Prep-U 14: Chapter 12

Which is the primary goal of continuity of care?

Ensuring a smooth and safe transition between different health care settings

The nursing student asks the home health nurse what data is required for a Medicare home plan of care. Which item would be incorrect for the nurse to include when responding to the student?

Documented need for a speech pathologist

Which role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client?

Educator

Which are community-based settings? Select all that apply.

Homes Schools Workplaces

When doing discharge planning for an older adult client who had a stroke, what is the nursing priority?

Plan reachable goals with the client and family.

When initiating home health care services, during which phase is it appropriate for the home health nurse to implement the initial client assessment?

Pre-entry phase

It is important for home health care nurses to remember which point?

The nurse is the guest in the client's home.

Community-based health care is best defined as:

health care developed in partnership with communities.

The nurse is providing care to a homeless client who presents to the emergency department with a foot wound. Which is the priority nursing intervention prior to discharge?

Refer the client to social services for assistance.

The client is being discharged to the home setting following a stroke. Which activity would the occupational therapist assist the client with?

Relearning how to cook safely

A nurse is caring for a client who is in acute respiratory distress from pneumonia but refuses to stay for treatment. It is the nurse's responsibility to:

notify the physician, discuss the outcomes of the client's decision, and have the client sign a release form.

Prior to the discharge of a client who is recovering from a stroke from an acute care facility, the nursing case manager has the nursing staff, client, client's family, physical therapist, and home health nurse meet. The most likely purpose of this meeting is to:

prepare the client for home care.

Which activities should the nurse engage in during the entry phase of the home visit? Select all that apply.

Establish rapport with the client and family. Assess the client and home situation. Educate the client and family about promoting self-care.

During the entry phase of a home visit, the nurse is most likely to perform which task?

Establishes nursing diagnoses based on client needs

A nurse is preparing a room for client admission. Which actions follow recommended guidelines for this process? Select all that apply.

Fold back the top bed linens. Assemble the necessary equipment and supplies, including a hospital admission pack. Adjust the physical environment of the room, including lighting and temperature.

Which activities should the nurse engage in during the pre-entry phase of the home visit? Select all that apply.

Gather supplies for the visit. Review the client's treatment orders. Evaluate the safety of the neighborhood.

The nurse is assigned to care for a middle-aged client who is agitated and wants to go home. The client states that the client does not have time to waste in the hospital, and no one is doing anything anyway. Which action by the nurse is most appropriate if the client insists on leaving the hospital against medical advice (AMA)?

Have the client sign the AMA form.

A nurse is covering all aspects of admission procedures for a client who is receiving home health services. The nurse explains what procedures will be covered during the nurse's visits. Which aspect of the admission process does this represent?

Clearly defining the purpose and expectations of the admission

The nurse is discharging five patients following surgeries. Which clients should the nurse consider candidates for referral to a long-term care facility? Select all that apply.

A client who will need frequent physical therapy to regain strength. A client who lives alone with few close friends or family. A client whose spouse is debilitated and requires care.

The nurse is assigned to care for an older adult client who had a stroke and will be discharged soon from the acute care facility. Which actions by the nurse will help meet the client's outcomes for discharge? Select all that apply.

Assesses the needs of the client and family throughout the hospitalization Collaborates with the health care team to obtain referrals the client will need Teaches the client and family about medications and treatments Supports the caregivers as they adjust to the discharge

Which are components of the nursing case management process? Select all that apply.

Coordinating Making referrals Monitoring medical progress Filing and completing paperwork

Which action must the nurse perform on discharge of a client from an acute care facility?

Coordinating future care for the client

A successful discharge includes effective planning. Identifying and meeting client needs beyond the acute care facility reduce readmissions. Which nursing role is of great importance to this success?

Coordinator

The nurse is working with a client's family and social worker to select a home health care agency. Which question does the nurse state should be the family's priority when interviewing potential home health agencies?

Does the agency meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs?

The client is being discharged to the home setting following a stroke. The client requires assistance in relearning how to cook safely. To which home health care team member should the nurse refer the client?

Occupational Therapist

The home health nurse is beginning the entry phase of the home visit. What important outcomes will the nurse achieve in this phase of the process? Select all that apply.

The nurse develops rapport with the client and family. The nurse completes a physical and psychosocial assessment. The nurse teaches the client and family members about wound care.

A nurse is preparing for handoff communication for a client who is being discharged from the hospital to home health care. Which example is not an action performed during this process?

The nurse prepares the new room for the client.

