FUNDS EXAM CH.12
The community based nurse is assessing a new patient and their home environment. What is a responsibility of the community-based nurse at this initial visit? a) Encourage the patient and their family to contact appropriate community resources. b) Encourage the patient and their family to use the internet to find local resources. c) Encourage the patient and their family to contact their church as a resource. d) Encourage the patient and their family to use local stores to support their community.
a) Encourage the patient and their family to contact appropriate community resources. During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because a home-health nurse would not encourage the patient to support the community; they would not necessarily encourage the patient to use their church as a resource or to use the internet to find their own local resources. They would provide the patient with the applicable local resources.
Which activities does the nurse engage in during the pre-entry phase of the home visit? Select all that apply. a) Gather supplies for the visit. b) Review client's treatment orders. c) Develop an individualized plan of care. d) Establish rapport with client and family. e) Evaluate the safety of the neighborhood.
a) Gather supplies for the visit., b) Review client's treatment orders., e) Evaluate the safety of the neighborhood. During the pre-entry phase of the home visit, the nurse would review client information, including client's diagnoses, surgical experience, socioeconomic status, and treatment orders. The nurse would evaluate the safety of the neighborhood and gather supplies in preparation for the visit. During the entry phase, the nurse makes a home visit to establish rapport with the client and family. The nurse makes an assessment, determines nursing diagnoses, establishes desired outcomes with input from the client and family, implements prescribed care, and provides education.
A client has had a total knee replacement and will need to walk with crutches for six weeks. The client is being discharged home with a referral for home health care. What will the home care nurse need to assess during her initial assessment? a) Home environment b) Previous health status c) Costs of the visits d) Assistance of neighbors
a) Home environment The initial assessment includes evaluating the client, the home environment, the client's self-care abilities or the family's ability to provide care, and the client's need for additional resources. There is no assessment made of assistance on the part of neighbors, the previous health status, or the costs of the visit.
Which of the following measures should a home health care nurse implement into his or her practice to minimize the potential for lawsuits? a) Perform thorough, accurate, and timely documentation. b) Integrate the client's learning needs and goals into plans of care. c) Apply more conservative interventions than those used in a hospital setting. d) Have the client sign a waiver prior to the entry phase of a visit.
a) Perform thorough, accurate, and timely documentation. 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-patient 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.
A single parent age 17 years, with one child and pregnant with her second child, has the mental age of a 12-year-old. What is the home care nurse's greatest concern in caring for this woman? a) her cognitive ability to understand b) her ability to receive financial aid c) her physical care abilities d) her ability to bond with her children
a) her cognitive ability to understand Regarding all aspects of her survival, the cognitive ability of this young woman is of greatest concern. The cognitive ability to understand how to organize work, manage financial responsibilities, and ensure safety within the home is essential.
A client is diagnosed with mild dementia while in the hospital. In preparing for discharge, what should the nurse discuss with the family? a) the possible need for home care b) the lack of free resources of care c) legal responsibility for the future d) the need for transfer to a long-term care facility
a) the possible need for home care The needs of the client should be considered when making discharge plans. Common risk factors associated with the need for home care include limited social, mental, or physical functioning. Legal issues, long-term care, and free resources are not indicated in this situation.
A discharge nurse is evaluating patients and their families to determine the need for a formal discharge plan or referrals to another facility. Which patients would most likely be a candidate for these services? Select all that apply. a. An older adult who is diagnosed with dementia in the hospital b. A 45-year-old man who is diagnosed with Parkinson's disease c. A 35-year-old woman who is receiving chemotherapy for breast cancer d. A 16-year-old boy who is being discharged with a cast on his leg e. A new mother who delivered a healthy infant via a cesarean birth f. A 59-year-old man who is diagnosed with end-stage bladder cancer
a, b, f. The patients who are most likely to need a formal discharge plan or referral to another facility are those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson's disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.
