention focuses on health promotion and prevention of illness or disease. Secondary prevention centers on health maintenance and is aimed at early detection and prompt intervention to prevent or minimize loss of function and independence. Outpatient is not a level of prevention.
Which of the following is a true statement regarding safety during a home visit? The nurse should take reactive measures. The nurse should park his or her car away from the home. The nurse should never walk into a patient's home uninvited. The nurse should schedule visits according to the patient's lifestyle.
The nurse should never walk into a patient's home uninvited. A plan of action should always be established in case of emergencies. The nurse should park his or her car close to the home. The scheduled visits should be only in the daylight hours.
In which situation is the nurse providing tertiary prevention? Teaching rehabilitation exercises to a client after a mastectomy Educating teens on the importance of sunscreen to reduce the risk of skin cancer Providing breast cancer screening information to a high-risk population Evaluating client understanding of discharge instructions
Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. The focus on primary prevention is on health promotion and prevention of illness or disease. Secondary prevention centers on health maintenance and is aimed at early detection and prompt intervention to prevent or minimize loss of function and independence. Evaluating patient understanding of discharge instructions is important, but it does not focus on health promotion and prevention of illness or disease.
According to the 2013 OASIS data study, which client would be at greatest risk for re-hospitalization? Female client with mild cognitive decline Male client who requires assistance to ambulate Female client with a live-in caregiver Male client with controlled congestive heart failure
According to the 2013 OASIS data study, the client at greatest risk for re-hospitalization is the male client who requires assistance to ambulate. According to the study, factors that increased the likelihood of re-hospitalization included: male gender, mid-level cognitive impairment, decreased ability to perform ADLs, or support deficits (psychosocial, financial, environmental).
A client is being discharged home after a hemorrhagic stroke. To which discipline should the nurse case manager make a referral to improve the client's ability to perform activities of daily living? Occupational therapy Physical therapy Case management Speech therapy
Although collaboration is required between each of these disciplines, occupational therapy is the discipline that will help clients identified as in need of help with activities of daily living. The other disciplines address other needs of the client: physical therapy evaluates mobility and need for assistive devices, and a speech therapist provides rehabilitation related to speech and swallowing disorders. Clients would not be referred to case management.
A novice nurse is learning the difference between community-based nursing and community-oriented nursing. Which scenario does the nurse recognize as a role of the community-oriented nurse? Nurse working a booth at a health fair performing blood pressure and glucose screenings Occupational health nurse immobilizing a fractured extremity of an injured employee Pediatric nurse teaching a group of parents on the treatments for cystic fibrosis Nurse working at a wound care clinic performing irrigation of a chronic wound
Community-oriented nursing targets improving the health status of groups of clients or individuals in the community. Community-based nursing is directed toward individuals and families with needs related to illness, injury, or disability. The health fair functions to promote improvement of health status while the other answer choices represent teaching or interventions in response to illness, injury, or disability.
A nurse acts as preceptor to a student nurse who is performing discharge planning for a client. What statement made by the student nurse about discharge planning indicates that the student needs additional teaching? "Discharge planning involves a multidisciplinary team." "Discharge planning involves the client." "Discharge planning occurs when the patient is discharged." "Discharge planning begins once the client is on the unit."
Discharge planning is a multidisciplinary approach that begins on admission. Adequate discharge planning involves the client and family, if possible.
What is the purpose of early discharge planning as explained to a client? "To ensure the hospital gets the reimbursement for your stay" "To ensure you have learned about the illness that brought you here" "To ensure you have the resources you need when you leave" "To ensure the hospital complies with quality improvement"
Discharge planning is an essential component of facilitating the transition of the client from acute care to the community or home care setting, or for facilitating the transfer of the client from one health care setting to another. Discharge planning does help to make sure the hospital gets the reimbursement needed and maintains compliance; however, these are not the primary reasons for discharge planning. Discharge planning does involve making sure the client has illness or disease education; however, this is not the primary reason for discharge planning.
Which of the following best describes home healthcare? Home healthcare can cover only short-term health needs. Home health nurses do not provide specialized care such as chemotherapy. The registered nurse manages and coordinates the care received by the client. Home health agencies do not provide any other service apart from nursing.
Home healthcare is able cover both long-term and short-term health needs and can provide comprehensive services. Home health nurses provide specialized care such as intravenous infusion of fluids, medications, and chemotherapy. The registered nurse manages and coordinates the care the client receives and has a high level of competency in assessment, communication, teaching, management, and documentation. In addition to nursing, home health agencies provide many other services.