Which are examples of factors the nurse would assess to determine a client's functional abilities? Select all that apply.

Whether the client wears eyeglasses The client's ability to ambulate The client's comprehension

Continuity of care is an important concept for quality nursing practice. The responsible nurse understands the best description of the process of continuity of care is to:

coordinate uninterrupted care and facilitate transfer between units and levels of care.

A nurse is caring for a 17-year-old pregnant teenager who needs to obtain assistance with essential baby items such as a crib. The client mentions not having any income from a job. The nurse should encourage the client to go to a:

social welfare office.

When a client is admitted to the hospital, admissions personnel are required to determine whether the client has a document indicating advanced directives. If so, a copy is made for the client's medical record. The advanced directive document indicates:

that the client has made wishes for terminal care known.

Why is it important for the home health nurse to inform the health care agency of the nurse's daily itinerary?

Supports suggested safety precautions for the nurse when making a home care visit

A home health care nurse is explaining to an emergency room nurse how nursing care in the home setting differs from that in the hospital setting. Which statement by the home health care nurse would be most appropriate?

"The client and family are in control of the setting, not the nurse."

A nurse is using the SBAR approach for handoff communication when transferring a client to the critical care unit. Which statement would the nurse include as part of the recommendation?

"The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes."

A client's son says, "Mom can come and live with me, but I will need help. I am going to call a home health agency to see about having someone come out to my house." Which nursing response is indicated?

"Your mother's primary health care provider will have to write a prescription for home health."

The nurse is discharging a client who is living with diabetes. Which education topic(s) will the nurse discuss with the client and caregiver? Select all that apply.

A review of the appointment schedule for follow-up care The timing and appropriate method of administration of all medications How to perform dressing changes Information about home care and physical therapy with appropriate phone numbers

A nurse sits down with a client and explains the "Patient Care Partnership." This action best exemplifies which role of the community-based nurse?

Client advocate

The home health care nurse is providing information to a client and family on medication changes. What role is the nurse performing?

Client and family educator

A single parent age 17 years, with one child and pregnant with a second, has the mental age of a 12-year-old. The home care nurse's greatest concern in caring for this client should be the client's ability to do which?

Cognitively understand how to care for the children

A nurse is assisting with the transfer of a client from the acute care facility to the rehabiliation facility for continued care. Which skill would be most important for the nurse to use to promote continuity of care?

Communication

A pregnant client is on bed rest at home, and a nurse will soon come to the home to assess the client. Which type of nursing is this nurse practicing?

Community-based nursing

The community-based nurse is assessing a new client and the home environment. What is a responsibility of the community-based nurse at this initial visit?

Encourage the client and family to contact appropriate community resources.

In anticipation of discharge, a nurse is teaching the daughter of an older adult client how to change the dressing on the client's venous ulcer. Which teaching strategy is most likely to be effective?

Demonstrate and explain the procedure and then have the daughter perform it.

A nurse is caring for a client who will be discharged home but will have a complex medication regimen and follow-up with several providers. Which strategies will the nurse employ to provide discharge teaching? Select all that apply.

Divide the content into several short sessions. Be prepared to review and repeat information. After teaching have the client repeat back the key points. Use visual aids to help explain teaching.

An 18-month-old child is ventilator-dependent due to infantile scoliosis. This is the first time the child has been home since birth and the parents are very concerned about providing care. What is this family's priority need for assistance?

Emotional bonding

A registered nurse is providing community-based health care for a client diagnosed with early onset dementia. Which strategy is best for the nurse to employ to facilitate the family participating in the client's care?

Encourage active participation of the client and family in health care decisions.

When initiating home health care services, during which phase is it appropriate for the nurse to implement the initial client assessment?

Entry phase

A client is having an increasing amount of difficulty caring for oneself in the home alone. The client states to the nurse, "I need more help. What am I going to do?" Which action would be the most appropriate for the nurse to take?

Have the social worker visit the client to discuss care options.

A client living alone has degenerative joint disease, hypertension, and neuropathy. It is difficult for the client to bathe, and the client's blood pressure is unstable. Which type of care would this client benefit from most?

Home care

Which are examples of subjective client information? Select all that apply.

Marital status and occupation Smoking and alcohol history List of medications

Home health care nurses are required to complete the Outcome and Assessment Information Set (OASIS) by which entity?

Medicare

Which is the largest single source of reimbursement for home health care services?

Medicare

A home health nurse uses different professional skills to achieve a successful care plan for clients in their home setting. Which skill is of most importance to the nurse?

