Chapter 08 My Nursing Test Banks

Kozier & Erbs Fundamentals of Nursing, 10/E
Chapter 08

Question 1

Type: MCMA

The nurse learns that two new home care agencies are opening in a community. What should the nurse consider as reasons why home care agencies are increasing in numbers?

1. The need for custodial care

2. Third-party payers who support cost control measures

3. The increase in the older adult population

4. The decreasing need for acute care

5. The focus on the needs of the community

Correct Answer: 2, 3

Rationale 1: A common misconception about home health nursing is that it is custodial in its scope of practice.

Rationale 2: Factors that have contributed to the growth of home care services include third-party payers that favor home care to control costs.

Rationale 3: Factors that have contributed to the growth of home care services include the increase in the older population.

Rationale 4: Acute care has not decreased, but the length of stay in acute care has.

Rationale 5: The focus of home health care nursing is individuals and their families.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Compare the characteristics of home health nursing to those of institutional nursing care.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 118

Question 2

Type: MCSA

During orientation with a home care agency, the nurse is learning the difference in care delivery between home health nursing and community nursing. What should the nurse understand as being the focus of home health care nursing?

1. Individuals, families, and groups

2. The individual and his or her family

3. The terminally ill client and his or her family

4. The client in a home setting

Correct Answer: 2

Rationale 1: Community health nursing focuses on individuals, families, and aggregate groups.

Rationale 2: The focus of home health care nursing is individuals and their families.

Rationale 3: Hospice nursing supports the care of the dying client and the clients family; this is not the focus of home health nursing.

Rationale 4: A home setting identifies the location of home health nursing, but not the focus.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum,

across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2. Compare the characteristics of home health nursing to those of institutional nursing care.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 118

Question 3

Type: MCSA

To help a home health client with a difficult medication regime, the nurse contacts the pharmacist for ideas to facilitate the process. Which behavior did the nurse demonstrate when caring for this client?

1. Hands-on care

2. Direct care

3. Advocacy

4. Indirect care

Correct Answer: 4

Rationale 1: Hands-on care includes physical assessments, dressing changes, and managing IV sites for therapies, which is not the scenario described here.

Rationale 2: Direct care is the same as hands-on care, which is not the scenario described here.

Rationale 3: Client advocacy is not the scenario described here.

Rationale 4: Indirect care is provided by the home health nurse to the client each time the nurse consults with other health care providers about ways to improve nursing care for the client.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 120

Question 4

Type: MCSA

A client being discharged needs physical therapy for progressive ambulation, wound care to treat a postoperative wound, and assistance with the payment of hospital bills. Before the nurse contacts a home care agency, who should write the order for the client to receive home care?

1. Physician

2. Nurse

3. Social worker

4. Physical therapist

Correct Answer: 1

Rationale 1: A client may be referred to home health care by providers, nurses, social workers, and therapists, but home care cannot begin without a physicians order and a physician-approved treatment plan. This is a legal reimbursement requirement.

Rationale 2: A client may be referred to home health care by providers, nurses, social workers, and therapists, but home care cannot begin with a nurses order.

Rationale 3: A client may be referred to home health care by providers, nurses, social workers, and therapists, but home care cannot begin with a social workers order.

Rationale 4: A client may be referred to home health care by providers, nurses, social workers, and therapists, but home care cannot begin with a social workers order.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3. Describe the types of home health agencies, including referral and reimbursement sources.

MNL Learning Outcome: 1.2.4. Compare the frameworks of care.

Page Number: 119

Question 5

Type: MCSA

During the first home care visit, the nurse determines that the client needs speech therapy, physical therapy, and custodial care several times a week. When should the nurse schedule the clients care to begin?

1. As soon as the nurse completes the initial assessment

2. As soon as the client agrees to the care

3. When the physician signs the plan of care the nurse develops

4. Within 48 hours of the nurses visit

Correct Answer: 3

Rationale 1: Completing the initial assessment identifies but does not initiate client care.

Rationale 2: The client agreeing to care indicates the clients involvement in the process but does not initiate care.

Rationale 3: At the initial visit, the nurse develops a plan of care that identifies the clients needs. This plan must by reviewed, approved, authorized, and signed by the attending physician before the home health agency providers can continue with services.

Rationale 4: Care might begin within 48 hours but initiation is dependent on many other factors.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 2. Compare the characteristics of home health nursing to those of institutional nursing care.