A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply. a. Making accurate assessments b. Researching new treatments for chronic diseases c. Communicating effectively d. Delegating tasks appropriately e. Performing clinical skills effectively f. Making independent decisions
a, c, e, f. Nurses working in the community must have the knowledge and skills to make accurate assessments, work independently, communicate effectively, and perform clinical skills accurately. Community-based nurses may be researchers and occasionally delegate care, but these are not key qualities for this type of nursing.
A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer? a. Provide a verbal report to the nurse on the new unit. b. Provide a detailed written report to the unit secretary. c. Delegate the responsibility for providing information. d. Make a copy of the patient's medical record.
a. The ICU nurse gives a verbal report on the patient's condition and nursing care needs to the nurse on the new unit. This information is not given to a unit secretary, nor is its provision delegated to others. The medical record is transferred with the patient; a copy is not made.
Which role is the home health nurse exhibiting when demonstrating how to suction the oropharynx of the client? a) Care coordinator b) Educator c) Caregiver d) Advocate
b) Educator The home healthcare nurse provides teaching, such as demonstration of a skill, to the family as a client educator. The home healthcare nurse develops and implements the plan of care in the caregiver role, such as obtaining a sputum specimen. As a client advocate, the home healthcare nurse protects and supports the client's rights. The home healthcare nurse coordinates direct care to the client and services of other healthcare providers.
The nurse is assigned to care for a client who will be transferred to the rehabilitation unit in the hospital following his postoperative recovery from hip surgery. What is the priority nursing responsibility when transferring a client from one unit in the hospital to another? a) Bring all the client's belongings to the new unit. b) Provide a verbal report of the client's status to the admitting nurse. c) Transport the completed client chart to the receiving 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. 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 her care. After assessing the client, the home health care nurse determines that the client needs assistance with financial concerns. The nurse would enlist the support of which member of the home health care team? a) Home health aide b) Social worker c) Physical therapist d) Occupational therapist
b) Social worker Social workers assist in finding and connecting the client with community resources or financial resources, and provide counseling and support. A physical therapist would assist with groups, restoring mobility, strengthening muscles to perform activities of daily living, and teaching ambulation with new devices. A home health aide provides hygiene care, cooking, supervision, and companionship. An occupational therapist would help the client adjust to limitations by teaching new vocational skills and better ways to perform activities of daily living.
The nurse is preparing to discharge a client. What education by the nurse should be performed prior to the discharge? a) information about home care/physical therapy with appropriate phone numbers. b) a review of the appointment schedule for follow-up care. c) when to take medications, their purpose, side effects, and appropriate administration. d) a family member's practice of dressing changes. e) how to contact the dietitian from home for meal plans.
b) a review of the appointment schedule for follow-up care., c) when to take medications, their purpose, side effects, and appropriate administration., d) a family member's practice of dressing changes., a) information about home care/physical therapy with appropriate phone numbers. Client education prior to discharge is essential and should include written information to support the lesson. This may include information about appointments, medications, information regarding 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.
Despite the presence of various types of public and private home health care agencies, one similarity among all home health care agencies is: a) the agencies are uniform in the way they are organized and administered. b) the agencies must meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs. c) the agencies must function as a not-for-profit organization. d) the agencies must demonstrate that they are affiliated with a hospital or other health care institution.
b) the agencies must meet uniform standards for licensing, certification, and accreditation by state agencies and/or federal programs. All home health care agencies are similar in that they must meet uniform standards for licensing, certification, and accreditation by the state agencies and/or federal programs (such as Medicare). They differ in the way they are organized and administered. Home care agencies may be official or public; voluntary or not-for-profit, private, proprietary; or institution-based.
A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply. a. Performing an admission health assessment b. Evaluating the nursing plan for effectiveness of care c. Participating in the transfer of the patient to the postoperative care unit d. Making referrals to appropriate facilities e. Maintaining records of patient satisfaction with services f. Assessing the strengths and limitations of the patient and family
b, d, f. The primary roles of the discharge planner as patients move from acute to home care are evaluating the nursing plan for effectiveness of care, making referrals for patients, and assessing the strengths of patients and their families. Although in smaller facilities a discharge planner may perform an admission health assessment and assist with patient transfers, it is not the usual job of the discharge planner. In most facilities, maintaining records of patient satisfaction is the role of the public relations manager or office manager.
