Chapter 12 Prep U
Public health nursing is the branch of nursing that: Community based nursing is nursing that:
-Provides health care for the community -Provides health care for defined geographic community.
Home health care nurses are required to complete the Outcome and Assessment Information Set (OASIS) by which entity? -Medicare -Medicaid -Private insurance -All insurances
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 is the largest single source of reimbursement for home health care services?
Medicare other sources of reimbursement may include medicaid, private insurance, self pay, and other public fund.
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 would need to obtain a higher level degree for the higher level critical care skills." "The client and family are in control of the setting, not the nurse." "You do not have to collaborate with the others when making decisions."
"The client and family are in control of the setting, not the nurse."
Which circumstance likely requires the most documentation and communication on the part of the nurse? -Transfer from one unit in the hospital to another -Transfer from hospital to home -Transfer from hospital to long term care
-A geriatric client is being transferred from a subacute medical unit to a new long-term care facility following recovery from pneumonia. 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 discharging a client who is living with diabetes. Which education topic(s) will the nurse discuss with the client and caregiver? Select all that apply. -How to find a dietitian from home for meal plans -A review of the appointment schedule for follow-up care -Information about home care and physical therapy with appropriate phone numbers -The timing and appropriate method of administration of all medications -How to perform dressing changes
-A review of the appointment schedule for follow-up care -Information about home care and physical therapy with appropriate phone numbers -The timing and appropriate method of administration of all medications -How to perform dressing changes 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 the client needs help from the dietitian, the nurse should make the referral prior to discharge.
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? -Call in a physical therapist -Call in home health aide -Call in occupational therapist -Call in social worker
-Call in a social worker the social worker will observe what the client needs and get them in touch with what they need to do. Do to the question not being specific on what the patient needs (rehab, bathing, etc) we dont need the care of the others as of right now.
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 feelings with family and friends -Encourage to allow religious leaders to visit -Encourage the client to increase activity
-Communicate feelings; family and friends need to understand the clients feelings to help them and understand.
A home health care nurse develops a client's individualized plan of care during the: -pre-entry phase. -entry phase.
-Entry 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.
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 -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.
The home care nurse asks the client and family about their socioeconomic status, culture, and beliefs. Which is the best response by the nurse when the family asks why those questions are being asked? -I have to ask because it is required in ever referral to home care -I want to understand what your desires are
-I want to understand what your desires are. During the assessment phase of home care visits, nurse get subjective info about how the home is managed, home like, family, and community support. Nurse also explores beliefs and culture, capabilities, concerns, deficits, and limitations.
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. -Insist that the client sign an against medical advice form before leaving. -Inform the client of the risks of leaving. -Witness the client's signature on the against medical advice form. -The nurse should tell the client he cant leave
-Inform the client of the risks of leaving. -Witness the client's signature on the against medical advice form. - 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 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? -Enlist the services to the clients family for some components of care, such as dressing changes and physical therapy -Refer to a social worker to determine eligibility and assistance -Discuss alternative therapies with provider
-Social worker assist in finding and connecting the client with community resource and financial resources.
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 -Transportation -Psychosocial support -Medication administration
-Support system A client who has had bowel surgery, particularly 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.
Which role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client? -Advocate -Director or coordination -Educator -Caregiver
-educator, the nurse is providing teaching, demonstration, to the family. -Caregiver would be obtaining a sputum specimen. -Advocate would be protecting and supporting the clients rights. -Coordinator would be direct care to the client and services of other healthcare providers.
Prior to the discharge of a client who is recovering from a stroke from an acute care facility, the nursing case manager has the nursing staff, client, client's family, physical therapist, and home health nurse meet. The most likely purpose of this meeting is to:
-prepare the client for home care. -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.
The nurse understands that planning for discharge actually begins at admission to the facility. The purpose of discharge planning is best described as:
-providing continuity care that is goal oriented.
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. -the client has refused to have resuscitation measures. -client has a plan in care in place. -client has assigned a relative to act on the client's behalf.
1 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 client'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.
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 strong support system; this could meet the clients needs for medication management, transportation and psychosocial support.
