NUR 108 Ch 12: Collaborative Practice and Care Coordination across Settings
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? "You need a graduate degree to specialize in home health care." "It requires that you have high-level critical care skills." "The client and family are in control of the setting, not the nurse." "Each team member works independently of other team members."
"The client and family are in control of the setting, not the nurse." Explanation: In home health care, the nurse is a "guest" in the client's home. Thus, the client and family retain the power and control that they normally relinquish to providers in other settings, such as an acute care facility. A generalist background and focus are useful, as well as broad assessment skills and a knowledge base to provide clients with appropriate education that will keep them as independent as possible. A graduate degree or high-level critical care skills are not necessary. Collaboration among team members is essential.
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 goals do you have for your family?" "What medications will you be taking at home?" "Do you have available transportation to appointments?" "Will you be helping prepare meals for the family?"
"What medications will you be taking at home?" Explanation: The key question to ask the client when assessing home management is, "What medications will you be taking at home?" Some medications can affect balance and mobility; the client's safety is paramount. Asking about goals is important but secondary to asking about safety. Similarly, asking about the client's available transportation and involvement in preparing meals for the family is not as important or urgent as asking about safety.
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 recovery from pneumonia. A client is being discharged home following a laparoscopic appendectomy 2 days earlier. A client is being transferred from one medical unit of the hospital to another to accommodate a client on isolation precautions. A client is returning to an assisted-living facility following a colonoscopy earlier that day.
A geriatric client is being transferred from a subacute medical unit to a new long-term care facility following recovery from pneumonia. Explanation: Transfer from the hospital setting to a long-term care facility is likely to require significant documentation and communication from the nurse facilitating the transfer. This may include copying the chart or summarizing a large amount of relevant data. Transfers within a hospital typically require somewhat less documentation and communication, and discharges home or to an existing facility may not require a formal report of any type.
The nurse is preparing to discharge a client. What education should the nurse provide to the client and family prior to the discharge? Select all that apply. A review of the appointment schedule for follow-up care The timing and appropriate method of administration, the purpose, and the side effects of all medications How to contact the dietitian from home for meal plans How to perform dressing changes Information about home care and physical therapy with appropriate phone numbers
A review of the appointment schedule for follow-up care The timing and appropriate method of administration, the purpose, and the side effects of all medications How to perform dressing changes Information about home care and physical therapy with appropriate phone numbers Explanation: Client education prior to discharge is essential and should include written information to support the lesson. This may include information about appointments, medications, home care, specific conditions, and so on. The nurse must evaluate that the caregiver is adequately prepared to do dressing changes or provide other care safely. If th
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? The client is living with an adult child's family. The client's home has a basement with small staircase. Medication bottles are on the counter without safety caps. Area rugs are present in multiple areas throughout the house.
Area rugs are present in multiple areas throughout the house. Explanation: An older adult client who recently suffered a stroke is at risk for injury from falls. Living with a family member would likely be an appropriate situation for the client. Medication bottles for an older adult should be kept where they are easy to reach. The medications likely do not have a child-proof safety cap. A house with a basement would not be concerning unless the client must enter the basement and the stairs are unsafe. Area rugs are a tripping hazard for a client who is a fall risk and should be removed.
Which action must the nurse perform on discharge of a client from an acute care facility? Coordinating future care for the client Writing a discharge order for the client Writing any orders for future home visits that may be necessary for the client Sending the client's records to the attending physician
Coordinating future care for the client Explanation: Coordinating future care is a means for providing continuity of care so that the client and family needs are consistently met as the client moves from a care setting to home. The physician, not the nurse, writes the discharge order for the client, as well as any orders needed for future home visits. Sending the client's records to the attending physician is not necessary unless the physician asks for certain records to be sent to the physician's office.
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? Caregiver Coordinator Nurse practitioner Clinician
Coordinator Explanation: Discharge planning is most successful when it is done in collaboration with the client and family, not for them. The discharge planner or coordinator is the health or social services professional who is responsible for coordinating the transition and serving as a link between the discharging facility and the community. A nurse practioner is an advanced clinician who prescribes medications and provides care. A clinician is a physician having direct contact with and responsibility for clients. A caregiver is a a family member or paid helper who regularly looks after a child or a person who is sick, older, or disabled.
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. Use a multimedia strategy that combines animation with narration. Explain the procedure clearly and slowly while providing multiple opportunities for the daughter to ask questions. Provide explicit written and verbal instructions and ask the daughter to explain back to the nurse how to perform the procedure.
Demonstrate and explain the procedure and then have the daughter perform it. Explanation: All steps of a procedure such as a dressing change should be demonstrated, practiced, and provided in writing. The client or caregiver should then perform the procedure or treatment in the presence of the nurse to demonstrate understanding and ability to carry out the procedure. This is more likely to facilitate success than providing a passive multimedia resource, explaining, or providing written instructions alone without reciprocal demonstration.
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? Types of services and equipment required Medications and treatments Functional limitations Documented need for a speech pathologist
Documented need for a speech pathologist Explanation: A documented need for a speech pathologist is not required for a Medicare home plan of care. Required data would include types of services and equipment required, functional limitations of the client, and ordered medications and treatments.