A nurse is working as an occupational health nurse at a local factory. With which activity would the nurse least likely be involved? Setting up a healthy lifestyle education program Logging workers' exposure to potentially toxic substances Caring for employees that become ill at work Providing case management services for the employees
In the work environment, the occupational health nurse would be least likely involved with case management services. More likely, the nurse would be involved in setting up education programs for healthy lifestyles, tracking or logging workers' exposure to radiation, infectious diseases, and toxic substance and reporting them to the government agencies as appropriate, and providing direct care to employees who become ill or injured
A woman has presented to the clinic with her sick school-aged child. The child's mother reports she rarely has enough money to meet the health care needs of her chronically ill child. What information should be provided to the woman? Medicaid is a federal program designed to meet the specific needs of children. Medicaid is a state assistance program that provides health care for all children under the age of 13. Medicare may be available to help with the health care needs of indigent children. Medicaid may be available to low-income parents and their children.
Medicaid is a joint federal and state program that provides health insurance to low-income parents and their children. It is state-administered, and each state has its own set of guidelines.
A novice public health nurse desires to learn more about developing professional cultural competence skills. What action by the nurse would best support the nurse's goal? Reading about various cultures Caring for various cultures Reflecting on own cultural beliefs Describing differences between cultural practices
Self-reflection about one's own cultural beliefs best supports the nurse's goal to develop cultural competence. Reading and caring for various cultures help to develop cultural awareness, but not necessarily competence. Describing differences between cultural practices does not address relevant concepts related to implicit bias. As such, in order to develop one's professional cultural competence skills, this must include self-reflection.
The nurse is transitioning to a home health setting. What factor has resulted in a shift in the health care delivery setting? fewer insurance regulations increased hospital revenues growing number of elderly clients consistent federal regulations
The growing number of older adults (increased life expectancy) is one factor that has resulted in a shift in the health care delivery setting. Tighter insurance regulations, decreasing hospital revenues, and changes in federal legislation have also affected the shift in health care delivery.
A community health nurse is helping develop teaching on the role of the community health nurse and how this discipline can help the community. What does the nurse describe as a key component of community-based care? Improving quality of life Improving hospital compliance Improving hospital payer reimbursement Improving quality improvement
The key components of community-based care include improving quality of life, promoting and maintaining health, and preventing or minimizing the progression of disease or illness.
A client is admitted to an acute care facility after having a stroke. The client will require a variety of healthcare services throughout the hospital stay as well as coordination of care prior to discharge. What referral would be a priority for overseeing the client's care? Case management Physical therapy Occupational therapy Dietary services
The person responsible for overseeing the client's care, usually an RN with a bachelor's or master's degree or another highly experienced health professional, is called the case manager. Physical therapy, occupational therapy, and dietary services are all important care disciplines but do not encompass all of the client's needs.
A nurse is reviewing the medical record of a client to determine his eligibility for home care services. Which of the following would alert the nurse to a potential problem in this area? Client requires sterile dressing changes to an abdominal wound. Client is discharged from the facility after open heart surgery. Client requires instructions about admininstering insulin injections. Client attends social groups at a senior center three times a week.
To be eligible for home care services, a client must be acutely ill, homebound, and in need of skilled nursing services. Attending social activities at a senior center three times a week suggests that the client may not be homebound. Sterile wound care and teaching about insulin administration are considered skilled nursing activities. Discharge after open heart surgery indicates that the client is experiencing an acute illness or condition.
A public health nurse administers influenza vaccines to a group of individuals during a community vaccination clinic. The nurse understands that this action is considered primary prevention due to which statement? The vaccination focuses on minimizing deterioration associated with illness. The vaccination is centered on health maintenance and prompt intervention. The vaccination focuses on health promotion and prevention of illness. The vaccination is centered on increasing innate immunity within the population.
Vaccination is considered primary prevention because the vaccination focuses on health promotion and the prevention of illness. Secondary prevention focuses on health maintenance and is aimed at early detection of disease, with prompt intervention to prevent or minimize loss of function. Tertiary prevention focuses on minimizing deterioration associated with disease and improving quality of life through rehabilitation measures.
A community health nurse understands the importance and impact of cultural competence when caring for clients in the community. In what situation will the nurse find that cultural competence is particularly important? When members of the community request religious resources When the nurse works in a larger city versus a small community When the nurse is new to the job and the role within the community When members of the community share a heritage that is unfamiliar to the nurse
When members of the community share a heritage that is unfamiliar to the nurse, the nurse must be very aware of the importance of cultural competence. Although the other answer choices may present challenges to the nurse, these are not universally true and are therefore not the best answer choices.
A nurse is evaluating a client's discharge collaboration between the referring agency and the home care agency. What response by the client would indicate an understanding of the discharge planning process? "The nurse helped me make a list of my needs and goals for recovery and shared them with the home care team" "The doctor provided a list of behavioral outcomes for me and the nurse faxed them to the home care agency." "My wife sat down with the discharge planner and established realistic and measurable goals for my recovery." "My daughter is my health care power of attorney and she decided when I left the hospital and selected my home care provider."