MNL Learning Outcome: 1.2.4. Compare the frameworks of care.

Page Number: 119

Question 6

Type: MCSA

A home health client has a complicated case involving occupational therapy, respiratory therapy, a dietitian, the nurse, and a nurses aide who provides assistance with bathing, housekeeping, and grocery shopping. Which care provider should be prepared to coordinate this clients care?

1. Physician

2. Nurse

3. Social worker

4. Home health agency

Correct Answer: 2

Rationale 1: Case coordination is essential but is not a physician responsibility.

Rationale 2: Because clients often require the services of several professionals, case coordination is essential and generally rests with the registered nurse.

Rationale 3: Case coordination is not the responsibility of a social worker.

Rationale 4: Case coordination is not the responsibility of a home health agency.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 121

Question 7

Type: MCSA

The nurse is hired to provide home care through a community agency that is operated by the state health department and financed by taxes. In which type of agency is this nurse employed?

1. Institution based

2. Private

3. Not-for-profit

4. Official

Correct Answer: 4

Rationale 1: Institution-based agencies operate under a parent organization such as a hospital and are funded by the same sources as the parent. That is not the situation described here.

Rationale 2: Private, proprietary agencies are for-profit organizations and are governed by either individual owners or national corporations. That is not the situation described here.

Rationale 3: Not-for-profit or voluntary agencies are supported by donations, endowments, charities such as the United Way, and third-party reimbursement. That is not the situation described here.

Rationale 4: Official or public agencies are operated by state or local governments and financed primarily by tax funds.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe the types of home health agencies, including referral and reimbursement sources.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 120

Question 8

Type: MCSA

While reviewing a health insurance plan, the nurse learns that a client has coverage for durable medical equipment (DME). What care need should the nurse identify as being covered by the clients health plan?

1. Dressings and bandages

2. Medications

3. A hospital bed

4. Visits by the home health nurse

Correct Answer: 3

Rationale 1: Supplies that the client uses and cannot be reused are not considered DME.

Rationale 2: Supplies that the client uses and cannot be reused are not considered DME.

Rationale 3: Durable medical equipment (DME) ranges from hospital beds to bedside commodes to ventilators and apnea monitors. Equipment that will not be used up is considered DME.

Rationale 4: Visits by the home health nurse are paid through a different aspect of the clients health care plan.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe the types of home health agencies, including referral and reimbursement sources.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 120

Question 9

Type: MCSA

The nurse would like to admit a client to home health care, but is worried about insurance reimbursement. What client action is causing the nurse to question if home care can be prescribed for this client?

1. Lives with a spouse

2. Needs skilled care

3. Needs intermittent care

4. Drives a car for trips to the barber

Correct Answer: 4

Rationale 1: Living with a spouse is allowed for reimbursement by insurance companies.

Rationale 2: Needing skilled care is allowed for reimbursement by insurance companies.

Rationale 3: Needing intermittent care is allowed for reimbursement by insurance companies.

Rationale 4: Clients must meet certain criteria, including homebound status, except for occasional outings. Barber trips are included as occasional outings, but the client is not the driver.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 3. Describe the types of home health agencies, including referral and reimbursement sources.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 120

Question 10

Type: MCSA

A client who has been the recipient of home health care has made the decision to discontinue hemodialysis. The client understands all the consequences of this decision and is not supported by his family. The nurse is meeting with the family to help them understand the significance of the clients decision and to help them support the client during this difficult time. In which role is the nurse functioning?

1. Caregiver

2. Advocate

3. Educator

4. Counselor

Correct Answer: 2

Rationale 1: The home health nurses major role as caregiver is to assess and diagnose the clients actual and potential health problems. That is not the role described here.

Rationale 2: As a client advocate, the nurse explores and supports the clients choices in health care. Advocacy includes having discussions about the clients rights, advance medical directives, living wills, and durable power of attorney for health care. At times, the clients views may vary from those of other family members. In the event of conflict, the nurse ensures that the clients rights and desires are upheld.

Rationale 3: The educator role focuses on teaching illness care, prevention of problems, and promotion of optimal wellness or well-being. That is not the role described here.

Rationale 4: Counselor is not a role for the home health nurse.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 120

Question 11

Type: MCSA

During a home visit, the client with terminal cancer undergoes respiratory arrest. The client has agreed to a DNR (do not resuscitate) order; however, the spouse tells the nurse to call 911. What action should the nurse take?