Which role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client? Caregiver Advocate Educator Care coordinator
Educator Explanation: The home healthcare nurse provides teaching, such as demonstration of a skill, to the family as a client educator. The home healthcare nurse develops and implements the plan of care in the caregiver role, such as obtaining a sputum specimen. As a client advocate, the home healthcare nurse protects and supports the client's rights. The home healthcare nurse coordinates direct care to the client and services of other healthcare providers.
Which is the primary goal of home health care? Treatment of illness Prevention of disease Functioning within limitations Provision of palliative care
Functioning within limitations Explanation: The primary goal of home health care is to help the client function within limitations. Home health care allows people to regain or maintain optimal health and to remain in the home environment. Although illness treatment and disease prevention through education do occur, these are not the goals of home health care. Palliative care is the focus of hospice care.
Home health care nurses are required to complete the Outcome and Assessment Information Set (OASIS) by which entity? Medicare Medicaid Any third-party payer Any insurance company
Medicare Explanation: OASIS provides standardized guidelines for admission and care, as well as a national database for evaluation, reimbursement, and quality improvement. The OASIS system of data collection is required by Medicare, not by Medicaid, insurance companies, or any other third-party payer.
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 Social worker Home health aide Physical therapist
Occupational therapist Explanation: The occupational therapist can evaluate the functional level of the client and teach activities to promote self-care in activities of daily living, such as cooking. The physical therapist provides direct care, such as muscle-strengthening exercises, gait training, and massage. The home health aide assists clients with hygiene and performing light housekeeping. The social worker provides assistance with health care finances and in securing equipment and supplies.
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 Improving oral communication Gait training with a walker Improving the ability to swallow
Relearning how to cook safely Explanation: The occupational therapist can evaluate the functional level of the client and teach activities to promote self-care in activities of daily living, such as cooking. The physical therapist provides direct care, such as muscle-strengthening exercises, gait training, and massage. The speech therapist assists with speech and language ability, as well as eating and swallowing.
Which qualities are essential for a community-based nurse? Select all that apply. Strong knowledge foundation Effective communication skills Keen physical assessment skills Ability to delegate client care tasks to unlicensed assistive personnel Competence in assisting with minor surgical procedures
Strong knowledge foundation Effective communication skills Keen physical assessment skills Explanation: Community-based nurses must possess several key qualities: they must be knowledgeable and skilled in their practice (including strong and effective communication and physical assessment skills), able to make decisions independently, and willing to remain accountable. They are less likely need skills in delegating client care or assisting with minor surgical procedures, as the nurse will typically work alone and as surgical procedures are not performed in the home care setting.
It is important for home health care nurses to remember which point? The nurse is the primary caregiver. The nurse is the guest in the client's home. Rehabilitation is the major client goal. The nurse should act as a counselor and advisor.
The nurse is the guest in the client's home. Explanation: An essential difference in home care versus acute care is that the home care nurse is a guest in the client's home. Family or other support persons are the primary caregivers, rehabilitation may not be the goal, and the nurse does not typically act as a counselor or advisor.
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 During chest radiography When the client is being triaged When the client is signing consent forms
When providing preoperative education related to a scheduled cataract extraction Explanation: Discharge planning prepares a client to move from one level of care to another within or outside of the current health care facility. Traditionally, this process involved discharge from the hospital to the home. In the current health care system, discharge planning occurs in all settings, including ambulatory surgical centers, rehabilitation units, drug treatment centers, and childbirth centers. A chest radiograph is used to diagnose a client's problem; thus, it would be premature to initiate discharge planning at this time, as too little is known about the client's condition, needed course of treatment, prognosis, and care needs following discharge. Similarly, clients are triaged before they are admitted to a health care facility, so it would be premature to initiate discharge planning before the client's condition is even known and before it is clear whether the client will even need to be admitted. Clients sign consent forms during the admission process, which clearly would be an inappropriate time to initiate discharge planning.
Public health nursing is the branch of nursing that: provides primary care to individuals. assesses individuals for community care. administers care for a defined geographic community. provides health care for the community.
provides health care for the community. Explanation: Public health nursing focuses on the whole population and the health of the community at large, not just on assessing or providing care to individuals. Community-based nursing, not public health nursing, involves administering care for a defined geographic community.
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 case manager The registered nurse The hospital discharge planner
The physician Explanation: Although referrals for home health care may originate from a variety of professions, the order that is required for care to proceed is provided by the physician or, in some cases, a nurse practitioner. Case managers, registered nurses, and hospital discharge planners do not have the authority to issues such an order.
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: manage the individual care needs of the client throughout the hospital stay. coordinate uninterrupted care and facilitate transfer between units and levels of care. assist the client to focus on health goals and reach outcomes. teach the client self-care regarding medications and plan of care.
coordinate uninterrupted care and facilitate transfer between units and levels of care. Explanation: The most comprehensive description of continuity of care is appropriate, uninterrupted care that facilitates transfer of the client between settings and levels of care. The others address specific needs/goals of the client, but do not describe coordination of care that provides for consistency and continuity.