Nurse-client rapport

A client with severe congestive heart failure (CHF) has been referred to a long-term care facility. The nurse is transferring care from the hospital setting to a long-term care facility. Which action is a priority to ensure continuity of care for this client?

Providing accurate and complete communication to the new facility.

Which type of home healthcare agency is a local health department?

Official or public agency

In preparation for discharge, the nurse is reviewing information related to new dietary guidelines with the client. This is an example of which step in discharge planning?

Providing client education

Which measure should a home health care nurse integrate into routine practice to minimize the potential for lawsuits?

Perform thorough, accurate, and timely documentation.

Which member of the health care team is most often responsible for providing the order that will begin a client's course of home health care?

The physician

The home care nurse is providing care and education to a client who is pregnant for the first time. The client states, "I have no money or food. I don't know what I should do. I want to provide for my unborn child." The nurse refers the woman to the WIC program and a local food bank. This is an example of what aspect of community-based nursing?

Planning

What is the priority nursing responsibility when transferring a client from one unit in the hospital to another?

Provide a verbal report of the client's status to the admitting nurse.

The nurse is admitting a client for outpatient surgery. When the nurse asks what the client has been told about self-care following discharge, the client says, "No one has told me anything." Which nursing intervention is indicated?

Provide the teaching.

A client is receiving home health services after having a stroke and being hospitalized. After a thorough assessment of the home environment and the client, what would indicate to the nurse that there is an impairment in the client's home management?

The client's caregiver is absent whenever the nurse visits and the client is alone.

The home health nurse is conducting a home safety assessment during the admission of a homebound client. Which factors should the nurse be sure to assess for? Select all that apply.

The feasibility of modifying the home The home's safety against home invasions The presence of indoor plumbing The presence of pest infestations

A nurse coordinator for a busy hospital provides for continuity of care for clients using the hospital services. Which cognitive skill would this nurse need to ensure continuity of care?

The knowledge of how to communicate client priorities and the related plan of care as a client is transferred between different settings

A nurse is admitting a client to a hospital. Which actions should the nurse perform initially upon this admission? Select all that apply.

The nurse asks the client to sign consent forms allowing treatment and the hospital to contact insurance companies as needed. The nurse obtains client information, which is printed on an admission sheet and becomes part of the client's permanent record. The nurse asks the client about existing advance directives; if none, the nurse gives the appropriate form to the client. The nurse clearly describes how the client information will be used and disclosed to other parties. The nurse gives the client a form explaining the Patient Care Partnership.

When would it be appropriate for the nurse to initiate discharge planning with a client who will be discharged the next morning?

When providing preoperative education related to a scheduled cataract extraction

The nurse is caring for a client who would benefit from home health care services. In preparing for discharge, the nurse is aware that home health care can only be initiated if the:

physician writes an order for home care.

Public health nursing is the branch of nursing that:

provides health care for the community.

When the nurse begins the entry phase of the home visit, the most important nursing action is:

using therapeutic communication.

The home care nurse asks the client and family about their socioeconomic status, culture, and beliefs. Which is the best response by the nurse when the family asks why those questions are being asked?

"I want to understand what your desires are."

A nurse has been asked to chair an action team tasked with prioritizing a list of possible new equipment purchases. Which statements, made by this nurse, will help the team be most effective? Select all that apply.

"Our goal is to prioritize this list of potential equipment purchases, offering rationale for our choices." "Before our next meeting, each of us will ask the nurses on the unit what their priority purchase would be." "Once we have completed the list and rationale, I will compile our recommendations for us all to sign before submission."

The initial step in discharge planning is:

collecting and organizing data about the client.

The nurse understands that planning for discharge actually begins at admission to the facility. The purpose of discharge planning is best described as:

providing continuity of care that is goal directed.

The home health nurse is making a home visit for an older adult client recently discharged from the hospital after suffering a stroke. Which finding would most concern the nurse?

Area rugs are present in multiple areas throughout the house.

Which is the primary goal of home health care?

Functioning within limitations

The nurse is preparing to begin the discharge planning process with a client whose pulmonary embolism has recently resolved. Which factor should the nurse prioritize during this process?

The client's identified needs and goals

One of the fastest growing venues of practice for the nurse is home health care. What is the basis for the growth in this health care setting?

The discharge home of clients who are more critically ill

The nurse is met in the staff lounge by the nurse who has been caring for the client team on this shift. The off-going nurse says, "Sorry, but I have to get out of here." The nurse then gives a quick overview of each client on the team and says, "All the rest is in the chart if you need anything." Which essential part of the handoff is missing?