Which statement or question MOST exemplifies the role of the nurse in establishing a discharge plan for a patient who has had major abdominal surgery? a. "I'll bet you will be so glad to be home in your own bed." b. "What are your expectations for recovery from your surgery?" c. "Be sure to take your pain medications and change your dressing." d. "You will just be fine! Please stop worrying."
b. The purpose of planning for continuity of care, commonly referred to in hospitals and community facilities as discharge planning, is to ensure that patient and family needs are consistently met as the patient moves from a care setting to home. Essential components of discharge planning include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the care plan; considering individual, family, and community resources; and evaluating the effectiveness of care. Answers a and c are not MOST reflective of the role of the nurse in discharge planning, although teaching and communication are elements of this process. The statement "You will just be fine! Please stop worrying." is a cliché and should not be used.
The home health care nurse is providing information to a client and family on medication changes. What role is the nurse performing? a) Coordinator of services b) Client advocate c) Client and family educator d) Caregiver
c) Client and family educator 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.
Which activity by the nurse exhibits the role of family educator? a) Supporting the client's wish to die at home. b) Obtaining a sputum specimen for laboratory testing. c) Demonstrating how to suction the oropharynx. d) Arranging for a swallowing evaluation by the speech pathologist.
c) Demonstrating how to suction the oropharynx. The home healthcare nurse provides teaching, such as demonstration of a skill, to the family as a client educator. The home healthcare nurse develops and implements the plan of care in the caregiver role, such as obtaining a sputum specimen. As a client advocate, the home healthcare nurse protects and supports the client's rights. The home healthcare nurse coordinates direct care to the client and services of other healthcare providers.
A registered nurse is providing community-based health care for a client and family. What would be most important for the nurse to do? a) Acknowledge that the client's health issues are independent of social issues. b) Determine outcomes that are based primarily on technology imperatives. c) Encourage active participation of the client and family in health care decisions. d) Ensure that the client is categorized as healthy if no disease is detected.
c) Encourage active participation of the client and family in health care decisions. 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 partnership based on respect, appreciation, and cooperation. The nurse's concern is for the health of the whole person, not just physiologic needs, but also psychosocial and spiritual needs in relation to the person's environment. The nurse should understand that health does not mean merely the absence of disease. It involves broader, quality-of-life issues. The nurse should acknowledge that health issues are not independent of social issues. Treatment effectiveness, rather than technology imperatives, drives decisions in such a setting.
Which activities does the nurse engage in during the entry phase of the home visit? Select all that apply. a) Review client's treatment orders. b) Educate the client and family about promoting self-care. c) Gather supplies for the visit. d) Establish rapport with client and family. e) Assess the client and home situation.
c) Gather supplies for the visit., d) Establish rapport with client and family., e) Assess the client and home situation., b) Educate the client and family about promoting self-care. During the pre-entry phase of the home visit, the nurse would review client information, including client's diagnoses, surgical experience, socioeconomic status, and treatment orders. The nurse would gather supplies in preparation for the visit. During the entry phase, the nurse makes a home visit to establish rapport with the client and family. The nurse makes an assessment, determines nursing diagnoses, establishes desired outcomes with input from the client and family, implements prescribed care, and provides education.
Which of the following is the largest single source of reimbursement for home health care services? a) Client's self-pay b) Private insurance c) Medicare d) Medicaid
c) Medicare 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.