The focus of community-based care is: providing care to clients within a defined geographic area. providing appropriate care for mental health. promoting the health of the nation. providing population-based care of the entire community.
providing care to clients within a defined geographic area. Explanation: Community-based care is health care provided to people who live within a defined geographic area; it is not focused on promoting the health of the nation. It centers on individual and family health care needs for acute and chronic health problems. It is not focused on mental health problems. In contrast, public health nursing and community health nursing are population-based and focus on the needs of the community.
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." "I am willing to prioritize the list if someone else will write the rationale." "Once we have completed the list and rationale, I will compile our recommendations for us all to sign before submission." "When I got this assignment, they said something about deciding what equipment to purchase next year."
"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." Explanation: The most important component of team structure is to have a common goal. The goal of this group is to list potential equipment purchases with rationale. The second-most important component of team structure is to have clear roles and responsibilities. The direction by the nurse for the members to query nurses on each unit is an example of establishing clear roles and responsibilities. Teams also should hold themselves mutually accountable for achieving the goal, such as by having all the team members sign the recommendation. The work should be done by the team, not by just one or two members, as in the option about one nurse prioritizing the list and another writing rationale. Clarity and specificity are important in communicating the purpose of the team, both of which are lacking in the statement, "they said something about deciding what equipment to purchase next year."
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 began complaining of severe chest pain, rating it as a 10 on a scale of 1 to 10, after walking back from the bathroom." "The client had an exploratory laparotomy 2 days ago and was progressing well. The vital signs were stable until this episode." "This event seemed to come out of the blue. The client denies any history of heart disease but does take a baby aspirin each night." "The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes."
"The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes." Explanation: SBAR provides a framework for communication between members of the health care team about a client's condition. It is an easy and focused way to set expectations for what will be communicated between members of the team, which is essential for developing teamwork and fostering a culture of client safety. S stands for the situation (complaint, diagnosis, treatment plan, and client's wants and needs); B stands for background (vital signs, mental and code status, list of medications, and lab results); A stands for assessment (current provider's assessment of the situation); and R stands for recommendations (identification of pending lab results and what needs to be done over the next few hours, along with other recommendations for care).
A nurse is caring for a 17-year-old pregnant client who is unable to afford health care. Which resource should the nurse suggest to the client to obtain support? The visiting nurse association The local acute care facility A local religious organization A social services office to inquire about Medicaid benefits
A social services office to inquire about Medicaid benefits Explanation: The nurse should refer the client to a social services office for help with determining the client's eligibility for Medicaid to support financial obligations related to childbirth. Local churches and other religious organizations may offer limited support but would be unlikely to meet all of the client's financial obligations related to prenatal care and childbirth in a hospital. Acute care facilities often have grants that pay for indigent care but would not address the financial care after birth. The visiting nurse association, which provides home health care to homebound clients, would not be an option for this client.
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 Information on other clients in the area with similar health care needs The nurse's phone number and home address Dates and times of all future home care visits
Available community resources to meet their needs Explanation: The community-based nurse is responsible for informing the client and family about the community resources available to meet their needs. During initial and subsequent home visits, the nurse helps the client and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. It is inappropriate to provide information on other clients; it is equally inappropriate for a nurse to provide the nurse's home address. It is not normally possible to provide details of every future visit at the initial visit.
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 are in the hospital for a longer period of time. Clients are locked into prenegotiated payment rates that have remained unchanged. Clients with high home care needs are being discharged into the community. Client use of ambulatory care has decreased.
Clients with high home care needs are being discharged into the community. Explanation: Clients are returning to the community with more health care needs, many of which are complex, thus increasing the need for home health care. Clients are not in the hospital for longer periods of time. Clients are not locked into payment rates that have remained unchanged. Client use of ambulatory care has not decreased but increased.
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? Bond with the children Receive financial aid Cognitively understand how to care for the children Physically perform care needed by the children
Cognitively understand how to care for the children Explanation: Regarding all aspects of survival, the cognitive ability of this young client is of greatest concern. The cognitive ability to understand how to organize work, manage financial responsibilities, and ensure safety within the home is essential to a single parent of two young children.
Which are components of the nursing case management process? Select all that apply. Coordinating Making referrals Monitoring medical progress Prescribing medications Driving a client to appointments Filing and completing paperwork
Coordinating Making referrals Monitoring medical progress Filing and completing paperwork Explanation: Coordinating, making referrals, monitoring medical progress, and filing and completing paperwork are just a few of the tasks that the nurse case manager performs on a regular basis. Prescribing medications and driving a client to appointments are beyond the scope of practice of a nurse.
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? Caregiver Coordinator Nurse practitioner Clinician
Coordinator Explanation: Discharge planning is most successful when it is done in collaboration with the client and family, not for them. The discharge planner or coordinator is the health or social services professional who is responsible for coordinating the transition and serving as a link between the discharging facility and the community. A nurse practioner is an advanced clinician who prescribes medications and provides care. A clinician is a physician having direct contact with and responsibility for clients. A caregiver is a a family member or paid helper who regularly looks after a child or a person who is sick, older, or disabled.
A nurse is discharging a client from the hospital. Which nursing actions should occur when a client is discharged from a health care setting? Select all that apply. Discharge planning should begin upon admission to the facility to ensure continuity of care. A hospital administrator coordinates and performs an approved handoff for the client to a new facility. The nurse assesses the client to ensure that the client does not require any complicated treatment or care performed by family members. The nurse ensures that the family members are taught the knowledge and skills needed to care for the client. The health care provider ensures that referrals are made to such agencies as home health care or social services to provide support and assistance during the recovery period. Preferably, the nurse who conducts the initial nursing assessment will determine the special needs of the client being discharged.