The opportunity for the oncoming nurse to ask questions

A nurse is caring for a client who decides to leave the hospital against medical advice (AMA). The nurse knows that the client must sign a form before leaving. What is the purpose of the AMA form?

To release the physician and the institution from any legal responsibility

A new client arrived on the unit while the nurse was obtaining the end-of-shift report from the night nurse. This client is admitted walking and is here for a cardiac workup; the client is assigned to the nurse. The nursing assistant has settled the client in the room and oriented the client to the surroundings, call system, bathroom, bedside supplies, and where to place clothes. The priority nursing action is to:

gather information and complete the admission database.

Which diseases would warrant a client receiving hospice care? Select all that apply.

Multiple sclerosis End-stage renal disease Congestive heart failure

The nurse is assessing the client's readiness to be discharged home after being admitted for 4 days due to falling at home. Which question should the nurse ask the client?

"What medications will you be taking at home?"

During the initial visit to a client's home, the nurse should provide the client and family with what information?

Available community resources to meet their needs

One significant change in the health care delivery system in recent years is earlier hospital discharges. What is one result of earlier hospital discharges?

Clients with high home care needs are being discharged into the community.

The nurse is planning discharge of the client who had surgery for a left hip replacement. The client is being discharged from the hospital to the home and requires home medical services. Which item would be provided by home medical services?

High-rise toilet seat

A client says, "You guys are not doing anything for me. I am leaving." Which interventions are indicated by the nurse? Select all that apply.

Inform the client of the risks of leaving. Witness the client's signature on the against medical advice form

When a multidisciplinary team is involved in meeting the home care needs of a client, who is the person responsible for the coordination of the care provided?

The registered nurse

Which activity by the nurse exhibits the role of family educator?

Demonstrating how to suction the oropharynx.

A nurse is caring for a 17-year-old pregnant client who is unable to afford health care. Which resources will the nurse access to obtain assistance for this client?

Make a referral to the social services department.

Which nursing action is appropriate when assuming the role of client case manager for a home health agency?

Managing client care from admission through discharge or resolution of illness

A client diagnosed with terminal leukemia is receiving home health care services to assist in the client's care. After assessing the client, the home health care nurse determines that the client is unable to afford needed medical supplies. Which is the best strategy for the nurse to implement to assist the client?

Refer the client to a social worker to determine eligibility for assistance.

A nurse working in a primary health care facility would most likely provide which service?

Screening

A nurse is completing a home visit to an older adult client who is receiving regular dressing changes for the treatment of a venous ulcer. What outcome does the nurse hope to achieve in the plan of care for this client?

To maximize the independence and health of the client

Which are examples of objective assessment information? Select all that apply.

Vital signs, height, and weight Findings on palpation of the abdomen

A home health care nurse develops a client's individualized plan of care during the:

entry phase.

When educating clients in the community on health promotion and prevention of disease, it is important to stress:

health education can benefit individuals and groups.

Which circumstance likely requires the most documentation and communication on the part of the nurse?

A geriatric client is being transferred from a subacute medical unit to a new long-term care facility following his recovery from pneumonia.

Which qualities are essential for a community-based nurse? Select all that apply.

Strong knowledge foundation Effective communication skills Keen physical assessment skills

Which type of data is most important to a home health nurse who is performing a comprehensive assessment for a new client recently discharged from the hospital?

Subjective data about how the client manages medications at home

An 82-year-old client is being discharged from the hospital following a bowel resection. The client lives alone and the client's family is out of town. Which factor will have the greatest effect on the client's home care management?

Support system

A hospital has begun to expand home health services to its clients. Which reason is the most likely cause for the expansion of these services?

The change to shorter hospital stays

A 16-year-old client has been injured in an accident and is receiving home care due to fractures and multiple trauma-related injuries. The client states, "I don't know why I survived and not my best friend." It is most important for the home care nurse to encourage the client to:

communicate these feelings to family and friends.

Continuity of care for a particular client is most important to prevent:

fragmentation of services.

When preparing to transfer an older adult client back to the long-term care facility where the client has been for several years, it is the primary responsibility of the nurse to:

provide for the coordination and continuity of care by the health care providers.

The focus of community-based care is:

providing care to clients within a defined geographic area.

On admission to the hospital, each client is asked whether the client has a living will or a durable power of attorney. If not, the admitting staff person provides a sample form to the client if wanted. The purpose of this inquiry is to determine:

whether the client has a document describing wishes for care when the client is no longer able to make decisions.