Chapter 12: Collaborative Practice and Care Coordination across Settings (Coursepoint)

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? A. Respite care B. Ambulatory care C. Acute care D. Home care

D. Home care p. 283 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 are examples of factors the nurse would assess to determine a client's functional abilities? Select all that apply. A. The client's comprehension B. The client's height and weight C. Who lives with the client D. Whether the client wears eyeglasses E. The client's ability to ambulate

A. The client's comprehension D. Whether the client wears eyeglasses E. The client's ability to ambulate p. 282 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 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? A. Assessment B. Planning C. Evaluation D. Restoration

B. Planning p. 280 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.

The initial step in discharge planning is: A. establishing goals with the client. B. collecting and organizing data about the client. C. providing home health care referrals. D. teaching the client self-care activities that are to be conducted in the home setting.

B. collecting and organizing data about the client. p. 280 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 nurse working in a primary health care facility would most likely provide which service? A. Screening B. Acute care C. Treatment D. Rehabilitation

A. Screening p. 278 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 are examples of subjective client information? Select all that apply. A. Findings on palpation of the abdomen B. Smoking and alcohol history C. List of medications D. Vital signs, height, and weight E. Marital status and occupation

B. Smoking and alcohol history C. List of medications E. Marital status and occupation p. 269 Subjective information includes what the client or family reports, perceives, or describes about a problem. This includes marital status, occupation, smoking and alcohol history, and a list of medications. Objective information is what the nurse or other health care professional obtains directly from examination--including observation, measurement, and palpation--and from laboratory analysis. This includes vital signs, height, weight, and findings on palpation of the abdomen.

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: A. obtain the physician's orders. B. gather information and complete the admission database. C. call the dietary department to get breakfast for the client. D. ask the nursing assistant to obtain vital signs.

B. gather information and complete the admission database. p. 277 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.

It is important for home health care nurses to remember which point? A. The nurse is the guest in the client's home. B. The nurse is the primary caregiver. C. Rehabilitation is the major client goal. D. The nurse should act as a counselor and advisor.

A. The nurse is the guest in the client's home. p. 288 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.

The home health nurse is assessing the client's family support. Which questions should the nurse consider? Select all that apply. A. Can the client walk to the bathroom unassisted? B. Does the client receive support from other family members? C. Are the family members upset with the client's situation? D. Who is involved in the daily care of the client? E. Can the client speak?

A. Can the client walk to the bathroom unassisted? B. Does the client receive support from other family members? C. Are the family members upset with the client's situation? D. Who is involved in the daily care of the client? p. 271 Assess family support to determine how well a person can function at home. Family assessment can be done with questionnaires covering a broad range of topics. The most significant factors to assess are strengths of family members and barriers to abilities of family members to provide care. Asking whether the client can speak is not relevant to determining whether the family supports the client's function while in the home.

One significant change in the health care delivery system in recent years is earlier hospital discharges. What is one result of earlier hospital discharges? A. Clients with high home care needs are being discharged into the community. B. Clients are in the hospital for a longer period of time. C. Client use of ambulatory care has decreased. D. Clients are locked into prenegotiated payment rates that have remained unchanged.

A. Clients with high home care needs are being discharged into the community. p. 283 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.

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? A. The physician B. The registered nurse C. The hospital discharge planner D. The case manager

A. The physician p. 283 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.

Which is the primary goal of continuity of care? A. Ensuring a smooth and safe transition between different health care settings B. Minimizing nurses' legal liability during client transitions between health care institutions C. Controlling costs and maximizing client outcomes after discharge from the hospital D. Increasing clients' knowledge base and improving their health maintenance behaviors

A. Ensuring a smooth and safe transition between different health care settings p. 269 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.

Which qualities are essential for a community-based nurse? Select all that apply. A. Keen physical assessment skills B. Competence in assisting with minor surgical procedures C. Effective communication skills D. Ability to delegate client care tasks to unlicensed assistive personnel E. Strong knowledge foundation

A. Keen physical assessment skills C. Effective communication skills E. Strong knowledge foundation p. 267 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.