Discharge planning should begin upon admission to the facility to ensure continuity of care. The nurse ensures that the family members are taught the knowledge and skills needed to care for the client. Preferably, the nurse who conducts the initial nursing assessment will determine the special needs of the client being discharged. Explanation: Discharge planning is started as soon as possible after admission in order to provide adequate time for education and arranging any necessary care following discharge from a facility. The nurse must validate that any family members that are going to be caring for the client understand and can perform necessary care. Continuity of care is improved if the nurse that performed the detailed admission assessment determines the discharge needs. The nurse, not the hospital administrator, prepares and performs the client handoff to the new facility. As long as family members are capable and are adequately taught and evaluated, they may perform complicated procedures required for caring for the client.
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. Use the same medical terms other providers use. After teaching have the client repeat back the key points. Use visual aids to help explain teaching.
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. Explanation: Short amounts of information are easier to comprehend because the client does not become as tired. Reviewing and repeating information is essential. Teach-back is a valid technique for evaluating learning. Visual aids are helpful in explaining content. The nurse should use common, nonmedical language as much as possible when teaching.
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? Is the facility listed as a government-approved facility with no infractions? Does the agency provide care to facilitate transition to a hospital? How does the agency train employees for accountability and do they require a background check?
Does the agency meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs? Explanation: The most important information a family should obtain before selecting a home health agency is determining whether the agency meets uniform standards for licensing, certification, and accreditation. Inquiring about infractions listed with government organizations is important but would not be a family's priority question. Home health agencies facilitate transition from hospital to home, not home to hospital. Home care agencies typically require background checks and conduct training of employees. While these requirements can and should be confirmed by the family, it is not the most important information to obtain.
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? Financial needs related to care Health assessment Emotional bonding Genetic counseling
Emotional bonding Explanation: The child has not been home since birth. Thus, the parents will need emotional assistance to enhance bonding. The nurse supports the parents to meet the infant's physical and emotional needs and encourages them to strengthen the parent-child bond. Genetic counseling is not relevant at this point and health assessment is primarily the nurse's responsibility. Financial assistance is beyond the nurse's scope of responsibility.
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? Reinforce the care plan to the family if it is determined the client is not properly cared for. Provide referrals for health care professionals to perform the client's activities of daily living (ADLs). Encourage active participation of the client and family in health care decisions. Create a care plan based on the client's requests and inform the family of the client's wishes.
Encourage active participation of the client and family in health care decisions. Explanation: In a community-based health care setting, the nurse should involve the client and the family in all health care decisions for the client. The nature of the relationship is that of a partnership based on respect, appreciation, and cooperation. Reinforcing to the family that the client is not well-cared for should be done, but it is more important to involve the client and family in the care. The client and family should be encouraged to provide ADLs as they are able. Client care decisions should be made in conjunction with the family, and the family should be encouraged to participate in those decisions. The client's plan of care should include input from the family.
Which is the primary goal of continuity of care? Ensuring a smooth and safe transition between different health care settings Increasing clients' knowledge base and improving their health maintenance behaviors Minimizing nurses' legal liability during client transitions between health care institutions Controlling costs and maximizing client outcomes after discharge from the hospital
Ensuring a smooth and safe transition between different health care settings Explanation: Continuity of care exists to ensure smooth and safe transitions for clients when moving from one health care setting to another. This requires that all providers involved in the client's care effectively communicate the client's health information among themselves so that the client may maximize recovery and health. The primary goal of continuity of care is not to build the client's knowledge base or improve health maintenance behaviors, minimize the nurse's legal liability, or control health care costs.
During the entry phase of a home visit, the nurse is most likely to perform which task? Makes calls to establish initial contact with the client and schedule a visit Gathers supplies and equipment needed for the first visit Obtains directions to the client's home Establishes nursing diagnoses based on client needs
Establishes nursing diagnoses based on client needs Explanation: During the entry phase of a home visit, the nurse develops rapport with the client and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. The pre-entry phase includes making initial contact, scheduling a visit, gathering supplies needed for the first visit, and obtaining directions to the client's home.
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. Establish rapport with the client and family. Develop an individualized plan of care.
Gather supplies for the visit. Review the client's treatment orders. Evaluate the safety of the neighborhood. Explanation: During the pre-entry phase of the home visit, the nurse reviews client information, including the client's diagnoses, surgical experience, socioeconomic status, and treatment orders. The nurse evaluates the safety of the neighborhood and gather supplies in preparation for the visit. During the entry phase, the nurse makes a home visit to establish rapport with the client and family. The nurse makes an assessment, determines nursing diagnoses, establishes desired outcomes with input from the client and family, develops an individualized plan of care, implements prescribed care, and provides education.
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 discharge form. Obtain a copy of the client's care plan. Have the client sign the AMA form. Have the client sign a consent form.
