Community PrepU (CC4)

The home care nurse is planning visits to the following patients: client newly diagnosed with diabetes, client with congestive heart failure (CHF) who gained 3 lb (1.36 kg) overnight and is experiencing dyspnea, postoperative client requiring a dressing change, and client on warfarin scheduled for monthly international normalized ratio (INR) testing. Drag and drop these clients into the order of visits, starting with the first visit of the day. 1 Client newly diagnosed with diabetes who requires teaching 2 Postoperative client requiring a dressing change 3 Client with CHF who had a weight gain overnight and experiencing dyspnea 4 Client on warfarin scheduled for monthly INR testing

3 Client with CHF who had a weight gain overnight and experiencing dyspnea 2 Postoperative client requiring a dressing change 1 Client newly diagnosed with diabetes who requires teaching 4 Client on warfarin scheduled for monthly INR testing

The community-health nurse has received a referral for a new client who resides in a high-crime area. What is the most important request that the nurse should make of the agency to ensure safety? a. An assigned parking space in the neighborhood b. A colleague to accompany the nurse on the visit c. An early morning or late afternoon appointment d. Someone to wait in the car while the nurse makes the visit

b. A colleague to accompany the nurse on the visit

A home care nurse is performing an initial visit for a client with congestive heart failure. Which questions or statements will the nurse include in the visit to assess the need for additional visits? Select all that apply. a. "Can you tell me about the medications you take?" b. "Do you need help to stand or walk?" c. "Do you live alone?" d. "Can you tell me the date of your last doctor's visit?" e. "Do you leave your home to perform errands?"

a. "Can you tell me about the medications you take?" b. "Do you need help to stand or walk?" c. "Do you live alone?" e. "Do you leave your home to perform errands?"

The home care nurse is finishing a visit with a client. What teaching points should the nurse cover with the client and client's family member prior to leaving? Select all that apply. a. A review of the teaching plan with written instructions b. Teach back instruction on new procedures or medication administration c. A review of the medications the client is currently taking d. Findings that need improving along with family homework e. Positive findings during the visit in order to provide encouragement

a. A review of the teaching plan with written instructions b. Teach back instruction on new procedures or medication administration e. Positive findings during the visit in order to provide encouragement

Discharge planning begins during which portion of a client's hospital stay? a. Admission b. 24 hours before discharge c. By the third hospital day d. The shift before discharge

a. Admission

The home care nurse is in the process of determining the need for future home visits. Which factors does the home care nurse need to consider? Select all that apply. a. Current health status of the client b. Existing cultural language barriers c. Cleanliness of the client's home d. Educational needs of the client e. Level of client self-care f. Mental status of the client

a. Current health status of the client d. Educational needs of the client e. Level of client self-care f. Mental status of the client

You are assessing a new patient and his home environment following the patient's 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? a. Encourage the patient and his family to connect with appropriate community resources. b. Encourage the patient and his family to focus primarily on online supports. c. Encourage the patient and his family to become more involved in their community. d. Encourage the patient and his family to delegate someone to contact community resources.

a. Encourage the patient and his family to connect with appropriate community resources.

Which of the following would be least helpful in ensuring the safety of a home care nurse? a. Making visits in the late evening hours b. Parking near the client's home c. Being familiar with exits from the home d. Having a charged cell phone readily available

a. Making visits in the late evening hours

The community health nurse is teaching a health care group levels of prevention. What is the nurse's foci with primary prevention? Select all that apply. a. Prevention of illness b. Health screening c. Self-care promotion d. Continuity of care e. Collaboration with health care providers

a. Prevention of illness c. Self-care promotion d. Continuity of care e. Collaboration with health care providers

Which statement corresponds with an action the nurse might take when providing home health care? a. The nurse uses a blood pressure cuff as a tourniquet to assist in locating a vein during a venipuncture. b. The nurse refuses to visit a client who lives in a roach-infested home. c. The nurse removes all high-sodium foods from the home of a client with congestive heart failure (CHF). d. Based on wound assessment, the nurse selects from a wide variety of dressing supplies.

a. The nurse uses a blood pressure cuff as a tourniquet to assist in locating a vein during a venipuncture.