Home health care nurses are required to complete the Outcome and Assessment Information Set (OASIS) by which entity? A. Medicare B. Medicaid C. Any third-party payer D. Any insurance company

A. Medicare p. 288 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.

Which diseases would warrant a client receiving hospice care? Select all that apply. A. Multiple sclerosis B. End-stage renal disease C. Congestive heart failure C. Stage 1 breast cancer D. Diabetes insipidus

A. Multiple sclerosis B. End-stage renal disease C. Congestive heart failure p. 284 Many clients receiving hospice services have cancer, AIDS, multiple sclerosis, congestive heart failure, or end-stage renal disease. Diabetes insipidus (DI), which is caused by a failure of the kidneys to respond to antidiruetic hormone (ADH), does not require hospice care; it can be treated medically. Stage 1 breast cancer is treated with chemotherapy, radiation, or surgery and does not warrant hospice care.

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? A. Occupational therapist B. Home health aide C. Physical therapist D. Social worker

A. Occupational therapist p. 281 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 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? A. Provide the teaching. B. Notify the surgeon. C. Advise the client to delay the surgery. D. Alert the charge nurse in surgery.

A. Provide the teaching. p. 278 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.

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? A. Providing client education B. Making home health care referrals C. Assessing the client's needs and identifying problems D. Developing goals with the client

A. Providing client education p. 227 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.

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? A. The discharge home of clients who are more critically ill B. The chronic nursing shortage C. The focus on treatment of disease D. The preference of nurses to work during the day instead of evening or night shifts

A. The discharge home of clients who are more critically ill p. 283 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.

Which is the largest single source of reimbursement for home health care services? A. Client's self-pay B. Medicaid C. Medicare D. Private insurance

B. Medicare p. 284 Medicare is the largest single source of reimbursement for home health care services. Other sources of reimbursement may include Medicaid, private insurance, self-pay, and other public funding.

Which are examples of objective assessment information? Select all that apply. A. Vital signs, height, and weight B. Findings on palpation of the abdomen C. List of medications D. Smoking and alcohol history E. Marital status and occupation

A. Vital signs, height, and weight B. Findings on palpation of the abdomen p. 269 Objective data are information that the nurse can gather through direct assessment, including what can be seen, heard, felt, or measured. These include vital signs, height, weight, and findings on palapation of the abdomen. Subjective data are those that the client reports or describes, such as marital status, occupation, smoking and alcohol history, and a list of medications.

Which are recommended guidelines to prevent the spread of infection in the home care setting? Select all that apply. A. Wearing gloves when contacting body fluids B. Placing the bag on a liner before setting it down in the client's home C. Using sterile technique when reaching into the bag for supplies D. Using standard precautions E. Performing hand hygiene after reaching into the bag for supplies

A. Wearing gloves when contacting body fluids B. Placing the bag on a liner before setting it down in the client's home D. Using standard precautions p. 286 Nurses use standard precautions during home care visits, including wearing gloves when contacting blood, body fluids, secretions, excretions, and contaminated items. Clean disposable gloves should be put on just before touching areas of broken skin or mucous membranes. To prevent the spread of infection, nurses should also use appropriate technique when handling their equipment bags, including the following: perform hand hygiene before reaching into the bag for supplies, clean any equipment removed from the bag before returning it to the bag, and place the bag on a liner when setting it down in the patient's home.

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. A. Witness the client's signature on the against medical advice form. B. Call security to the client's room. C. Tell the client that the client cannot leave. D. Insist that the client sign an against medical advice form before leaving. E. Inform the client of the risks of leaving.

A. Witness the client's signature on the against medical advice form. E. Inform the client of the risks of leaving. p. 283 The nurse should ask the client to sign an against medical advice form but cannot make the client sign it. The nurse should witness the client's signature if the form is signed. The nurse cannot hold the client against the client's will and should not call security unless the client is a threat to others. The nurse should inform the client of the risks of leaving.

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: A. communicate these feelings to family and friends. B. allow a religious leader in the client's life to visit. C. increase the client's activity to assist in coping. be D. certain that the client's educational needs are being met.

A. communicate these feelings to family and friends. p. 283 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.

Community-based health care is best defined as: A. health care developed in partnership with communities. B. health care directed to members of a community who are currently healthy. C. health care that is not provided to specific individuals. D. health care in a non-hospital setting.

A. health care developed in partnership with communities. p. 265 Community-based health care is developed within the context of a community. It is ultimately delivered to individuals and is not limited to healthy people. There are many examples of care outside of hospitals that are not considered to be community care.

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: A. prepare the client for home care. B. evaluate the effectiveness of the hospitalization. C. provide client education. D. determine hospital-based services needed by the client.