Have the client sign the AMA form. Explanation: The client is free to leave the hospital but should be informed of the risks of leaving AMA. The client is required to sign a form releasing the hospital and physician of responsibility. The client is informed of any possible risk before signing the form. The client's signature must be witnessed, and the form becomes part of the client's record. The client does not need to sign a discharge form. Although it would be appropriate for the nurse to give the client a copy of the client's care plan, this is not the priority when the client is leaving AMA. There is no need for the client to sign a consent form, as the client is leaving and will not be undergoing any treatment that would require consent.
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. Have the physical therapist help the client with rehabilitation. Have the home health aide increase visits for bathing the client. Have the occupational therapist assess for the client's need for adaptive devices.
Have the social worker visit the client to discuss care options. Explanation: Services to manage health care needs in the home can involve a team of interdisciplinary professionals, including social workers. The social worker is able to broadly identify resources to meet the client's needs. As no specific needs are indicated in this case, such as the need for rehabilitation, bathing, or adaptive devices, it would be more appropriate for the nurse to refer the client to the social worker than to a physical therapist, home health aide, or occupational therapist.
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 Intravenous therapy Pain management Homemaking
High-rise toilet seat Explanation: Home medical services provide durable medical equipment, such as walkers, canes, crutches, wheelchairs, high-rise toilet seats, commodes, beds, and oxygen. Custodial services include homemaking and housekeeping services, as well as companionship and live-in services. Hospice services provide pain management, physician services, spiritual support, respite care, and bereavement counseling. High-technology pharmacology services provide intravenous therapy, home uterine monitoring, ventilator management, and chemotherapy.
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? Acute care Ambulatory care Home care Respite care
Home care Explanation: Home health care services are delivered to persons at home who are recovering from illness, are disabled, or are chronically or terminally ill and need various services to progress, maintain function, or perform their activities of daily living. Acute and ambulatory care are delivered on a short-term basis, and respite care's focus is on the caregiver.
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 Delegating care and consulting when new problems develop or modifications are needed Reviewing the plan of care on a daily basis to evaluate whether predictable outcomes are met Handling the day-to-day operations of the nursing unit
Managing client care from admission through discharge or resolution of illness Explanation: When assuming the role of a client case manager, the nurse collaborates with the interdisciplinary team while managing care for a client (or group of clients) for a designated period of time throughout the course of the illness. The other actions, such as delegating care and consulting when new problems develop or modifications are needed and reviewing the plan of care on a daily basis to evaluate whether predictable outcomes are met, are more descriptive of nursing care in an acute care setting. A nurse manger is responsible for handling the day-to-day operations of the nursing unit.
Which type of home healthcare agency is a local health department? Official or public agency Private not-for-profit agency Private, proprietary agency Institution-based agency
Official or public agency Explanation: Health departments are public agencies supported through tax dollars and benefit the community in which they are located. Private not-for-profit agencies are supported by donations, endowments, charities, and insurance reimbursement. Private, proprietary agencies are usually for-profit organizations governed by individual owners or national corporations. Institution-based agencies operate under a parent organization, such as a hospital.
When doing discharge planning for an older adult client who had a stroke, what is the nursing priority? Involve the family in discussing when the client will go home. Help the client after discharge to establish goals. Realize that goals may not be met after discharge. Plan reachable goals with the client and family.
Plan reachable goals with the client and family. Explanation: Goals are best met when mutually set by both the client and the nurse, with input from the family. If the client is involved in setting the goals, it is more likely that the expected outcomes of the plan will be met. The goals should be reachable by the client. Although the family should be included in discharge planning, they should have no say in when the client goes home, as this is determined by the client's physician. The goals should be planned before the client is discharged, not afterward. Of course goals may not be met after discharge, but realizing this should not be the nurse's priority; planning reachable goals should be the priority.
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? Assessment Planning Restoration Evaluation
Planning Explanation: Planning and intervention focus on using individual, family, and community resources to assist in restoring a client's health to maximum possible functioning, while continuing to monitor for possible side effects or complications to treatment. Assessment involves determining the client's care needs. Restoration involves helping a client regain a former level of functioning after an injury or other debilitating health event. Evaluation involves determining the effectiveness of a care plan after it has been implemented.
What is the priority nursing responsibility when transferring a client from one unit in the hospital to another? Bring all of the client's belongings to the new unit. Transport the completed client chart to the receiving unit. Provide a verbal report of the client's status to the admitting nurse. Help the client become familiar with the new unit.
Provide a verbal report of the client's status to the admitting nurse. Explanation: Although the nurse may transport belongings and the chart, the priority responsibility for the nurse is the verbal report/communication with the nurse on the new unit. It is not the the task of the nurse who brings the client to the new unit to orient the client.
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. Notify the surgeon. Alert the charge nurse in surgery. Advise the client to delay the surgery.
Provide the teaching. Explanation: The nurse assesses what has been done prior to the day of surgery and tailors the care plan to meet the client's needs. In this case, the client should receive information about postoperative self-care, including written instructions. The nurse, not the surgeon or charge nurse, should provide the teaching. There is no need to delay the client's surgery; moreover, it would be the surgeon's responsibility to decide whether to delay the surgery, not the nurse's.
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? Notifying all departments of the room change. Discussing the move with both client and his or her family. Asking family members to meet with the social worker at the receiving facility prior to the client's arrival. Providing accurate and complete communication to the new facility.
