Chapter 36: Home Health Nursing My Nursing Test Banks

Chapter 36: Home Health Nursing

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition

MULTIPLE CHOICE

1.What became effective in 1966 by an act of legislation that revolutionized home care?

a. Life insurance
b. Medicare
c. Private insurance
d. Social Security

ANS: B

When Medicare became effective in 1966, it revolutionized home care by changing it to a medical rather than nursing model of practice, defining and limiting services it would reimburse, and changing the payment source and even changing the reason home care was provided.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1165

OBJ: 2 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

2.A major change to Medicare reimbursement was implemented in 1983. The new system paid a set rate according to diagnosis. What was the new payment system based upon?

a. Interim payment systems
b. Diagnosis-related groups
c. Title XVIII
d. Title XIX

ANS: B

The new payment system introduced in 1983 provided reimbursement based upon set rates that were determined by diagnosis-related groups (DRGs).

PTS: 1 DIF: Cognitive Level: Application REF: Page 1165

OBJ: 2 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

3.How often must the homecare treatment plan be recertified in order for the patient to continue to receive services?

a. Every 3 days
b. Every 60 days
c. Every 10 days
d. Every 2 weeks

ANS: B

Medicare and Medicaid home care services are based on the medical model of treatment and depend on the physician for entry into the formalized system. Medicare requires a plan of treatment signed by the physician, outlining all disciplines, treatment, frequency, and duration. These orders must be recertified every 60 days.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1169

OBJ: 2 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

4.Nurses who work in home settings rather than a hospital setting require a different level of ability to be technically proficient, self-motivated, and innovative. This requires a higher level of what quality?

a. Knowledge
b. Performance
c. Independence
d. Cooperation

ANS: C

The independence of home care practice can be difficult for nurses who depend on the security of the institutional setting.

PTS: 1 DIF: Cognitive Level: Application REF: Pages 1169-1170

OBJ: 7 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

5.The LPN/LVN may provide many services to the patient in the home. Several of these are high-level skills. Under whose supervision should these high-level skills be directed and performed?

a. Physician
b. Family
c. Facility supervisor
d. RN

ANS: D

The LPN/LVN must always work under the supervision of an RN.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1170

OBJ: 7 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

6.For physical therapy services to be reimbursed by Medicare, what must be the goal of the therapy?

a. Preventive
b. Restorative
c. Maintenance
d. Educational

ANS: B

The goals of treatment must be restorative in order for Medicare to provide reimbursement. In some cases, the goals can be preventive or maintenance for other payer sources.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1171

OBJ: 5 TOP: Services KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

7.Speech therapy goals include minimizing speech disorders and maximizing rehabilitation of speech abilities. To be reimbursed by Medicare, who must provide these services?

a. Bachelors-level clinician
b. Speech therapist
c. Masters-level clinician
d. Physiatrist

ANS: C

To be reimbursed by Medicare, speech therapy must be provided by a masters-prepared clinician. Other payers will sometimes reimburse services provided by a bachelors-level clinician.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1171

OBJ: 5 TOP: Services KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

8.Medical social services focus on the emotional and social aspects of illness. What is another area of service?

a. Home problems
b. Marriage problems
c. Crisis intervention
d. Work problems

ANS: C

Coping with stress and crisis intervention are also part of medical social workers services.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1172

OBJ: 5 TOP: Services KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

9.If solely for this reason, Medicare will not cover home health aide visits. What is that reason?

a. Physical assistance
b. Physician orders
c. Personal care
d. Household chores

ANS: D

Medicare will not pay for visits made solely for household chores.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1172

OBJ: 5 TOP: Services KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

10.The patient, family, social service agency, hospital, physician, or another agency all can provide the entry point to the home health care system. What is the entry point for the home health care system called?

a. Recommendation
b. Survey
c. Referral
d. In-taking

ANS: C

The entry point for home health care system is by referral. This can come from the patient, family, social service agency, hospital, physician, or another agency.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1172

OBJ: 5 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

11.The initial evaluation and admission visit is made by an RN, who has been provided with general orders by a physician before the visit. This visit must be made within how many hours of the referral?

a. 4 to 8
b. 12 to 15
c. 18 to 24
d. 24 to 48

ANS: D

The initial evaluation and admission visit made by an RN must be made within 24 to 48 hours of the referral. In some cases, if nursing will not be providing any services, the physical therapist may conduct the admission visit.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1172

OBJ: 8 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

12.The evaluation and admission process for entry to the home health care system includes physical and psychosocial examination, explanation of the patients rights, and evaluation of family, home, and nursing interventions. What is the normal minimum time for the admission visit?

a. 30 minutes
b. 1 hour
c. 2 hours
d. 3 hours

ANS: B

The admission process typically takes a minimum of 1 hour.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1173

OBJ: 8 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

13.After the patient is admitted to the home health services system, a treatment plan is drafted cooperatively with the physician and is signed. A separate, detailed care plan is always required for which disciplines?

a. Registered nurse
b. Physical therapist
c. Home health aide
d. LPN/LVN

ANS: C

A separate, detailed care plan is always required for the home health aide.