A. prepare the client for home care. p. 284 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.

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. A. "When I got this assignment, they said something about deciding what equipment to purchase next year." B. "Once we have completed the list and rationale, I will compile our recommendations for us all to sign before submission." C. "I am willing to prioritize the list if someone else will write the rationale." D. "Before our next meeting, each of us will ask the nurses on the unit what their priority purchase would be." E. "Our goal is to prioritize this list of potential equipment purchases, offering rationale for our choices."

B. "Once we have completed the list and rationale, I will compile our recommendations for us all to sign before submission." D. "Before our next meeting, each of us will ask the nurses on the unit what their priority purchase would be." E. "Our goal is to prioritize this list of potential equipment purchases, offering rationale for our choices." p. 271 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."

During the initial visit to a client's home, the nurse should provide the client and family with what information? A. Dates and times of all future home care visits B. Available community resources to meet their needs C. Information on other clients in the area with similar health care needs D. The nurse's phone number and home address

B. Available community resources to meet their needs p. 268 - 269 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.

The home health care nurse is providing information to a client and family on medication changes. What role is the nurse performing? A. Client advocate B. Client and family educator C. Coordinator of services D. Caregiver

B. Client and family educator p. 269 Nurses providing home health care educate clients and families about all the aspects of care in the home, including the disease process or treatment, nutrition, medications, or treatment of care of wounds. As a caregiver, the nurse develops and implements a plan of care. As a client advocate, the nurse protects and supports the rights of another person. As a coordinator of services, the nurse must use effective communication skills with other health care providers while coordinating services for the client.

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? A. Bond with the children B. Cognitively understand how to care for the children C. Physically perform care needed by the children D. Receive financial aid

B. Cognitively understand how to care for the children p. 288 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 action must the nurse perform on discharge of a client from an acute care facility? A. Sending the client's records to the attending physician B. Coordinating future care for the client C. Writing a discharge order for the client D. Writing any orders for future home visits that may be necessary for the client

B. Coordinating future care for the client p. 280 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.

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? A. Explain the procedure clearly and slowly while providing multiple opportunities for the daughter to ask questions. B. Demonstrate and explain the procedure and then have the daughter perform it. C. Provide explicit written and verbal instructions and ask the daughter to explain back to the nurse how to perform the procedure. D. Use a multimedia strategy that combines animation with narration.

B. Demonstrate and explain the procedure and then have the daughter perform it. p. 269 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.

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? A. Use a multimedia strategy that combines animation with narration. B. Demonstrate and explain the procedure and then have the daughter perform it. C. Provide explicit written and verbal instructions and ask the daughter to explain back to the nurse how to perform the procedure. D. Explain the procedure clearly and slowly while providing multiple opportunities for the daughter to ask questions.

B. Demonstrate and explain the procedure and then have the daughter perform it. p. 269 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? A. Medications and treatments B. Documented need for a speech pathologist C. Functional limitations D. Types of services and equipment required

B. Documented need for a special pathologist p. 284 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.

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? A. Is the facility listed as a government-approved facility with no infractions? B. Does the agency meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs? C. Does the agency provide care to facilitate transition to a hospital? D. How does the agency train employees for accountability and do they require a background check?

B. Does the agency meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs? p. 284 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.

Which role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client? A. Advocate B. Educator C. Caregiver D. Care coordinator

B. Educator p. 269 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 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? A. Reinforce the care plan to the family if it is determined the client is not properly cared for. B. Encourage active participation of the client and family in health care decisions. C. Create a care plan based on the client's requests and inform the family of the client's wishes. D. Provide referrals for health care professionals to perform the client's activities of daily living (ADLs).

B. Encourage active participation of the client and family in health care decisions. p. 280 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 are components of the nursing case management process? Select all that apply. A. Prescribing medications B. Making referrals C. Monitoring medical progress D. Coordinating E. Filing and completing paperwork F. Driving a client to appointments

B. Making referrals C. Monitoring medical progress D. Coordinating E. Filing and completing paperwork p. 278 - 281 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 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? A. Comprehensive health assessment B. Nurse-client rapport C. Social connections to facilitate meeting the client's needs D. Knowledge of the regulations and policies of the home health care set-up

B. Nurse-client rapport p. 288 A key to successful care management in the home setting is the quality of the nurse-client relationship in the context of the client's family and community. In partnership with clients, the nurse facilitates individuals' abilities to accomplish health and self-care goals. The other answers represent skills that would be useful for meeting other goals but not as useful as the nurse-client rapport for managing the client's overall care. Knowing the policies and regulations would facilitate an understanding of what care equipment and services are available to the client. A comprehensive assessment provides assessment data to support the development of a plan of care. Social connections would facilitate social interactions for a client diagnosed with social isolation.