Providing accurate and complete communication to the new facility. Explanation: To ensure continuity of care for the client, the nurse should send a detailed assessment and care plan from the hospital to the extended care facility. Frequently, the nurse at the hospital provides a verbal report to the nurse at the new facility using the approved handoff technique. Other departments at the hospital should be notified of the client's discharge, but this does not affect the client's continuity of care. Discussing the move with the client and family is important, but this does not ensure continuity of care. The family members are asked to meet with the social worker but, again, this does not ensure continuity of care.
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 Assessing the client's needs and identifying problems Developing goals with the client Making home health care referrals
Providing client education Explanation: The nurse is teaching the client important information about self-care at home prior to the client's discharge. The initial step in discharge planning is collecting and organizing data about the client, as this provides information on the client's health care needs. Home referrals may be made after the education process, based on orders provided by the physician. Developing goals may occur after the education process, as the goals need to be realistic.
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? Discuss the client situation with the provider for possible therapies that are more cost-conscious. Enlist the services of the client's family for some components of care, such as dressing changes and physical therapy. Refer the client to a local religious organization or non-profit agency for support. Refer the client to a social worker to determine eligibility for assistance.
Refer the client to a social worker to determine eligibility for assistance. Explanation: Social workers assist in finding and connecting the client with community resources or financial resources and provide counseling and support. A social worker is better equipped to find community resources or financial resources than a health care provider. Discussing alternative therapies with the provider may be beneficial, but typically this does not apply to some medical supplies that the client needs. Likewise, having the client's family participate in dressing changes is helpful, but will not particularly offset certain medical supplies that may be needed. Local non-profit organizations and religious organizations may be able to offer some assistance, but a social worker would be the best person to find resources and make referrals.
A nurse working in a primary health care facility would most likely provide which service? Screening Acute care Treatment Rehabilitation
Screening Explanation: Screening falls within the category of primary health care. Acute care and treatment are a part of secondary health care. Rehabilitation falls under tertiary health care.
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 Objective data regarding the weekly dietary plan for a client with diabetes Subjective data on types of social support that the home health team can provide to the client Objective data on community resources readily available to the client
Subjective data about how the client manages medications at home Explanation: Assessment should encompass the functional abilities, strengths, and assets of the client, family, home, and community. The nurse should collect subjective information to assess how the person normally manages at home, what the home is like, and what family and community support is available. The health care team will then develop strategies to assist with meeting the client's needs for dietary assistance, a support system, and community resources after the assessment is completed.
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 Medication management Transportation Psychosocial needs
Support system Explanation: A client who has had bowel surgery, particulalry an older client, would require much assistance in performing activities of daily living while recovering. Because this client lives alone and has no family available, the client may not be able to stay at home and may need to be placed in a facility to provide adequate support. A strong support system could meet the client's needs for medication management, transportation, and psychosocial support. A lack of a support system would likely mean that none of these other needs would be met. Thus, the client's support system is the most important factor related to home care management.
Why is it important for the home health nurse to inform the health care agency of the nurse's daily itinerary? Allows the agency to keep track for payment of the nurse Supports suggested safety precautions for the nurse when making a home care visit Allows easy accessibility of the nurse for changes in assignments Allows the client to cancel appointments with minimal inconvenience
Supports suggested safety precautions for the nurse when making a home care visit Explanation: Whenever a nurse makes a home visit, the agency should know the nurse's itinerary for the safety of the nurse. Providing the agency with a copy of the daily schedule is not for the purpose of correctly paying the nurse; nor for the ease of the nurse in changing assignments or for the client's ease in canceling appointments.
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? Changes to the structure of Medicare and Medicaid The increase in the incidence and prevalence of infectious diseases The change to shorter hospital stays The need for decreased financial expenditures
The change to shorter hospital stays Explanation: Decreased hospital stays have led to an increase in community-based health care services, including home health services. This phenomenon has not been directly linked to structural changes in Medicare or Medicaid, financial considerations, or changes in disease patterns.
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 reports having slipped in the restroom the first night in the hospital. The client refuses to allow the caregiver to help the client sit up in bed. The home care nurse has to reschedule an appointment with the client. The client's caregiver is absent whenever the nurse visits and the client is alone.
The client's caregiver is absent whenever the nurse visits and the client is alone. Explanation: The nurse determines that there is an impairment in home management when the caregiver is not present to provide care to the client as well as answer questions regarding the care of the client. Education should be able to be provided to the client and caregiver. The nurse having to reschedule an appointment may occur for any number of reasons, but the client should have support in the home even if the nurse is unable to be there. Refusal of care does not indicate home management impairment. Slipping in the hospital environment has no bearing on home management.
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 The nurse's knowledge base and experience level The client's potential for recurrence The NANDA diagnoses relevant to the client's condition
The client's identified needs and goals Explanation: The central focus of client teaching and the larger discharge planning process should be the identified health care needs of the client and the goals that the client identifies or acknowledges. The nurse's skills and knowledge, the client's potential for recurrence, and the relevant NANDA nursing diagnoses are all elements that may inform the discharge planning process, but they are superseded by the client's goals and expressed needs.