1. Assess vital signs.

2. Call 911.

3. Start CPR.

4. Remind the spouse of the clients desires.

Correct Answer: 4

Rationale 1: Assessment of vital signs does not address the immediate situation.

Rationale 2: In the event of conflict between the clients desires and the familys wishes, the nurse, being the clients primary advocate, ensures that the clients rights and desires are upheld. This is a difficult situation, but the nurse is bound to the clients desires. Calling 911 would not support the clients desires.

Rationale 3: In the event of conflict between the clients desires and the familys wishes, the nurse, being the clients primary advocate, ensures that the clients rights and desires are upheld. This is a difficult situation, but the nurse is bound to the clients desires. Starting CPR would not support the clients desires.

Rationale 4: In the event of conflict between the clients desires and the familys wishes, the nurse, being the clients primary advocate, ensures that the clients rights and desires are upheld. This is a difficult situation, but the nurse is bound to the clients desires.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 121

Question 12

Type: MCSA

During a home visit, the nurse explains the procedures for preventing infection in a central venous access device to the spouse who watches while the nurse hooks the client to the medication infusion. Which role is the nurse performing at this time?

1. Caregiver

2. Advocate

3. Educator

4. Coordinator

Correct Answer: 3

Rationale 1: The role of caregiver involves assessing and diagnosing actual or potential health problems, planning care, and evaluating the clients outcomes. That is not the role described here.

Rationale 2: The advocate role ensures that the rights and desires of the client are upheld. That is not the role described here.

Rationale 3: Education can be the most essential aspect of home care practice, the goal of which is to help clients learn to manage as independently as possible. Involving the spouse in care and educating the spouse along with the client promotes wellness and helps prevent problems.

Rationale 4: The home health nurse coordinates the activities of all other home health team members involved in the clients treatment plan. That is not the role described here.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 121

Question 13

Type: MCSA

While assessing a clients environment for safety concerns, the nurse finds that most of the rooms in the house have only one outlet with various cords entering the outlet. When this concern is shared with the client and spouse, they state that this is the way weve lived for years. What should the nurse do?

1. Provide telephone numbers for local electricians.

2. Continue to persuade the client to have the home rewired.

3. Not bring the subject up again.

4. Document the findings and the client and spouses response to the concern.

Correct Answer: 4

Rationale 1: Although not inappropriate, this option is not likely to be acted upon by the client.

Rationale 2: Home health nurses cannot expect to change a familys living space and lifestyle, and such an intervention may be resented by the client.

Rationale 3: The nurse has an obligation to bring safety issues to the clients attention.

Rationale 4: Home health nurses cannot expect to change a familys living space and lifestyle. However, they can express concern when a situation suggests the possibility for injury. Nurses must document information they provide and the familys response to instruction as well as make ongoing assessments about the familys use of safety precautions.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring

NLN Competencies: Quality and Safety; Practice; Encourage patients and families to communicate their observations and concerns regarding safety

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Discuss the safety and infection control dimensions applicable to the home care setting.

MNL Learning Outcome: 4.1.1. Recognize factors that affect client safety.

Page Number: 121

Question 14

Type: MCSA

A home health client lives alone in a small apartment and has only one phone, which is a land line. What safety recommendation should the visiting home health nurse make for this particular client?

1. Suggest that the client move to a nursing home or assisted living dwelling.

2. Recommend that the client be enrolled in an emergency response system.

3. Enroll the client in a program that places all of the clients vital medical information in one place for emergency personnel.

4. Have the client post a list of emergency numbers (fire, police, ambulance) near the phone.

Correct Answer: 2

Rationale 1: Making suggestions for the client to relocate may be a possibility, but this might be premature to suggest at this point.

Rationale 2: An emergency response system provides a small device with a help button that attaches to the clients wrist or is worn around the neck. The client can send a signal to a home base that would indicate if the client is in trouble (i.e., has fallen or become ill) and cant get to the phone. This system is particularly useful for clients who live alone.

Rationale 3: Having all of the clients medical information in one place is a helpful idea but does not address the concern of effective means of communication.