Which type of home healthcare agency is a local health department? A. Private not-for-profit agency B. Official or public agency C. Institution-based agency D. Private, proprietary agency

B. Official or public agency p. 284 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.

Which measure should a home health care nurse integrate into routine practice to minimize the potential for lawsuits? A. Integrate the client's learning needs and goals into plans of care. B. Perform thorough, accurate, and timely documentation. C. Have the client sign a waiver prior to the entry phase of a visit. D. Apply more conservative interventions than those used in a hospital setting.

B. Perform thorough, accurate, and timely documentation. p. 287 The need for thorough documentation is especially high in home health care settings, both to ensure continuity of care and to provide a legally acceptable record of what occurred during nurse-client interactions. The nurse should not implement more conservative interventions solely to minimize liability. A waiver of rights is not a component of home health care. The client's learning needs and goals should indeed be integrated into plans of care, but this action does not protect against lawsuits.

What is the priority nursing responsibility when transferring a client from one unit in the hospital to another? A. Transport the completed client chart to the receiving unit. B. Provide a verbal report of the client's status to the admitting nurse. C. Bring all of the client's belongings to the new unit. D. Help the client become familiar with the new unit.

B. Provide a verbal report of the client's status to the admitting nurse. p. 279 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.

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? A. Enlist the services of the client's family for some components of care, such as dressing changes and physical therapy. B. Refer the client to a social worker to determine eligibility for assistance. C. Discuss the client situation with the provider for possible therapies that are more cost-conscious. D. Refer the client to a local religious organization or non-profit agency for support.

B. Refer the client to a social worker to determine eligibility for assistance. p. 275 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.

The client is being discharged to the home setting following a stroke. Which activity would the occupational therapist assist the client with? A. Improving the ability to swallow B. Relearning how to cook safely C. Gait training with a walker D. Improving oral communication

B. Relearning how to cook safely p. 281 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.

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? A. Transportation B. Support system C. Medication management D. Psychosocial needs

B. Support system p. 283 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.

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? A. Changes to the structure of Medicare and Medicaid B. The change to shorter hospital stays C. The need for decreased financial expenditures D. The increase in the incidence and prevalence of infectious diseases

B. The change to shorter hospital stays p. 277 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 nurse working in a hospital setting is responsible for transferring clients. Which recommended nursing actions would the nurse perform during this process? Select all that apply. A. The nurse does not formally discharge a client who is being transferred from the hospital to a long-term care facility. B. The hospital nurse prepares a detailed assessment and care plan to send to the long-term facility to which a client is transferred. C. The nurse informs the client's family of the change and asks them to remove the client's personal belongings. D. The nurse asks the family of a client moved to a critical care unit to take home the client's personal belongings. E. The nurse carefully packs the belongings of a client being discharged and sends them to the new facility. F. The nurse sends the original chart to the new facility when a client is being transferred to a long-term care facility.

B. The hospital nurse prepares a detailed assessment and care plan to send to the long-term facility to which a client is transferred. D. The nurse asks the family of a client moved to a critical care unit to take home the client's personal belongings. E. The nurse carefully packs the belongings of a client being discharged and sends them to the new facility. p. 279 - 280 In the critical care environment there is little room for the client's personal belongings; therefore, the family is asked to take these items home. The nurse, not the family, is responsible for packing the client's personal items and sending these items to the transfer facility. In order to provide continuity of care, the nurse prepares a detailed assessment and care plan to send to any facility the client is discharged to. When a client is transferred to another facility the nurse must obtain a discharge order from the physician. The nurse does not send the original client chart to the new facility; it remains at the hospital, although portions of it may be communicated to the new facility.

When would it be appropriate for the nurse to initiate discharge planning with a client who will be discharged the next morning? A. When the client is being triaged B. When providing preoperative education related to a scheduled cataract extraction C. When the client is signing consent forms D. During chest radiography

B. When providing preoperative education related to a scheduled cataract extraction p. 280 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.

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: A. teach the client self-care regarding medications and plan of care. B. coordinate uninterrupted care and facilitate transfer between units and levels of care. C. assist the client to focus on health goals and reach outcomes. D. manage the individual care needs of the client throughout the hospital stay.