PTS: 1 DIF: Cognitive Level: Application | Cognitive Level: Knowledge

REF: Page 1173 OBJ: 5 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

14.How long is the average home health care visit by the skilled nurse?

a. 10 to 15 minutes
b. 20 to 30 minutes
c. 30 to 45 minutes
d. 45 to 60 minutes

ANS: C

Skilled nursing visits typically take 30 to 45 minutes.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1173

OBJ: 6 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

15.Complete documentation is essential and must include an accurate picture of the type and quality of care given, as well as the effectiveness of the plan of care. Which model should be followed to best provide adequate documentation?

a. Caretaker
b. Nursing process
c. Home health care
d. Nursing efficiency

ANS: B

Documentation that follows the nursing process model provides an accurate picture of the type and quality of care.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1173

OBJ: 8 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

16.When should discharge planning begin for a patient receiving home care services?

a. A week before discharge
b. Two days before discharge
c. The day of discharge
d. On admission

ANS: D

Discharge planning for home care begins on admission.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1173

OBJ: 8 TOP: Discharge KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

17.When implementing quality assurancespecific criteria, measurements are developed for three criteria: structural, process, and outcome. How is this method of assessment different from previous methods?

a. It is objective
b. It is specific
c. It is subjective
d. It is generalized

ANS: A

In the past, measurements of quality in an agency, the care delivered, and the staff were all subjective. The quality assurancespecific criteria measurements are objective.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1174

OBJ: 4 TOP: Quality assurance KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

18.What is an eligibility requirement for an individual to qualify for Medicare services?

a. Retired
b. At least 65 years old
c. Low-income
d. Poor health

ANS: B

Beneficiaries of service must be at least 65 years of age.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1174-1175

OBJ: 9 TOP: Reimbursement KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

19.Medicaid pays for home care services for people who have low incomes. Who administers the Medicaid program?

a. Federal government
b. City government
c. State government
d. County government

ANS: C

Medicaid is administered by the state. Medicare is a federal program.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1175

OBJ: 9 TOP: Reimbursement KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

20.During a time of acute illness, the family may become extremely distressed and neglect the needs of other family members. On what does the family seem to focus?

a. The outcomes
b. The disease
c. The physician
d. The patient

ANS: D

During times of acute illness, the family may become extremely distressed and focus only on the patient. The nurse can refer family members to an appropriate resource.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1177

OBJ: 8 TOP: Nursing process KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

21.What should be the focus when the family and the patient work with the nurse to plan interventions?

a. Determining actions
b. Participating in care
c. Setting goals
d. Celebrating achievements

ANS: C

When planning interventions, it is important that the nurse work with the patient and the family on setting goals.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1177

OBJ:8TOP:Nursing process

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22.The nurse should provide the patient and family with accurate health information concerning diagnoses and progress. What will accurate information help the family to become?

a. Active participants
b. Effective caregivers
c. Encouraged supporters
d. Active providers

ANS: B

Providing accurate information about the diagnosis and progress helps the family to be effective caregivers.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1177

OBJ:8TOP:Nursing process

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23.Because many illnesses are now controlled rather than cured, the number of people with chronic, debilitating illnesses has increased. What do home care nurses prevent by providing?

a. Deaths
b. Increased morbidity
c. Increased hospitalization
d. Acute episodes

ANS: D

Home care provides assessment and evaluation of chronic illnesses to prevent acute episodes.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1177

OBJ: 8 TOP: Home health KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

24.What is the fastest-growing group in the U.S. population today?

a. 30- to 40-year-olds
b. 40- to 50-year-olds
c. 50- to 65-year-olds
d. Those 85 and older

ANS: D

The age group older than 85 is the fastest-growing group in the United States today.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1177

OBJ: 8 TOP: Aging KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

25.By offering enteral, parenteral, intravenous, and blood transfusion therapies, what can home care services prevent?

a. Morbidity
b. Hospitalization
c. Hospice care
d. Mortality

ANS: B

Home care services can prevent hospitalization by offering enteral, parenteral, intravenous, and blood transfusion therapies. Morbidity, mortality, and hospice care cannot be prevented.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1177

OBJ: 6 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

26.What has been influenced by the increase in home health providers supporting healthy living and illness prevention, and a movement toward deinstitutionalization of technology-dependent children and adults?

a. Criteria for admission
b. Age of eligibility
c. Reimbursement criteria
d. Length of financial support

ANS: C

The increase in home health providers supporting healthy living and illness prevention and the movement toward deinstitutionalization of technology-dependent children and adults resulted from Medicare and third-party payers changing reimbursement criteria.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1177

OBJ: 9 TOP: Home health KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

27.The licensed nurse can delegate which task(s) to the home health assistive personnel?

a. Bathing the patient
b. Assessing ability to void
c. Administering an injection
d. Teaching about medications

ANS: A

Bathing the patient is a task that can be delegated safely to the home health assistive personnel.  Home health assistive personnel cannot assess, teach, or administer injections.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1172

OBJ: 5 TOP: Home health KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

MULTIPLE RESPONSE

28.The home health nurse plans interventions to meet which general service goals? (Select all that apply.)

a. Restore function as is appropriate
b. Improve level of function
c. Maintain current health level
d. Ensure return of health
e. Teach healthy lifestyle

ANS: A, B, C, E

The general service goals are restoration, improvement, maintenance, and promotion of health.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1169

OBJ: 8 TOP: Home health KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

29.The nurse describes a new technological service to the patient that will monitor several assessments remotely. This new intervention is known as ___________ home visits.

ANS:

electronic

Electronic programs call and gather information from patients remotely.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1168

OBJ:3TOP:Electronic interviews

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

30.When the decision is made with the family to place the patient on hospice care, the home health nurse explains that the reimbursement changes from fee per visit to fee per _________.

ANS:

diem

Medicare-supported hospice care is billed on a fee per diem.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1168

OBJ: 9 TOP: Hospice KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

31.The nurse can best confirm that the patient understands the communication by obtaining ____________ from the patient.

ANS:

feedback

Feedback confirms that the patient has understood the communication.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1176

OBJ:4TOP:Communication

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

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