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 chronic nursing shortage The focus on treatment of disease The preference of nurses to work during the day instead of evening or night shifts The discharge home of clients who are more critically ill
The discharge home of clients who are more critically ill Explanation: With shorter hospital stays and increased use of outpatient health care services, more clients who are critically ill require nursing care in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting. The chronic nursing shortage and the focus on the treatment of disease do not affect the growth in home heatlh care, because both of these factors have no more or less of an effect on home health care than they do care provided in an acute care facility. Nurses, as a whole, do not necessarily prefer to work during the day rather than at night; some prefer to work in the day and some prefer to work at night. In any case, nurses work both day and night shifts in home health care just as in an acute care facility.
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 ability to provide technical nursing assistance to meet the needs of clients and their families The ability to establish trusting professional relationships with clients, family caregivers, and health care professionals in different practice settings The knowledge of how to communicate client priorities and the related plan of care as a client is transferred between different settings The commitment to securing the best setting for care to be provided for clients and the best coordination of resources to support the level of care needed
The knowledge of how to communicate client priorities and the related plan of care as a client is transferred between different settings Explanation: Continuity depends on excellent communication as clients move from one caregiver or health care site to another. Breakdowns in communication often result in medical errors due to lack of continuity of care. Technical skills are necessary to provide one aspect of good client care but do not always require a great deal of cognitive skills, nor do they ensure continuity of care. Trusting relationships help in developing good rapport for a working relationship but are not associated with cognitive skills. Securing the best setting and resources provides coordination of care but is not a cognitive skill.
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 determines who should be involved in the handoff communication. The nurse prepares the new room for the client. The nurse asks the other health care professionals if they have any questions. The nurse uses the SBAR technique during the handoff.
The nurse prepares the new room for the client. Explanation: The nurse prepares the new room for a client prior to admission, not during the discharge process. The client handoff refers to transferring responsibility for a client from one caregiver to another with the goal of providing timely, accurate information about a client's plan of care, treatment, current condition and anticipated changes. The nurse determines who she needs to communicate with during the discharge and asks those health care professionals if they have any questions in order to provide continuity of care. SBAR (Situation-Background-Assessment-Recommendation) is an outline that many facilities follow to ensure that proper communication occurs during the handoff procedure.
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 The social worker The chaplain or minister The home health care aide
The registered nurse Explanation: Regardless of the number of providers for home health care, the responsibility for care coordination remains with the registered nurse, not with the social worker, chaplain or minister, or home health care aide.
When meeting a new client on arrival to the unit, what is the nurse responsible for during the admission process? Select all that apply. Welcoming the client as if to the client's home Assessing the family's need to be present during the admission Delegating the admission physical assessment and history to the medical resident Asking the client whether the client wants the family to remain during the admission process Communicating the rules about visiting hours, the cafeteria, and other services
Welcoming the client as if to the client's home Assessing the family's need to be present during the admission Asking the client whether the client wants the family to remain during the admission process Communicating the rules about visiting hours, the cafeteria, and other services Explanation: The nurse is responsible for welcoming the client and family to the unit. The nurse should determine whether the client wants family present and/or whether the family needs to be included during the admission. The nurse must complete the admission assessment and client history, not delegate it to the medical resident, and orient the client and family to the unit and services.
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 height and weight The client's comprehension Who lives with the client
Whether the client wears eyeglasses The client's ability to ambulate The client's comprehension Explanation: To determine functional abilities, the nurse must assess the client's ability to care for oneself and what devices or assistance the client needs to do so. The client's need for eyeglasses, ability to ambulate, and comprehension all would affect the client's ability to function. The client's height and weight and who the client lives with would not affect the client's ability to function.
The initial step in discharge planning is: collecting and organizing data about the client. establishing goals with the client. teaching the client self-care activities that are to be conducted in the home setting. providing home health care referrals.
collecting and organizing data about the client. Explanation: The initial step in discharge planning is collecting and organizing data about the client, as this provides information on the client's health care needs. Establishing goals, client teaching, and providing home health care referrals are steps that follow the collection and organization of data.
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. allow a religious leader in the client's life to visit. be certain that the client's educational needs are being met. increase the client's activity to assist in coping.
communicate these feelings to family and friends. Explanation: The home health care nurse can assist in coordinating care needs and encouraging family, teachers, schoolmates, and friends to understand the client's struggles and help support the client's needs. Encouraging the client to allow a religious leader to visit may or may not be appropriate, depending on the client's beliefs. Ensuring that the client's educational needs are being met does not address the client's emotional and spiritual needs. Because the client has fractures and multiple trauma injuries, increasing activity is not likely to be an option and, in any case, would not directly address the client's emotional and spiritual concerns.
A home health care nurse develops a client's individualized plan of care during the: entry phase. referral process. pre-entry phase. discharge planning.
entry phase. Explanation: Nurses provide home health care interventions during the entry phase, using an individualized plan of care for each client based initially on identifying individualized health care needs. In the entry phase, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes (along with the patient and family), plans and implements prescribed care, and provides teaching. During the pre-entry phase, which includes the referral process, the provider or discharge planner of a hospital contacts the home care facility and provides a brief medical history, along with indications for home health services, and then the referral nurse at the home care facility collects as much information as possible about the patient's diagnoses, surgical experience, socioeconomic status, and treatments ordered. Discharge planning occurs during the pre-entry phase and would be too soon for creating a client's individualized plan of home health care, as the home health nurse still needs to meet and assess the client and family first.