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? -physician -rn -case manager -hospital discharge planners
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.
The home health care nurse is providing information to a client and family on medication changes. What role is the nurse performing? -Caregiver -Educator -Advocate -Coordinator of services
Client and family educator -Caregiver; develops and implements a plan of care -Advocate; protects and supports the client -Coordinator of services; use effective communication skills with other health care providers whole coordinating services.
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 longer periods of time -Clients are locked into payment rates that have remained unchanged -Clients use of ambulatory care has decreased -Clients with high home care needs are sent home
Clients with high home care needs are discharged into the community. This is increading the need for home health care workers.
Which qualities are essential for a community-based nurse? Select all that apply. -Ability to delegate client care tasks to unlicensed assistive personnel -Effective communication skills -Keen physical assessment skills -Strong knowledge foundation -Assist in minor surgeries
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.
Which are components of the nursing case management process? Select all that apply. Prescribing medications Monitoring medical progress Making referrals Filing and completing paperwork Coordinating driving a client to appointments
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.
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 how then have the daughter perform it. -Also provided in written
A registered nurse is providing community-based health care for a client diagnosed with early onset dementia. Which strategy is best for the nurse to employ to facilitate the family participating in the client's care?
Encourage active participation of the client and family in health care decisions. -due to it being community based the nurse should include as many family and friends as possible
The nurse is assessing the birth rates and death rates of the local municipality and comparing these rates to those of the nation and the world. Which type of nursing is this nurse practicing? -Research nursing -Community health nursing -Home health nursing -Parish nursing
Examining birth rates and death rates of a community is the focus of community health nursing, also known as public health nursing. Community health nursing focuses on the health of populations in the community. Research nursing is more comprehensive than just the gathering of data and would involve analyzing the data obtained. Home health nursing focuses on the care of the individual client and family in the home environment, performing a skilled nursing service as a registered nurse. Parish nursing is a form of community health nursing but does not include the gathering of data regarding populations.
Continuity of care for a particular client is most important to prevent: -Fragmentation of services -A client from needing the services of multiple providers -Directly prevent infection -Help prevent rising health care cost
Fragmentation of services, continuity of care is the provision of health care services without disruption.
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? -Sign a discharge form -Sign a AMA form -Sign a consent form -Give a copy of the care plan
Have the client sign an ama form by signing the form it releases the hospital and physician of responsibility. The signature must be witnessed and the form goes into the client record. giving a copy of the plan is nice but it is not the most important. the others are incorrect.
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 -Day care -Respite care
Home care; home care are for those recovering from a illness, disabled, or chronically ill, need services to maintain adls. -acute and ambulatory are short term basis this patient needs long -Respite care is more for the caregivers
What is the priority nursing responsibility when transferring a client from one unit in the hospital to another?
Make sure to provide verbal report on the clients status to the admitting nurse even if the report is copied and given to the nurse you should verbalize it.
Which type of home healthcare agency is a local health department?
Official or public agency
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?
Provide accurate and complete communication to the new facility. Even if the client is bringing a file.
A nurse is caring for a 17-year-old pregnant client who is unable to afford health care. Which resources will the nurse access to obtain assistance for this client? -Tell the client to better management of money is required to care for infants. -Make a referral to the social services department -Make a referral to local welfare agency -Suggest asking family members for assistance
Social services department, social workers are educated to assist clients in such situation
A client is receiving home health services after having a stroke and being hospitalized. After a thorough assessment of the home environment and the client, what would indicate to the nurse that there is an impairment in the client's home management? -The client's caregiver is absent whenever the nurse visits and the client is alone. -The nurse having to reschedule an appointment -Refusal of care by the client -Slipping in the hospital
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.
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 the health status of the individual -provide for the coordination and continuity of care by the health care providers. -notify the next of kin of the transfer
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.
Why is it important for the home health nurse to inform the health care agency of the nurse's daily itinerary? -Payment -Notify itinerary change -Safety -Cancelations
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.
Continuity of care is an important concept for quality nursing practice. The responsible nurse understands the best description of the process of continuity of care is to:
coordinate uninterrupted care and facilitate transfer between units and levels of care. -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.