The nurse is assigned to care for an older adult client who suffered a stroke. The client will soon be going home. When the nurse is actually doing the discharge planning, what is the nursing priority? a) Involve the family in discussing when the client will go home. b) Realize that goals may not be met after discharge. c) Plan reachable goals with the client and family. d) Realistically assist the client to establish what they want after discharge.
c) Plan reachable goals with the client and family. Goals are best met when mutually set by both the client and the nurse. If the client is involved in setting the goals, it is more likely that the expected outcomes of the plan will be met. The focus of the goal is with the client and not the family. Plan to work on reachable goals is more direct than assisting the client to determining goals before discharge. The nurse and client should work together. Waiting until after discharge to reach goals is not appropriate and timely.
A nurse is caring for a client who decides to leave the hospital against medical advice (AMA). The nurse knows that the client must sign a form before leaving. What is the purpose of the AMA form? a) To let the cafeteria staff know a meal will no longer be required b) To ensure the client knows he or she must still pay the bill c) To release the doctors and the institution from any legal responsibility d) To have relevant information all in one place in case the client is readmitted
c) To release the doctors and the institution from any legal responsibility A client who decides to leave the hospital against medical advice (AMA) must sign a form. This form releases the physician and the health care institution from any legal responsibility for his or her health status. The client is informed of any possible risk before signing the form. The client's signature must be witnessed, and the form becomes part of the client's record. The form does not address the financial component of the health care facility nor alerts the cafeteria that a meal is no longer needed for the client. Relevant information related to the client is in the medical record.
A nurse is caring for a 17-year-old pregnant woman who needs to obtain assistance with essential baby items, such as a crib. The client mentions that she does not have any income from a job. The nurse should encourage the client to go to a a) rental equipment store. b) visiting nurse from a clinic. c) social welfare office. d) resale or thrift shop.
c) social welfare office. 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 patients. The aim is to link patients with these resources in the community to enhance their well-being, to improve information exchange, and to reduce fragmentation and duplication of services.
A home health care nurse is scheduled to visit a 38-year-old woman who has been discharged from the hospital with a new colostomy. Which duties would the nurse perform for this patient in the entry phase of the home visit? Select all that apply. a. Collect information about the patient's diagnosis, surgery, and treatments. b. Call the patient to make initial contact and schedule a visit. c. Develop rapport with the patient and her family. d. Assess the patient to identify her needs. e. Assess the physical environment of the home. f. Evaluate safety issues including the neighborhood in which she lives.
c, d, e. In the entry phase of the home visit, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. In the pre-entry phase of the home visit, the nurse collects information about the patient's diagnoses, surgical experience, socioeconomic status, and treatment orders. In the pre-entry phase, the nurse also gathers supplies needed, makes an initial phone contact with the patient to arrange for a visit, and assesses the patient's environment for safety issues.
A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process? a. To assist with screening tests b. To provide patient teaching c. To assess what has been done and what still needs to be done d. To assist with hernia repair
c. Although all the actions may be performed by the ambulatory care nurse, it is the nurse's primary responsibility to assess what has been done and to tailor the care plan to the patient's needs. Screening tests and teaching are usually completed before the patient enters an ambulatory care facility.
A home health care nurse is discussing home health care during a presentation for a group of senior nursing students, as part of a Career Day seminar. One of the students asks, "How is home health care different from care in a hospital?" Which response by the nurse would be most appropriate? a) "It requires that you have high-level critical care skills." b) "You need a graduate degree to specialize in home health care." c) "Each team member works independently of other team members." d) "The client and family are in control of the setting, not the nurse."
d) "The client and family are in control of the setting, not the nurse." 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 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. Graduate degree and high-level critical care skills are not necessary. Collaboration among team members is essential.
The nurse is assigned to care for a middle-aged client who is very agitated and wants to go home. The client states that he does not have time to waste in the hospital, and no one is doing anything anyway. Which action by the nurse is most appropriate if the client insists on leaving the hospital against medical advice (AMA)? a) Obtain a copy of the client's care plan. b) Have the client sign the discharge form. c) Have the client sign a consent form. d) Have the client sign the AMA form.
d) Have the client sign the AMA form. The client is free to leave the hospital, but should be informed of the risks of leaving against medical advice (AMA). The client is required to sign a form releasing the hospital and physician of responsibility. The client is informed of any possible risk before signing the form. The client's signature must be witnessed, and the form becomes part of the client's record.