Continuity of care for a particular client is most important to prevent: multiple providers. infection. fragmentation of services. rising health care costs.
fragmentation of services. Explanation: Continuity of care is the provision of health care services without disruption, regardless of movement between settings. It is most important in preventing fragmentation of health care services. It does not prevent a client from needing the services of multiple providers, although it can ensure better communication and coordination among these providers, resulting in improved outcomes for the client. Continuity of care would not directly prevent infection, but in preventing fragmentation of care, it could indirectly help prevent infection. Ensuring continuity of care for a single client would not help prevent rising health care costs, in general, although it could help lower some costs for the individual client by reducing redundancy
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: obtain the physician's orders. call the dietary department to get breakfast for the client. gather information and complete the admission database. ask the nursing assistant to obtain vital signs.
gather information and complete the admission database. Explanation: The nurse's priority is to complete the admission of the client and perform the history, assessment, and documentation. Additional interventions that can be completed after the assessment include asking the nursing assistant to obtain vital signs, retrieving the admission orders from the prescriber, and following up with dietary if warranted.
When educating clients in the community on health promotion and prevention of disease, it is important to stress: strenuous exercise is necessary for health. health education can benefit individuals and groups. the ideal location for education is in a health care institution. health promotion may not be possible for many of the older members of a community.
health education can benefit individuals and groups. Explanation: An axiom of health promotion and disease prevention is the fact that health education is highly beneficial. These benefits are not the same for everyone, but everyone can benefit from some sort of health promotion, including older clients. Strenuous exercise is not appropriate for everyone. Education does not always need to happen in a formal healthcare setting.
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: appropriate transfer forms are completed. physician writes an order for home care. social worker assesses the need and Medicare agrees to pay for home health care services. home health care agency evaluates the client and determines the need for services.
physician writes an order for home care. Explanation: Initiating home care after discharge first requires a written order by the physician. Transfer forms should be completed to provide continuity of care, but this does not initiate the service. Social services may assist in the transfer after the order has been obtained. The home care agency does not typically evaluate the client in the hospital.
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: provide client education. evaluate the effectiveness of the hospitalization. determine hospital-based services needed by the client. prepare the client for home care.
prepare the client for home care. Explanation: Given that this client is being discharged from the acute care facility following a stroke, it is most likely that the nurse is calling a meeting of the entire health care team and the client and family to prepare the client for home care. Simply providing client education or evaluating the effectiveness of hospitalization could be done by the nurse alone and would not warrant calling a meeting with the entire health care team. As the client is being discharged, there is no reason to discuss hospital-based resources that the client might need.
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: ensure that the current health state of the client is maintained. provide for the coordination and continuity of care by the health care providers. communicate to the next of kin so they are aware of the transfer. discuss the return to familiar surroundings with the client.
provide for the coordination and continuity of care by the health care providers. Explanation: The primary responsibility of the nurse is to ensure continuity of care by communicating the client's status and needs. The nurse cannot ensure the health status of the individual. The nurse may notify the next of kin of the transfer and also discuss this with the client, but these are not the primary nursing responsibilities.
The nurse understands that planning for discharge actually begins at admission to the facility. The purpose of discharge planning is best described as: decreasing stress for client and family members. providing continuity of care that is goal directed. ensuring client safety and health maintenance. promoting less dependence on others.
providing continuity of care that is goal directed. Explanation: The purpose of discharge planning is to provide for continuity of care so that the needs of the client and family are consistently met as the client goes from hospital to home. The others may be additional goals.
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. that an attorney has verified the living will papers. that the client refuses to have resuscitation measures or any life-prolonging care. that the client assigned a relative to act on the client's behalf.
that the client has made wishes for terminal care known. Explanation: It is important to determine whether the client has advanced directives, which indicate the client's wishes regarding future care should the client become unable to communicate them. Advanced directives may be documented in a living will or a durable power of attorney for health care document. A copy should be placed in the clent's hospital record. Simply having an advanced directive only means that the client has expressed some wishes regarding terminal care, not necessarily that an attorney has verified the document, that the client has refused to have resuscitation measures or any life-prolonging care, or that the client has assigned a relative to act on the client's behalf, although any or all of these could be true.
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: what the client wants to have happen during the hospitalization. how the client feels about being resuscitated and maintained on life support if this is necessary. whether the client has a document describing wishes for care when the client is no longer able to make decisions. previous decisions made regarding whom to contact should the client die in the hospital.
whether the client has a document describing wishes for care when the client is no longer able to make decisions. Explanation: It is important to determine whether the client has advanced directives that describe the client's wishes for care if unable to communicate or participate in health care decisions. Although these advanced directives cover the client's desires regarding whether to be resuscitated or maintained on life support should it be necessary, the inquiry is regarding whether the client has a document (an advanced directive) stating these desires, not what the client's feelings about these issues are. A copy of any advanced directives should be placed in the client's hospital record. What the client wants to have happen during hospitalization and previous decisions made regarding whom to contact should the client die in the hospital are not relevant to whether the client has an advanced directive.