Rationale 4: An emergency response system provides a small device with a help button that attaches to the clients wrist or is worn around the neck. The client can send a signal to a home base that would indicate if the client is in trouble (i.e., has fallen or become ill) and cant get to the phone. This system is particularly useful for clients who live alone. Making suggestions for the client to relocate may be a possibility, but this might be premature to suggest at this point. Having emergency numbers in a visible spot is a helpful idea but does address the concern of effective means of communication.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring

NLN Competencies: Quality and Safety; Practice; Encourage patients and families to communicate their observations and concerns regarding safety

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Discuss the safety and infection control dimensions applicable to the home care setting.

MNL Learning Outcome: 4.1.1. Recognize factors that affect client safety.

Page Number: 122

Question 15

Type: MCSA

The home health nurse has scheduled a visit to a client who lives in a neighborhood that is known to be unsafe because of gang activity. Before going to the clients home, what should the nurse do?

1. Call for an escort.

2. Call the client to let the client know the nurse is on the way.

3. Ask if the client could meet the nurse at the agency.

4. Take a second nurse along on the visit.

Correct Answer: 1

Rationale 1: Some less desirable living locations pose safety concerns for the nurse. Many home health agencies have contracts with security firms to escort nurses needing to see clients in potentially unsafe neighborhoods. If there is no such firm for escort, the police can also provide security for the nurse.

Rationale 2: Calling ahead to the clients home is routine practice, regardless of where the client lives.

Rationale 3: Having the client meet the nurse at the agency is inappropriate, especially if the client meets the criteria for home care.

Rationale 4: Taking a second nurse along may not be a realistic intervention.

Global Rationale:

Cognitive Level: Applying

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring

NLN Competencies: Quality and Safety; Practice; Encourage patients and families to communicate their observations and concerns regarding safety

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Discuss the safety and infection control dimensions applicable to the home care setting.

MNL Learning Outcome: 4.1.4. Use the nursing process to maintain a safe and effective client care environment.

Page Number: 122

Question 16

Type: MCSA

A home health nurse has a weekly visit to a client living in less than desirable cleanliness. The client has a central venous access device and requires weekly infusion therapy. What is the best way for the nurse to protect the client against infection?

1. Have the client wash her hands before the infusion begins.

2. Practice strict aseptic technique during the infusion process.

3. Help the client clean the room before starting the infusion.

4. Suggest that the client have a housekeeper come on the morning of the infusion.

Correct Answer: 2

Rationale 1: This intervention will not directly impact the minimization of the risk for infection because the client is not performing the infusion.

Rationale 2: Infection control can present a challenge to the home health nurse, especially if the home care facilities are not conducive to basic aseptic requirements. The most important ways to prevent infection are making sure the site is clean, accessing the port following sterile procedure, and following Standard Precautions while accessing the line.

Rationale 3: Even if the clients environment is not clean, that doesnt necessarily mean the client is unclean. There is another option that will impact the risk of infection.

Rationale 4: Teaching about health practices that prevent infection is important, but the nurse cannot expect to change the clients lifestyle.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 6. Discuss the safety and infection control dimensions applicable to the home care setting.

MNL Learning Outcome: 4.1.4. Use the nursing process to maintain a safe and effective client care environment.

Page Number: 123

Question 17

Type: MCMA

The nurse is concerned that the spouse of a home care client with multiple sclerosis is experiencing caregiver role strain. What did the nurse observe to come to this conclusion?

1. The home appears cluttered.

2. The spouse expresses feelings of anger.

3. The spouse reports decreased energy.

4. The spouse reports that she is learning how to manage finances.

5. The client asks when the nurse will return for the next visit.

Correct Answer: 2, 3

Rationale 1: Evidence of caregiver role strain would be dramatic change in the home environments appearance. Clutter would not be a dramatic change.

Rationale 2: Feelings of anger are evidence of caregiver role strain.

Rationale 3: Reports of declining physical energy and insufficient time for caregiving indicate caregiver role strain.

Rationale 4: Learning how to manage finances is a positive statement and would not indicate caregiver role strain.

Rationale 5: Asking when the nurse will make the next visit is not an indication of caregiver role strain.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Psychosocial Integrity

Client Need Sub:

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 7. Identify ways the nurse can recognize and minimize caregiver role strain.

MNL Learning Outcome: 4.1.4. Use the nursing process to maintain a safe and effective client care environment.

Page Number: 123

Question 18

Type: MCSA

After completing an initial assessment, the nurse identifies teaching that the client will need. Why did the nurse identify learning needs for this client?