Which action should a nurse perform to avoid disrupting family routine when visiting to provide home care? a. Keep all client information confidential during the visit. b. Avoid coming during mealtimes. c. Obtain directions to the home. d. Greet the client and any other family members present at the door.

b. Avoid coming during mealtimes

A home care nurse is planning a first client visit. While reviewing the referral information, the orders are not clear. What priority action will the nurse take? a. Visit the client and call the provider during the visit. b. Contact the referring agency. c. Contact the provider on the orders. d. Visit the client and clarify after needs are assessed.

b. Contact the referring agency.

When assisting a community after a hurricane, the nurse determines that the community members are in the disillusionment phase of disaster recovery. What is the most appropriate intervention by the nurse when working with individual members? a. Remind them that everyone is doing the best they can. b. Encourage them to verbalize their feelings. c. Remind them that they are lucky to be alive. d. Encourage them to contact family members

b. Encourage them to verbalize their feelings.

An advance practice nurse is preparing to write a grant for a local homeless shelter. Based on the nurse's knowledge that the population of homeless people is growing, what topic will the nurse include in the funding request? a. Obesity b. Immunizations c. Driver's education d. Skin cancer

b. Immunizations

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 the nurse's daily schedule. What is the rationale for this action? a. It allows the agency to keep track for billing purposes. b. It supports safety precautions for the nurse when making a home care visit. c. It allows for greater flexibility for the nurse and his or her colleagues for changes in assignments. d. It allows the client to cancel or change appointments with minimal inconvenience.

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

The nurse is working in an ambulatory health clinic. What is the focus of community-based nursing practice? a. Adapting hospital care to the home environment for less cost b. Promoting and maintaining population health and preventing and minimizing disease progress c. Delivery of hospice services for clients with terminal illness d. Monitoring clients at home because clients do not have hospital insurance coverage e. Providing rehabilitation and restorative services

b. Promoting and maintaining population health and preventing and minimizing disease progress

A home care nurse has just received a referral for home care services. Which of the following should the nurse do first? a. Check the home care agency's policies about how to make a visit. b. Review the referral form for the pertinent information. c. Contact the referring agency to confirm receipt of the referral. d. Telephone the client to determine a visit schedule.

b. Review the referral form for the pertinent information.

Which nursing action is appropriate for a home care nurse? a. Organizing a free breast cancer screening for homeless women b. Teaching pursed-lip breathing to a client diagnosed with chronic obstructive pulmonary disease (COPD) c. Volunteering to administer flu vaccinations and the local free clinic d. Writing a grant to obtain funding to establish a homeless shelter

b. Teaching pursed-lip breathing to a client diagnosed with chronic obstructive pulmonary disease (COPD)

The nurse evaluates a family to see if they are a good candidate for home care for a sick child. Which factor would be most important to see in the prospective family's home? a. An above-average income b. Nearby fire department c. A dedicated home-care provider d. A one-floor building plan

c. A dedicated home-care provider

A nurse is reviewing the medical record of a client to determine his eligibility for home care services. Which of the following would alert the nurse to a potential problem in this area? a. Client requires instructions about administering insulin injections. b. Client is discharged from the facility after open heart surgery. c. Client attends social groups at a senior center three times a week. d. Client requires sterile dressing changes to an abdominal wound.

c. Client attends social groups at a senior center three times a week.

Which client at the community mental health clinic should the nurse refer for immediate inpatient hospitalization? a. Client who is displaying a posture in an odd fixed position b. Client who has a tendency to speak very little c. Client who is hearing voices telling him or her to kill one's parents d. Client who is performing repetitive, idiosyncratic movements

c. Client who is hearing voices telling him or her to kill one's parents

The home health nurse has been working with an elderly client with limited means who required long-term wound care. The client's wound is almost healed and the client tells the nurse that he will be sorry when she no longer comes around. He reveals that he no longer has anyone to take him to the grocery store and he just can't keep the house up like he used to. He also tells the nurse that he would like to be able to participate in some social activities. The nurse knows that what type of healthcare setting would be most appropriate for this client at this time? a. Boarding home b. Intermediate care facility c. Congregate housing d. Assisted living facility

c. Congregate housing

A nurse is working as part of a team developing a community-based care program for the local homeless population. Which of the following would be important to keep in mind when developing the program? Select all that apply. a. Most homelessness is chronic. b. The homeless population is a relatively homogenous group. c. Health problems are often related to a person's living situation. d. Homeless people often have no or insufficient health insurance. e. Ill homeless people often deteriorate more rapidly than those who are not homeless.

c. Health problems are often related to a person's living situation. d. Homeless people often have no or insufficient health insurance. e. Ill homeless people often deteriorate more rapidly than those who are not homeless.