B. coordinate uninterrupted care and facilitate transfer between units and levels of care. p. 269 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.

A home health care nurse develops a client's individualized plan of care during the: A. pre-entry phase. B. entry phase. C. referral process. D. discharge planning.

B. entry phase. p. 288 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.

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: A. how the client feels about being resuscitated and maintained on life support if this is necessary. B. whether the client has a document describing wishes for care when the client is no longer able to make decisions. C. previous decisions made regarding whom to contact should the client die in the hospital. D. what the client wants to have happen during the hospitalization.

B. whether the client has a document describing wishes for care when the client is no longer able to make decisions. p. 278 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.

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? A. "You need a graduate degree to specialize in home health care." B. "It requires that you have high-level critical care skills." C. "The client and family are in control of the setting, not the nurse." D. "Each team member works independently of other team members."

C. "The client and family are in control of the setting, not the nurse." p. 268 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.

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? A. "The client had an exploratory laparotomy 2 days ago and was progressing well. The vital signs were stable until this episode." B. "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." C. "The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes." D. "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."

C. "The client is scheduled for a cardiac catheterization in about an hour and needs monitoring every 15 minutes." p. 269 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 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? A. "Home health is very expensive. You might wish to check into an individual sitter instead." B. "Home health can only help you for 60 days." C. "Your mother's primary health care provider will have to write a prescription for home health." D. "I can get the telephone numbers of several home health agencies for you."

C. "Your mother's primary health care provider will have to write a prescription for home health." p. 286 Home health cannot begin without a prescription from a primary health care provider. The son should discuss this plan with the health care provider prior to contacting home health agencies. The nurse should not infer that a sitter would be better or less expensive. Home health is certified for an initial 60-day period but can be recertified at intervals after the first 60 days.

Which circumstance likely requires the most documentation and communication on the part of the nurse? A. A client is being transferred from one medical unit of the hospital to another to accommodate a client on isolation precautions. B. A client is being discharged home following a laparoscopic appendectomy 2 days earlier. C. A geriatric client is being transferred from a subacute medical unit to a new long-term care facility following recovery from pneumonia. D. A client is returning to an assisted-living facility following a colonoscopy earlier that day.

C. A geriatric client is being transferred from a subacute medical unit to a new long-term care facility following recovery from pneumonia. p. 279 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.

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? A. Assisting in participation of the care-related decisions B. Establishing rapport and showing willingness to listen C. Clearly defining the purpose and expectations of the admission D. Documenting the procedure

C. Clearly defining the purpose and expectations of the admission p. 269 During the admission to the health care system, the nurse should clearly explain to the client the purpose and expectations of admission, such as what procedures will be covered. Explaining what procedures will be covered does not pertain to establishing rapport with the client, documenting a procedure, or helping the client participate in care-related decisions.

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? A. Assessment B. Documentation C. Communication D. Care planning

C. Communication p. 269 Although assessment, documentation, and care-planning skills are important, continuity depends on excellent communication as clients move from one caregiver or health care site to another. Too often, breakdowns in communication among caregivers result in medical errors or deficient plans of care.

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? A. Nurse practitioner B. Clinician C. Coordinator D. Caregiver

C. Coordinator p. 274 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.

When initiating home health care services, during which phase is it appropriate for the home health nurse to implement the initial client assessment? A. Referral phase B. Initiation phase C. Pre-entry phase D. Termination phase

C. Pre-entry phase Initial assessment is conducted by the nurse during the pre-entry and entry phases of the home visit. The referral phase involves the physician or discharge planner of a hospital contacting the home health care agency with the indications for the referral. The initiation phase consists of clarifying the source of referral and the purpose of the visit, as well as the initial contact with the family. Determining the need for further visits occurs during the termination phase.

Why is it important for the home health nurse to inform the health care agency of the nurse's daily itinerary? A. Allows the agency to keep track for payment of the nurse B. Allows easy accessibility of the nurse for changes in assignments C. Supports suggested safety precautions for the nurse when making a home care visit D. Allows the client to cancel appointments with minimal inconvenience

C. Supports suggested safety precautions for the nurse when making a home care visit p. 270 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.