1. Lack of knowledge related to health conditions and self-care

2. The fact that there is little time to complete education in the acute care setting

3. The fact that teaching someone who is willing to learn is easier in the home

4. The need for reimbursement for education by Medicare

Correct Answer: 1

Rationale 1: One of the most common health issues that nurses address with clients in home care settings is lack of knowledge related to health conditions and self-care. Client education is considered a skill reimbursed by Medicare.

Rationale 2: Although this may be true in some situations, it is not the reason that education is a focus of home health nursing care. Not all home care clients come from acute care, and education is still implemented in this setting.

Rationale 3: Not all home clients are willing or ready to learn, even though they are in their own home environment.

Rationale 4: Client education is considered a skill reimbursed by Medicare.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Health Promotion and Maintenance

Client Need Sub:

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5. Identify the essential aspects of the home visit.

MNL Learning Outcome: 1.3.1. Use appropriate strategies to promote health.

Page Number: 124

Question 19

Type: MCSA

An older client being discharged from an acute care facility is prescribed home care. When should the home care nurse see the client to understand needs for safety and mobility?

1. At the initial home visit, in order to see the client in the home environment

2. While the client is still a patient in the acute care hospital

3. After the client has been home for a few days and can help the nurse decide what is needed

4. When the spouse is available to assist in the assessment

Correct Answer: 2

Rationale 1: Once the client is at home, the need for the devices will be immediate and the client may have to wait unnecessarily for the required items.

Rationale 2: Assessment for the older client being discharged to home health should be initiated while the client is in the hospital to determine the need for assistive devices or environmental changes before the client returns home.

Rationale 3: Waiting a few days is a delay that is not beneficial for the client, who requires these items upon arriving home.

Rationale 4: Waiting until the spouse is able to help is a delay that is not beneficial for the client, who requires these items upon arriving home.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settingsNLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 119

Question 20

Type: MCSA

A client has been receiving home care for several weeks. Which individual should the nurse realize is responsible for ensuring that the client is receiving care at the appropriate times and in the appropriate amounts?

1. Client

2. Nurse

3. Physician

4. Clients spouse

Correct Answer: 2

Rationale 1: Even though the client may become independent in self-care skills, assurance is not the clients responsibility.

Rationale 2: Even though the client and family may become independent in self-care skills, the home health nurse still has the ultimate responsibility to ensure that the client is receiving the prescribed therapy at the appropriate timed intervals. On subsequent home visits, the nurse observes the same parameters assessed on the initial visit.

Rationale 3: Even though the physician has responsibilities to the client, assurance in this area is not one of them.

Rationale 4: Even though family members may assume responsibility for a clients care, it is not their responsibility to assure appropriate care.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 121

Question 21

Type: MCMA

The nurse is attending a seminar that focuses on the changes within the home health care industry. Which statements that the nurse makes indicate an understanding of home care as a primary health service delivery system?

Standard Text: Select all that apply.

1. Its unfortunate that clients can be screened for illnesses in the privacy of their own home.

2. With people living well into their 70s and 80s, the healthcare system is being stressed immensely.

3. The cost of acute hospital-based health care has become an economic burden to most people.

4. A clients chronic cardiac problems can be monitored well with in-home health services.

5. It relieves so much stress when care can come to them instead of their going to the health provider.

Correct Answer: 2, 3, 4, 5

Rationale 1: Health preventative screening can be accomplished as a part of home care when needed.

Rationale 2: Numerous factors have contributed to trend toward home health care; among them is the increasing number of aging adult clients.

Rationale 3: Numerous factors have contributed to the trend toward home health care; among them is rising health care costs.

Rationale 4: Numerous factors have contributed to the trend toward home health care; among them is the growing emphasis on managing chronic illness.

Rationale 5: Numerous factors have contributed to the trend toward home health care; among them is the growing emphasis on managing stress for the chronically ill.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2. Compare the characteristics of home health nursing to those of institutional nursing care.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 118

Question 22

Type: MCMA

The nurse is taking a tour of a home care agency as part of the interview process. Which services should the nurse recognize as being provided through this health agency?

Standard Text: Select all that apply.

1. A case manager arranging services to meet the clients need for physical therapy after a fall

2. A nurse educating the pregnant teenager on the signs of premature labor

3. A durable supply company delivering a wheelchair to a client with spina bifida

4. A nurse assessing the feet of a homebound diabetic client

5. A grocery store delivering groceries to a client recovering from cancer surgery

Correct Answer: 1, 3, 4

Rationale 1: Home care today involves a wide range of health care professionals providing services, such as physical therapy, in the home setting to people who are recovering from an acute illness or injury, are disabled, or have a chronic condition.

