Chapter 37: Long-Term Care My Nursing Test Banks

Chapter 37: Long-Term Care

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

MULTIPLE CHOICE

1.The home health nurse is assisting a family to select a long-term care facility for an 80-year-old widow in good health who no longer drives, loves to play cards, can ambulate with a walker, and is oriented. Which facility would be the best selection for this patient?

a. Subacute unit setting
b. Long-term care facility (nursing home)
c. Assisted living center
d. Continuing care retirement center (CCRC)

ANS: C

The assisted living center provides meals, transportation, social interaction, and a home-like quality without the intrusion of the medical model. The patients age does not make her a reasonable candidate for a CCRC. The patient does not require acute skilled nursing care.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1184

OBJ:2TOP:Long-term care

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

2.The home health nurse helps an older adult couple plan changes in their home that will facilitate care in their home as they age. What percentage of people over 65 live in a home setting?

a. 42%
b. 48%
c. 55%
d. 67%

ANS: D

The majority (67%) of people over the age of 65 live in a home or family setting.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1181

OBJ:2TOP:Long-term care

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

3.The nurse confirms that the cost of caring for a relatively unimpaired older adult in a private home is approximately what fraction of the cost of placing the older adult in a long-term care facility?

a.
b. 1/3
c.
d. 2/3

ANS: C

It costs approximately half as much to care for an older adult at home as it would cost in a long-term care facility.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1182

OBJ:4TOP:Long-term care

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

4.What is the goal for services provided by home health care agencies?

a. Self-care
b. Assisted living
c. Rehabilitation
d. Improved function

ANS: C

Services provided by home health care agencies are aimed at rehabilitation.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1182

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

MSC: NCLEX: Health Promotion and Maintenance

5.The nurse clarifies to the family of a patient that one of the roles of the LPN/LVN in the home care setting is to evaluate the care provided to the patient by which provider?

a. The family
b. Other licensed care providers
c. Nonlicensed staff
d. The physician

ANS: C

One of the roles of the LPN/LVN in the home care setting may be to evaluate the care provided by CNAs, HHAs, homemakers, and personal care attendants.

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

REFage 1183OBJ:7TOP:Home health

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

6.The family caring for an older adult in their home feels that they need assistance from a hospice service. What is necessary for hospice service to be initiated?

a. A family request
b. A patient request
c. Medical certification
d. A referral by a hospice nurse

ANS: C

Hospice agencies provide care at the end of life. Medical certification is required for terminal care.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183

OBJ: 8 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7.The nurse suggests to a family caring for a member with early Alzheimer disease in their home that they investigate the services of an adult day care center. What is a major benefit of adult day care centers?

a. It takes the patient out on recreational outings.
b. It can provide daily hygiene.
c. It expands social interaction.
d. It is free to the public.

ANS: C

Adult day care centers are open a large part of the day and offer several modalities to enhance social interaction and also give the family respite.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183

OBJ:8TOP:Adult day care

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

8.What differentiates the services of a long-term care facility from that of an assisted living facility?

a. Skilled nursing care
b. Personal care services
c. Weekly visits by the staff physician
d. Intensive rehabilitation services

ANS: B

Assisted living is a type of residential care setting where the resident receives personal care services.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1184

OBJ:8TOP:Long-term care

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

9.What would be the most appropriate guidance the nurse could provide an older adult couple that is considering a continuing care retirement community (CCRC)?

a. Admittance is limited to people who are relatively unimpaired.
b. A contract is usually a lifetime commitment.
c. A contract is an acceptable tax shelter.
d. Contracts can be signed on a month-to-month basis.

ANS: B

CCRCs offer a complete range of health care services, from independent living to 24-hour skilled nursing. In most cases, signing a contract with a CCRC is a lifetime commitment.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1185

OBJ:8TOP:Long-term care

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

10.An 82-year-old patient recovering from a hip replacement could be expected to move from the acute care hospital to which setting for rehabilitation?

a. A subacute care unit
b. An assisted living center
c. An adult day care center
d. A continuing care retirement community

ANS: A

Subacute units have a strong rehabilitative focus and a shorter length of stay than a long-term care center.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1185

OBJ: 1 TOP: Subacute KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance

11.What is the correct term for people who live in long-term care facilities?

a. Patients, because they will be receiving acute care
b. Residents, because the facility has become their home
c. Patients, because they seek professional medical services
d. Customers, because they are purchasing care service

ANS: B

The older adult in a long-term care facility is referred to as a resident to reinforce the home-like environment.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 1186

OBJ:2TOP:Long-term care

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12.Which statement is true concerning a 50-year-old patient recovering from a stroke who is going to a long-term care facility for a short stay?

a. Her regular hospitalization insurance will pay for the care.
b. She will still have daily physician visits.
c. She will need to contract outside physical therapy services.
d. She will probably be discharged within 6 months.