A client has end-stage chronic obstructive pulmonary disease (COPD) and is terminally ill. The family wants the client to spend her last days in a facility that will be able to keep the patient comfortable and control her severe dyspnea. What facility will meet the needs of the client and family? a. Rehabilitation care b. Intermediate care facilities c. Hospice care d. Ambulatory care

c. Hospice

A home health nurse is conducting a home visit to a client 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 nurse's best action? a. Phone a colleague to bring the required supplies as soon as possible. b. Schedule a return visit for the following day. c. Improvise, if possible, using sterile gauze and adhesive tape. d. Leave the wound open to air and teach the client about infection control.

c. Improvise, if possible, using sterile gauze and adhesive tape.

The community health nurse is preparing to conduct a home visit. When performing the home visit, how should the nurse best implement the principles of infection control? a. Use transmission based precautions with each client. b. Remove the client's soiled wound dressings from the home promptly. c. Perform hand hygiene before and after giving direct client care. d. Establish a sterile field in the client's home before providing care.

c. Perform hand hygiene before and after giving direct client care

After making the initial home visit, a nurse develops a plan of care for a client with diabetes. As part of the plan of care, the nurse identifies the nursing diagnosis "deficient knowledge related to daily insulin administration for diabetic self-care." Which outcome would be most appropriate? a. The client will state the proper steps for insulin administration. b. The client will give himself an insulin injection. c. The client will demonstrate independence in daily insulin self-administration. d. The client will improve his ability to self-administer insulin.

c. The client will demonstrate independence in daily insulin self-administration.

A home care nurse is approached by the client's neighbor while walking to the car after visiting the client. The neighbor asks, "What's wrong with Tom? Is he sick?" How should the nurse respond? a. "I'm a nurse caring for Tom but can't talk now. Here is my contact information for questions." b. "I'm a nurse caring for Tom, but you should ask his wife about his condition." c. "I'm a nurse caring for Tom. I can say he is improving dramatically." d. "I'm a nurse caring for Tom, but I cannot tell you anything about his condition."

d. "I'm a nurse caring for Tom, but I cannot tell you anything about his condition."

A nurse is evaluating a client's discharge collaboration between the referring agency and the home care agency. What response by the client would indicate an understanding of the discharge planning process? a. "My wife sat down with the discharge planner and established realistic and measurable goals for my recovery." b. "The doctor provided a list of behavioral outcomes for me and the nurse faxed them to the home care agency." c. "My daughter is my health care power of attorney and she decided when I left the hospital and selected my home care provider." d. "The nurse helped me make a list of my needs and goals for recovery and shared them with the home care team"

d. "The nurse helped me make a list of my needs and goals for recovery and shared them with the home care team"

A client has had a total knee replacement and will need to walk with a two-wheeled walker for 6 weeks. The client is being discharged home with a referral for home health care. What assessment should the nurse prioritize during the initial nursing assessment in the home? a. Assistance of family and neighbors b. Qualification for government subsidies c. Costs related to the visits d. Characteristics of the home environment

d. Characteristics of the home environment

A home care nurse is assessing a client's need for home visits. Which of the following would the nurse use as the primary determinant for future visits? a. Agency's policies b. Client's insurance provider c. Available community resources d. Client's current health status

d. Client's current health status

Which type of care is used for clients with terminal illness who have a life expectancy of less than 6 months? a. Skilled nursing care b. Ambulatory care c. Intermediate care d. Hospice care

d. Hospice care

A client is being discharged home after a hemorrhagic stroke. To which discipline should the nurse case manager make a referral to improve the client's ability to perform activities of daily living? a. Physical therapy b. Speech therapy c. Case management d. Occupational therapy

d. Occupational therapy

Which of the following is a true statement regarding safety during a home visit? a. The nurse should park his or her car away from the home. b. The nurse should take reactive measures. c. The nurse should schedule visits according to the patient's lifestyle. d. The nurse should never walk into a patient's home uninvited.

d. The nurse should never walk into a patient's home uninvited.

The goal of OSHA is a. To enhance achievement in school. b. To create nursing interventions to evaluate health care needs. c. To provide cost-effective health insurance. d. To ensure safe work conditions.

d. To ensure safe work conditions