Rationale 2: Pregnancy education would not be addressed in the home setting unless the pregnancy required bed rest.

Rationale 3: Home care today involves a wide range of health care professionals providing services, such as assistive devices, in the home setting to people who are recovering from an acute illness or injury, are disabled, or have a chronic condition.

Rationale 4: Home care today involves a wide range of health care professionals providing services, such as nursing care, in the home setting to people who are recovering from an acute illness or injury, are disabled, or have a chronic condition.

Rationale 5: Home care does not include non-professional services such as grocery delivery.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1. Define home health care.

MNL Learning Outcome: 1.2.2. Recognize the functions of health care agencies.

Page Number: 119

New Questions:

Question 23

Type: MCMA

The nurse has two older parents who were recently hospitalized at the same time and are being discharged home on the same day. What should the nurse do to ensure these family members receive the highest quality of care in the home?

Standard Text: Select all that apply.

1. Call off from work to provide care to both parents.

2. Adjust his or her personal schedule to provide care to the parents.

3. Move in with the parents until conditions are stabilized.

4. Determine if custodial support is needed for the parents.

5. Find out when the home care nurse is scheduled to arrive.

Correct Answer: 4, 5

Rationale 1: A particular challenge exists when the nurse is in a position to be a caregiver to a family member. The nurse may feel obligated to provide care, even when this is over and above regular employment responsibilities. The nurse should not call off from work to provide care to both parents.

Rationale 2: A particular challenge exists when the nurse is in a position to be a caregiver to a family member. The nurse may feel obligated to provide care, even when this is over and above regular employment responsibilities. The nurse should not adjust his or her personal schedule to provide care to the parents.

Rationale 3: A particular challenge exists when the nurse is in a position to be a caregiver to a family member. The nurse may feel obligated to provide care, even when this is over and above regular employment responsibilities. Moving in with the parents should not be done.

Rationale 4: A particular challenge exists when the nurse is in a position to be a caregiver to a family member. The nurse may feel obligated to provide care, even when this is over and above regular employment responsibilities. The nurse must have the opportunity to step back and experience the role and emotions of being a family membernot only those of being a nurse. Determining if custodial support is needed would be appropriate because the nurse is unable to provide this level of care.

Rationale 5: A particular challenge exists when the nurse is in a position to be a caregiver to a family member. The nurse may feel obligated to provide care, even when this is over and above regular employment responsibilities. The nurse must have the opportunity to step back and experience the role and emotions of being a family membernot only those of being a nurse. Finding out when the home care nurse is scheduled to arrive would be appropriate.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: I.B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings

NLN Competencies: Context and Environment; Practice; conduct population-based transcultural health assessments and interventions

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4. Describe the roles of the home health nurse.

MNL Learning Outcome: 1.2.1. Explore the various roles in nursing practice.

Page Number: 123

Question 24

Type: MCMA

During a home visit, the nurse is concerned that a client recovering from hip replacement surgery is at risk for falling in the home. What information from the home assessment did the nurse use to come to this conclusion?

Standard Text: Select all that apply.

1. Laminated floors highly polished

2. Scatter rugs in the kitchen and bathroom

3. Smoke detector battery low in the bedroom

4. Cleaning solution placed in an unlabeled jar

5. Expired medication in the bathroom cabinet

Answer: 1, 2

Rationale 1: Highly polished floors can be a safety hazard and increase the clients risk of falling.

Rationale 2: Scatter rugs are a safety hazard and can increase the clients risk of falling.

Rationale 3: Although a safety hazard, a low smoke detector battery will not increase this clients risk of falling.

Rationale 4: Although a safety hazard, placing a caustic substance in an unlabeled jar will not increase the clients risk of falling.

Rationale 5: Although a safety hazard, expired medications will not increase the clients risk of falling.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: I.B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management

AACN Essentials Competencies: II. 7. Promote factors that create a culture of safety and caring

NLN Competencies: Quality and Safety; Practice; Encourage patients and families to communicate their observations and concerns regarding safety

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6. Discuss the safety and infection control dimensions applicable to the home care setting.

MNL Learning Outcome: 4.1.1. Recognize factors that affect client safety.

Page Number: 122

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