ANS: D

A short-stay resident in a long-term care facility for rehabilitation will have residential physical therapy services and will usually be discharged within 6 months. Regular hospitalization insurance does not cover long-term care. Daily physician visits do not occur in the long-term care facility.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1186

OBJ:2TOP:Long-term care

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

13.In the long-term care facility, health care professionals work together to meet the needs of older adults and to go over the care plan with the resident and family members. What is this approach called?

a. Team approach
b. Individualized approach
c. Interdisciplinary approach
d. Outgoing approach

ANS: C

The long-term care facility is an interdisciplinary setting.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1186

OBJ: 7 TOP: Long-term care KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

14.What is the time limit for the legal administration of medications?

a. 30 minutes
b. 1 hour
c. 90 minutes
d. 2 hours

ANS: D

In long-term care, there is a 2-hour window for legal administration of medications, 1 hour before and 1 hour after the official administration time.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1187

OBJ:3TOP:Long-term care

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

15.The Omnibus Budget Reconciliation Act (OBRA) defines the requirements for which aspect of care as it relates to long-term care?

a. Nursing care
b. Nutritional support
c. Quality of care
d. Staffing requirements

ANS: C

OBRA defines requirements for the quality of care given to residents of long-term care facilities.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188

OBJ:3TOP:Long-term care

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

16.The Health Care Financing Administration (HCFA) conducts unannounced institutional surveys annually to assess the quality of life for the patients. The findings of the surveys are reported to:

a. various licensing boards.
b. facility administrators.
c. the public.
d. the U.S. Department of Health and Human Services.

ANS: C

Surveyors are required by law to visit the long-term care facility unannounced, on an annual basis and as needed, and the report is made public.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188

OBJ:3TOP:Long-term care

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

17.A 48-year-old long-term care facility resident expresses concern that the cost of his care has used up his assets. For what program should the nurse suggest that the resident apply to cover the continued cost of living in a long-term facility?

a. Medicare
b. Hospitalization insurance
c. Medicaid
d. Public health funds

ANS: C

When adults have used all of their assets, they may then qualify for Medicaid. Medicaid is a federally funded, state-operated program of medical assistance for people with low incomes.

PTS: 1 DIF: Cognitive Level: Analysis REF: Page 1188

OBJ:3TOP:Long-term care

KEY: Nursing Process Step: Assessment MSC: NCLEX: Psychosocial Integrity

18.Although the Occupational Safety and Health Act (OSHA) increases the cost of care, what is a benefit that it provides for long-term care?

a. It ensures a safe environment for personnel.
b. It ensures that medications are administered safely.
c. It ensures that food is prepared safely.
d. It ensures safe ambulation and transportation of patients.

ANS: A

The OSHA guidelines significantly increase costs, but they also ensure a safe environment for personnel, which is mandatory today.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188

OBJ: 3 TOP: Long-term care KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

19.A nurse helps a family understand that once hospice service is initiated, the focus of care changes from rehabilitation and restoration to what type of care?

a. Maintaining the patient at the optimal level
b. Assisting with funeral planning
c. Relieving the family of care
d. Maintaining comfort as death approaches

ANS: D

Hospice care is focused on the provision of comfort to the person who is approaching death. While hospice will assist with funeral planning as needed, it is not the focus of care. Hospice provides respite for the family, but hospice does not relieve the family of care duties.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183

OBJ: 8 TOP: Hospice KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

20.What is included when the LVN/LPN completes the Resident Assessment Instrument (RAI)?

a. Minimum Data Set (MDS) and the signature of the physician
b. Resident Assessment Protocols (RAPs) and the drug list
c. Minimum Data Set, Resident Assessment Protocols, and the RNs signature
d. Resident Assessment Protocols and the signature of the administrator

ANS: C

The RAI must be signed by the RN and contain the RAPs and MDS.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1189

OBJ:3TOP:Long-term care

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

21.The nurse assesses a patients ability to perform self-care activities, as well as more complex social and household activities. What is provided from this assessment?

a. Physical status
b. Emotional status
c. Health status
d. Functional status

ANS: D

The functional status is related to activities of daily living (ADLs) and instrumental activities of daily living (IADLs).

PTS: 1 DIF: Cognitive Level: Application REF: Page 1189

OBJ:2TOP:Long-term care

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

22.How often does the Omnibus Budget Reconciliation Act (OBRA) require that a summary (including vital signs and weight) be obtained in the long-term care setting?

a. Daily
b. Weekly
c. Monthly
d. Yearly

ANS: C

A summary, including vital signs and weight, is only required on a monthly basis.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1189

OBJ:3TOP:Long-term care

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23.In a long-term care facility, the nurse takes an active part in formulating the residents plan of care. How often is the plan of care revised?

a. Weekly
b. Every 90 days
c. Monthly
d. Every six months

ANS: B

In long-term care, the residents plan of care is reviewed by the interdisciplinary team every 90 days for resolution of problems or revision of goals and interventions.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1190

OBJ:3TOP:Nursing process

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

24.The nurse recognizes that an ongoing assessment will help set priorities in the nursing care plan of a long-term care resident. What does this allow the planning process to become?

a. Timely
b. Patient-centered
c. Preferential
d. Categorized

ANS: B

The planning process must be patient-centered.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1191