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? A. The client's potential for recurrence B. The NANDA diagnoses relevant to the client's condition C. The client's identified needs and goals D. The nurse's knowledge base and experience level

C. The client's identified needs and goals p. 269 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.

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? A. 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 B. The ability to provide technical nursing assistance to meet the needs of clients and their families C. The knowledge of how to communicate client priorities and the related plan of care as a client is transferred between different settings D. The ability to establish trusting professional relationships with clients, family caregivers, and health care professionals in different practice settings

C. The knowledge of how to communicate client priorities and the related plan of care as a client is transferred between different settings p. 269 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.

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? A. The chance for the oncoming nurse to assess the clients B. The oncoming nurse's opportunity to meet new clients C. The opportunity for the oncoming nurse to ask questions D. The oncoming nurse's chance to check intravenous (IV) sites and fluids

C. The opportunity for the oncoming nurse to ask questions p.269 Handoffs should always include a chance for the oncoming nurse to ask questions and to clarify anything that is unclear. The nurse should not expect an opportunity to assess the clients, check IV sites, or meet new clients prior to the previous nurse leaving. In instances where bedside report is given, the nurse may have some of these opportunities, but they are not required in a handoff.

When educating clients in the community on health promotion and prevention of disease, it is important to stress: A. strenuous exercise is necessary for health. B. the ideal location for education is in a health care institution. C. health education can benefit individuals and groups. D. health promotion may not be possible for many of the older members of a community.

C. health education can benefit individuals and groups. p. 265 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.

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: A. communicate to the next of kin so they are aware of the transfer. B. discuss the return to familiar surroundings with the client. C. provide for the coordination and continuity of care by the health care providers. D. ensure that the current health state of the client is maintained.

C. provide for the coordination and continuity of care by the health care providers. p. 269 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.

Public health nursing is the branch of nursing that: A. assesses individuals for community care. B. administers care for a defined geographic community. C. provides health care for the community. D. provides primary care to individuals.

C. provides health care for the community. p. 265 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.

The nurse understands that planning for discharge actually begins at admission to the facility. The purpose of discharge planning is best described as: A. decreasing stress for client and family members. B. ensuring client safety and health maintenance. C. providing continuity of care that is goal directed. D. promoting less dependence on others.

C. providing continuity of care that is goal directed. p. 269 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 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? A. The chaplain or minister B. The social worker C. The home health care aide D The registered nurse

D The registered nurse p. 284 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.

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? A. Have the physical therapist help the client with rehabilitation. B. Have the occupational therapist assess for the client's need for adaptive devices. C. Have the home health aide increase visits for bathing the client. D. Have the social worker visit the client to discuss care options.

D. Have the social worker visit the client to discuss care options. p. 269 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? A. Homemaking B. Intravenous therapy C. Pain management D. High-rise toilet seat

D. High-rise toilet seat p. 280Home 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.

When doing discharge planning for an older adult client who had a stroke, what is the nursing priority? A. Involve the family in discussing when the client will go home. B. Help the client after discharge to establish goals. C. Realize that goals may not be met after discharge. D. Plan reachable goals with the client and family.

D. Plan reachable goals with the client and family. p. 281 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.

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: A. visiting nurse from a clinic. B. resale or thrift shop. C. rental equipment store. D. social wellness office

D. Social wellness office p. 280 Nurses must be advocates for vulnerable populations such as pregnant teenagers. Advocacy involves community care coordination. The nurse should be familiar with available community resources, including those that can provide financial assistance to clients. The aim is to link clients with these resources in the community to enhance their well-being, to improve information exchange, and to reduce fragmentation and duplication of services. The best way to do that in this scenario is to refer the client to a social welfare office. The other answers would not meet the client's need for financial assistance.

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? A. The nurse determines who should be involved in the handoff communication. B. The nurse asks the other health care professionals if they have any questions. C. The nurse uses the SBAR technique during the handoff. D. The nurse prepares the new room for the client.

D. The nurse prepares the new room for the client. p. 269 - 270 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.

Continuity of care for a particular client is most important to prevent: A. rising health care costs. B. infection. C. multiple providers. D. fragmentation of services.

D. fragmentation of services. p. 274 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 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: A. call the client's family and have them discharge the client. B. restrain the client until a social worker can explain the possible results of the client's actions. C. call for a psychological consultation to see whether the client is mentally stable. D. notify the physician, discuss the outcomes of the client's decision, and have the client sign a release form.

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

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: A. home health care agency evaluates the client and determines the need for services. B. appropriate transfer forms are completed. C. social worker assesses the need and Medicare agrees to pay for home health care services. D. physician writes an order for home care.

D. physician writes an order for home care. p. 283 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.