Chapter 2

Nursing care is provided in an increasingly diverse variety of settings. Despite the variety in settings, some characteristics of professional nursing practice are required in any and every setting. These characteristics include which of the following?

Cultural competence

The community-health nurse has received a referral for a new patient who resides in a high-crime area. What is the most important request that the nurse should make of the agency to best ensure safety?

A colleague to accompany the nurse to visit

A home health nurse has completed a visit to a patient and has immediately begun to document the visit. Accurate documentation that is correctly formatted is necessary for which of the following reasons?

Accurate documentation ensures that the agency is correctly reimbursed for the visit

You are the community-based nurse who performs the role of case manager for a small town about 60 miles from a major health care center. When planning care in your community, what is the most important variable in community-based nursing that you should integrate into your planning?

Community resources available to patients

You are assessing a new patient and his home environment following the patients referral for community-based care. Which of the following is the most important responsibility that you, as a community-based nurse, have at this initial visit?

Encouraging the patient and his family to connect with appropriate community resources

Discharge planning is an integral part of community-health nursing and home health. Which of the following is prioritized in the discharge-planning process?

Identifying the patients specific needs

A home health nurse is conducting a home visit to a patient who receives wound care twice weekly for a diabetic foot ulcer. While performing the dressing change, the nurse realizes that she forgot to bring the adhesive gauze specified in the wound care regimen. What is the nurses best action?

Improvise, if possible, using sterile glaze and adhesive tape

A community health nurse in a large, urban setting is participating in a pilot project that will involve the establishment of a community hub. On what population should the nurse focus?

Individuals with vulnerable health

A community health nurse has scheduled a hypertension clinic in a local shopping mall in which shoppers have the opportunity to have their blood pressure measured and learn about hypertension. This nursing activity would be an example of which type of prevention activity?

Secondary prevention

A home health nurse has been assigned to the care of an 82 year-old woman who has been discharged home following hip replacement surgery. At what level of care is this nurse most likely practicing?

Tertiary prevention

A home health nurse is collaborating with a hospice nurse in order to transfer the care of a woman who has a diagnosis of lung cancer. To qualify for hospice care, the patient must meet what criterion?

The patient must be in the final six months of his or her life

An urban, community-based nurse is looking for community resources for a patient who has complex rehabilitation needs coupled with several comorbid, chronic health conditions. Where is the best place for the nurse to search for appropriate resources?

A community directory

A community health nurse is aware that restoration of health often depends on appropriate interventions performed early in the course of a disease. Which patient is most likely to seek health care late in the course of his or her disease process and deteriorate more quickly than other patients?

A patient who has been homeless for an extended period of time

A nurse is comparing some of the similarities and differences between the care that is provided in community- and hospital-based settings. What type of care is provided in both of these settings?

Ambulatory health care

A home health nurse is preparing to make the initial visit to a new patients home. When planning educational interventions, what information should the nurse provide to the patient and his or her family?

Available community resources to meet their needs

The home health nurse receives a referral from the hospital for a patient who needs a home visit for wound care. After obtaining the referral, what would be the first action the nurse should take?

Call the patient to obtain permission to visit

Your patient has had a total knee replacement and will need to walk with a two-wheeled walker for 6 weeks. He is being discharged home with a referral for home health care. What will the home care nurse need to assess during the initial nursing assessment in the home?

Characteristics of the home environment

You are admitting two new patients to your local home health care service. These patients live within two blocks of each other and both homes are in a high-crime area. What action best protects your personal safety?

Do not wear expensive jewelry

The nursing instructor is preparing a group of students for their home care rotation. In preparation, the group discusses the patients that they are most likely to care for in the home. Which of the following groups are the most common recipients of home care services?

Elderly patients

You are a community-based care manager in a medium-sized community that does not have an up-to- date resource directory available. As a result, you have been given the task of beginning to compile such a directory. What would be important to include in this directory? Select all that apply.