A nurse is transferring a client from a hospital setting to a long-term care facility. Which action is most important to ensure continuity of care for this client? a) carefully moving all the client's personal items b) notifying all departments of the room change c) asking family members to take home the client's jewelry, money, or other valuables d) Providing accurate and complete communication to the new facility.
d) Providing accurate and complete communication to the new facility. In order to ensure continuity of care for the client a detailed assessment and care plan is sent from the hospital to the extended care facility. Frequently, the nurse at the hospital often provides a verbal report to the nurse at the new facility using the approved handoff technique. Other departments should be notified of the client's discharge. Some personal items may be sent with the client to the long-term care facility, but this does not ensure continuity of care. The family members are asked to take the client's valuables home when the client is initially admitted to the hospital.
A client is having an increasing amount of difficulty caring for herself in her home alone. She states to the nurse, "I need more help. What am I going to do?" What would be important for the nurse to do? a) The nurse should have the occupational therapist assess for adaptive devices. b) The nurse should have the home health aide increase visits for bathing. c) The nurse should have the physical therapist help with rehabilitation. d) The nurse should have the social worker visit to discuss care options.
d) The nurse should have the social worker visit to discuss care options. 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 identify resources to meet the client's needs.
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 surroundings, call system, bathroom, bedside supplies, and where to place clothes. The priority is to: a) obtain the physician's orders. b) ask the nursing assistant to obtain vital signs. c) call the dietary department to get breakfast for the client. d) gather information and complete admission database.
d) gather information and complete admission database. The nurse's priority is to complete the admission of the client, and the history, assessment, and documentation.
A nurse is completing a home visit to an older adult client who is receiving regular dressing changes for the treatment of her venous ulcer. What outcome does the nurse hope to achieve in the plan of care for this client? a) to limit the progression of chronic health problems. b) to enable clients to make informed choices about their health. c) to prevent recurrent admissions to hospitals and other inpatient settings. d) to maximize the independence and health of clients.
d) to maximize the independence and health of clients. The goal of helping the client reach maximum independence and health is central to the philosophy and practice of home health care. This goal may encompass enabling client choices, preventing future admissions, or limiting the progression of existing diseases, but each of these measures is an expression of the larger goal of maximizing health and independence.
A nurse ensures that a hospital room prepared by an aide is ready for a new ambulatory patient. Which condition would the nurse ask the aide to correct? a. The bed linens are folded back. b. A hospital gown is on the bed. c. Equipment for taking vital signs is in the room. d. The bed is in the highest position.
d. A properly prepared hospital room includes a bed in the lowest position for an ambulatory patient, an open bed with top linens folded back, routine equipment and supplies and special equipment and supplies assembled, and the physical environment of the room adjusted.
A hospital nurse is admitting a patient who sustained a head injury in a motor vehicle accident. Which activity could the nurse delegate to licensed assistive personnel? a. Collecting information for a health history b. Performing a physical assessment c. Contacting the health care provider for medical orders d. Preparing the bed and collecting needed supplies
d. The nurse may delegate preparation of the bed and collection of needed supplies to unlicensed personnel but would perform the other activities listed.
A nurse is counseling an older woman who has been hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: "I don't like being in the hospital. There are too many bad bugs in here. I'll probably go home sicker than I came in." She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation? a. To inform the patient that only the primary health care provider can authorize discharge from a hospital b. To collect the patient's belongings and prepare the paperwork for the patient's discharge c. To request a psychiatric consult for the patient and inform her PCP of the results d. To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form
d. The patient is legally free to leave the hospital AMA; however, patients who leave the hospital AMA must sign a form releasing the health care provider and hospital from legal responsibility for their health status. This signed form becomes part of the medical record.