Patient-centered goals are essential to identify and require active participation by the patient. Communication with family members will increase the likelihood that patient goals will be met. Transmitting information via fax does not allow collaboration between agencies. Health care power of attorney comes into effect when patients can no longer make decisions for themselves.
A nurse educator for a local home care company is teaching staff nurses on the use of the Outcome and Assessment Information Set (OASIS). What statement will the nurse include when teaching about the OASIS? "Demographic information remains confidential as required by HIPAA." "Results are used to improve overall quality improvement efforts." "This document is optional but provides important data." "This document is required but is only used for reimbursement."
The OASIS requires documentation that ensures outcome-based care is provided for all care reimbursed by Medicare. Demographic information, along with other data collected, is used to improve the overall quality improvement efforts of the agency and home care in general.
A home care nurse is planning to visit a 60-year-old client diagnosed with heart failure for the first time. Which of the following would be most appropriate for the nurse to do? Contact the client to say that the nurse is coming out to visit. Telephone the client to obtain permission to visit. Ask the client if he lives alone or with someone else. Obtain information about the client's health insurance.
When planning an initial visit, it is imperative that the nurse contact the client and obtain permission to visit first. The home care nurse is a guest in the client's home and must have permission to visit and give care. During this contact, the nurse would also schedule a time for the visit and verify the home address. Additionally, the nurse could also check with the client about his living situation in case special arrangements need to be made to enter the home. Obtaining information about health insurance would be done during the initial visit.
A client receives dialysis four times a week at a dialysis center. Which type of care is provided at a dialysis center? ambulatory care home care intermediate care long-term acute care
Ambulatory care is also referred to as outpatient care. Many settings qualify as outpatient settings, including diagnostic facilities, outpatient surgery centers, and treatment centers such as those that provide specific therapies or dialysis. Home care refers to services provided within the client's home, not at an outside center. Intermediate care is a type of inpatient care. Long-term acute care is a type of inpatient care.
A client in an acute care facility is assigned a case manager to oversee and coordinate care. What important function does a case manager have? Provide early, thorough discharge planning. Make sure the client is administered medications. Provide care to the client who is terminally ill and has less than 6 months to live. Make home visits to see that the client is taken care of after discharge.
An important function of case managers is to provide early, thorough discharge planning. The case manager is not responsible for the administration of medications. Hospice care provides care to the client who is terminally ill. The case manager oversees the care of the clients while they are hospitalized. Referrals to community agencies and home healthcare will be made for home visits.
A novice nurse is learning the difference between community-based nursing and community-oriented nursing. Which scenario does the nurse recognize as a role of the community-oriented nurse? Nurse working a booth at a health fair performing blood pressure and glucose screenings Occupational health nurse immobilizing a fractured extremity of an injured employee Pediatric nurse teaching a group of parents on the treatments for cystic fibrosis Nurse working at a wound care clinic performing irrigation of a chronic wound
Community-oriented nursing targets improving the health status of groups of clients or individuals in the community. Community-based nursing is directed toward individuals and families with needs related to illness, injury, or disability. The health fair functions to promote improvement of health status while the other answer choices represent teaching or interventions in response to illness, injury, or disability.
The home care nurse is finishing a visit with a client. What teaching points should the nurse cover with the client and client's family member prior to leaving? Select all that apply. Teach back instruction on new procedures or medication administration Findings that need improving along with family homework Positive findings during the visit in order to provide encouragement A review of the teaching plan with written instructions A review of the medications the client is currently taking
Prior to leaving, the nurse should make sure the client and client's family member understands any new procedures or medication administration techniques by using the teach back method. The nurse should discuss positive findings during the visit in order to provide encouragement and motivation. A brief review of the teaching plan allows both the client and client's family member a review on what the overall plan is for care. While it is not necessarily wrong to discuss findings that need improvement, this does not provide the client or family member with encouragement and should not be stressed at the end of a visit. A review of the client's medications is always correct; however, this action should be taken at the beginning of the visit, not the end.
Which is a role of a school nurse? Caring for major injuries Monitoring immunization status Discussing a student's school performance Performing comprehensive physical examinations
School nurses perform health screenings, provide basic care for minor injuries, administer medications, monitor the immunization status of students and families, and identify children with health problems.
The nurse is assessing the blood pressure of a pregnant client on a routine prenatal visit. This nurse is employing which level of prevention for this client?' Primary Secondary Tertiary Not considered prevention
Secondary prevention refers to teaching and screening performed to assist early diagnosis and treatment of an existing or potential problem to avoid long-term negative effects. Pregnant women should have their blood pressure monitored to ensure they are not developing preeclampsia, for example. Primary prevention involves health-promoting activities to prevent the development of illness or injury, such as providing immunizations. Tertiary prevention involves health-promoting activities that focus on rehabilitation and provide information to prevent further injuries or illness, such as teaching the older adult client how to use a walker after knee replacement surgery.