Eligibility requirements for services, lists of most commonly used resources, costs associated with services

A home health nurse is conducting an assessment of a patient who may qualify for Medicare. Consequently, the nurse is utilizing the Outcome and Assessment Instrument Set (OASIS). When performing an assessment using this instrument, the nurse should assess which of the following domains of the patients current status?

Functional status

A home health nurse has completed a scheduled home visit to a patient with a chronic sacral ulcer. The nurse is now evaluating and documenting the need for future visits and the frequency of those visits. What question can the nurse use when attempting to determine this need?

Is that patient willing to participate in care?

At the beginning of a day that will involve several home visits, the nurse has ensured that the health care agency has a copy of her daily schedule. What is the rationale for the nurses action?

It supports safety precautions for the nurse when making a home care visit

A home health nurse has been working for several months with a male patient who is receiving rehabilitative services. The nurse is aware that maintaining the patients confidentiality is a priority. How can the nurse best protect the patients right to confidentiality?

Keep the patients medical record secured at all times

Medicare is a federal program that finances many Americans home health care expenses. The Medicare program facilitates what aspect of home health care?

Managing and evaluating patient care for seriously ill patients

A nurse who has an advanced degree in primary care for a pediatric population is employed in a health clinic. In what role is this nurse functioning?

Nurse practitioner

Infection control is a high priority in every setting where nursing care is provided. When performing a home visit, how should the nurse best implement the principles of infection control?

Perform hang hygiene before and after giving direct patient care

A nurse is collaborating with a team of community nurses to identify the vision and mission for community care. What is the central focus of community-based nursing?

Promoting and maintaining the health of individuals and families

A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles in their homes and the nurses own practices and beliefs. To work therapeutically with the patient, what must the nurse do?

Resolve to convey respect for the patients belief and choices

A home health nurse is making a visit to a new patient who is receiving home care following a mastectomy. During the visit, the patients husband arrives home in an intoxicated state and speaks to both you and the patient in an abusive manner. What is your best response?

Return to your agency and notify your supervisor

A nursing student has taught a colleague that nursing practice is not limited to hospital settings, explaining that nurses are now working in ambulatory health clinics, hospice settings, and homeless shelters and clinics. What factor has most influenced this increased diversity in practice settings for nurses?

Shift of health care delivery into the community

An adult patient is ready to be discharged from the hospital after undergoing a transmetatarsal amputation. When should your patients discharge planning begin?

The day that the patient is admitted

Within the public health system there has been an increased demand for medical, nursing, and social services. The nurse should recognize what phenomenon as the basis for this increased demand?

The growing number of older adults in the US

A recent nursing school graduate has chosen to pursue a community nursing position because of increasing opportunities for nurses in community settings. What changes in the health care system have created an increased need for nurses to practice in community-based settings? Select all that apply.

Tighter insurance regulation, changed in federal legislation, decreasing hospital revenues

There are specific legal guidelines and regulations for the documentation related to home care. When providing care for a patient who is a Medicaid recipient, what is most important for the nurse to document?

The patients homebound stays and the specific need for skilled nursing care

A community-based case manager is sending a community nurse to perform an initial home assessment of a newly referred patient. To ensure safety, the case manager must make the nurse aware of which of the following?

The potential for at-risk working environments

You are a school nurse who will work with an incoming kindergarten student who has a diagnosis of cerebral palsy. Why would you make a home visit before school starts?

To provide anticipatory guidance to the family

A school nurse has been working closely with a student who has cystic fibrosis. The nurse is aware that children with health problems are at major risk for what problem?

Underachievement in school

In two days you are scheduled to discharge a patient home after left hip replacement. You have initiated a home health referral and you have met with a team of people who have been involved with this patients discharge planning. Knowing that the patient lives alone, who would be appropriate people to be on the discharge planning team? Select all that apply.

home health nurse, physical therapist, social worker

A nurse is based in an automotive assembly plant and works with the plants employees in the areas of health promotion and basic primary care. What nursing role is this nurse performing?

occupational health nurse