OBJ:6TOP:Nursing process

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

25.The long-term care facility nurse recognizes that visiting the resident, changing his or her position, assessing for incontinence, providing skin care, and offering fluids are part of the nurses responsibility. What does the initiation of these interventions provide?

a. Continuity
b. Safety
c. Prevention
d. Reassurance

ANS: B

Nursing interventions basic to long-term care include monitoring such safety measures as changing the residents position every two hours, assessing for incontinence, providing skin care when needed, and offering fluids.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1190

OBJ:6TOP:Nursing process

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

26.How often should the long-term care facility nurse make rounds and monitor residents for safety?

a. Every 2 hours
b. Every 4 hours
c. Every 6 hours
d. Once per shift

ANS: A

Nursing interventions related to long-term care include making rounds and monitoring for resident safety every 2 hours.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1190

OBJ:7TOP:Nursing process

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

27.When a patient asks why he must be transferred to a subacute unit from the hospital, what would be an appropriate response by the nurse?

a. Reimbursement guidelines limit adults stays in an acute setting.
b. The physician can oversee care more closely in a subacute setting.
c. Financial restrictions of insurance limit time spent in an acute care setting.
d. Cost and services at the acute care setting are the same as at the hospital.

ANS: A

In the acute care setting, strict rules about length of stay and limitations in cost reimbursement limit the amount of time adults can be hospitalized. These strict reimbursement rules for acute care do not apply, however, to subacute care provided in a skilled nursing facility setting.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1185

OBJ:3TOP:Nursing process

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

MULTIPLE RESPONSE

28.The LPN/LVN performs which function(s) when working as a staffing coordinator of a home health agency? (Select all that apply.)

a. Scheduling appropriate care providers
b. Reviewing documentation
c. Verifying financial coverage
d. Making referrals
e. Performing comprehensive assessments

ANS: A, C

Reviewing documentation may be done by an LPN/LVN but not in the role of staffing coordinator but as a medical chart auditor or reviewer. Scheduling care providers and verifying financial coverage are among the duties of the staffing coordinator. Making referrals and performing comprehensive assessments are duties of the RN.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183

OBJ:8TOP:Staffing coordinator

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

29.The LPN/LVN suggests to the RN that the nursing care plan be modified to include referral to an adult day care center. What benefits should the client expect to receive? (Select all that apply.)

a. Overnight care
b. Respite care for the family
c. Social interaction for the patient
d. Mental stimulation for the patient
e. Supporting maintenance of the ADLs

ANS: B, C, D, E

Overnight care is usually not offered from a day care center.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1183

OBJ:8TOP:Adult day care

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

30.A daughter is assessing a nursing home before placing her mother there for what she feels will be a long-term stay. Which of the following are important aspects of quality to consider when selecting a nursing home? (Select all that apply.)

a. Privacy is respected
b. Staff members are task-focused
c. The staff welcomes family visits
d. There is a homelike environment
e. Rooms are maintained like a hospital

ANS: A, C, D

It is important that privacy is respected, family members are welcomed, and a homelike environment is maintained. Staff members should be resident-focused, not task-focused. Rooms should be maintained like a home instead of like a hospital.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1187, Box 37-4

OBJ: 7 TOP: Quality Indicators KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

31.What impact will the Affordable Care Act have on nursing homes and long-term care centers when fully implemented? (Select all that apply.)

a. A weaker consumer complaint system
b. Better training for state inspectors
c. Program to support national criminal background checks
d. Public disclosure of nursing home owners and operators
e. Training of nursing assistants in the care of people with dementia

ANS: B, C, D, E

The Affordable Care Act will result in a stronger consumer complaint system, better training for state inspectors, a program to support national criminal background checks, public disclosure of nursing home owners and operators, and training for nursing assistants in the care of people with dementia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 1188, Box 37-5

OBJ: 3 TOP: Federal Regulations KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

COMPLETION

32.The nurse explains to a patient that shopping, using a phone, and administering his own medications are classified as ____________ activities of daily living.

ANS:

instrumental

IADLs are more complex skills than ADLs and indicate a higher level of independent functioning.

PTS: 1 DIF: Cognitive Level: Application REF: Page 1184

OBJ: 8 TOP: Instrumental activities of daily living (IADLs)

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

33.When a resident who is a Muslim becomes concerned about his religiously dictated dietary requirements, the nurse may refer this concern to the long-term care ____________ department.

ANS:

dietary

Long-term facilities take into consideration the patients individual needs, including diet preferences. The dietary department is usually able to meet most requests.

PTS:1DIF:Cognitive Level: Application

REF: Page 1181, Cultural Considerations OBJ: 7

TOP: Ethnic considerations KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

34.Two unique members of the caregiving team in a long-term care facility are the ___________ ___________ aide/technician and the ___________ _____________ assistant.

ANS:

certified medication, restorative nursing

These two members of the care team are unique to the long-term care facility. Both have had extra training over and above that of the certified nursing assistant.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Pages 1187-1188

OBJ: 8 TOP: Long-term caregiving team KEY: Nursing Process Step: N/A

MSC:NCLEX: N/A

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