CHAPTER 4: COMMUNITY AND HOME HEALTH NURSING My Nursing Test Banks

CHAPTER 4: COMMUNITY AND HOME HEALTH NURSING

MULTIPLE CHOICE

1. The largest percentage of community health nurses work in:

a.

state and local health departments

c.

school health nursing

b.

U.S. Department of Veterans Affairs

d.

home health

ANS: D

Feedback

A

Incorrect. About one in four community health nurses work in local and state health departments and community health centers.

B

Incorrect. Not applicable.

C

Incorrect. Community health nurses working in school health are a minority.

D

Correct. The majority of community health nurses work in home health.

PTS: 1 REF: p. 96 Introduction OBJ: Cognitive Level: Knowledge

2. Which of the following best represents the focus of the community health nurse?

a.

health promotion and disease prevention

b.

curing people who are chronically ill

c.

working with those who do not have health insurance

d.

optimal functioning of the family

ANS: A

Feedback

A

Correct. The community health nurse has a focus on health promotion and disease prevention.

B

Incorrect. The community health nurse does not cure people who are chronically ill. The nurse promotes health in order to prevent chronic illness.

C

Incorrect. Although the community health nurse may work with those who are uninsured, this option does not best represent the focus.

D

Incorrect. The community health nurse is not focused upon the optimal functioning of the family, but of the community or a population as a whole.

PTS: 1 REF: p. 96 Community Health Nursing

OBJ: Cognitive Level: Comprehension

3. While community health nurses focus on the individual or the family, which of the following do they also have as their final objective?

a.

the well-being of the extended family

c.

the financial well-being of the family

b.

the well-being of the community

d.

the well-being of the chronically ill

ANS: B

Feedback

A

Incorrect. The final objective of the community health nurse is not the well-being of the extended family.

B

Correct. The well-being of the community as a whole is the final objective for community health nursing.

C

Incorrect. The final objective of the community health nurse is not the financial well-being of the family.

D

Incorrect. The final objective of the commmunity health nurse is not the well-being of the chronically ill.

PTS: 1 REF: p. 96 Community Health Nursing OBJ: Cognitive Level: Knowledge

4. The community health nurse is coordinating all the services needed by a child who has a chronic illness and is staying at home: physical therapy, tutoring, occupational therapy, respite care, as well as financial resources for the caregivers. This activity best represents which of the following legitimate roles for the community health nurse?

a.

case manager

c.

collaborator

b.

advocate

d.

consultant

ANS: A

Feedback

A

Correct. The community health nursing role, case manager, develops and coordinates services for a selected client and family.

B

Incorrect. The role of advocate involves promoting their needs and desires.

C

Incorrect. The role of collaborator involves working with other nurse, social services, judicial systems and school systems to ensure holistic care.

D

Incorrect. The role of consultant involves the community health nurse as an expert able to propose solutions for identified problems.

PTS: 1 REF: p. 97 Table 4-1

OBJ: Cognitive Level: Comprehension

5. You are the community health nurse working with a single mother who has small children. You have helped the mother get on the Women, Infants, and Children (WIC) program. She receives coupons from this program to get food for her children, but she often fails to use the coupons, saying she is embarrassed to take charity. Which of the following responses from you would most likely succeed in getting her to use the coupons?

a.

Its really not charity. You have paid taxes and will pay more taxes some day when you have a job.

b.

If you dont take the help, someone else less deserving will.

c.

If I were in your shoes, I would use the coupons and be glad of having them.

d.

It is important to give your children nutritious meals so they will grow, and this is a way to provide them.

ANS: D

Feedback

A

Incorrect. Telling her it is not charity when she feels it is charity is ignoring her feelings, and is ineffective.

B

Incorrect. Saying someone less deserving is saying that she may also be undeserving; this will not meet the goal of making sure she feeds hungry children.

C

Incorrect. You can never be in someone elses shoes, and saying you can does not make it so.

D

Correct. Focus upon the reason the community provides the coupons, to make sure her children are fed.

PTS: 1 REF: p. 96 Governmental Influence

OBJ: Cognitive Level: Comprehension

6. Children with chronic illnesses, chronic conditions, or disabilities are often referred by community health nurses to which of the following programs to receive help with health care services?

a.

NSAID Title I

c.

CSHCN Title V

b.

WECM

d.

WIC

ANS: C

Feedback

A

Incorrect. NSAID Title I has nothing to do with chronic health conditions.

B

Incorrect. WECM are the call letters for a popular radio station.

C

Correct. Children with disabilities and those with chronic conditions can receive assistance with health care services through the Title V Children with Special Health Care Needs (CSHCN).

D

Incorrect. WIC is the Women, Infants, and Children nutrition program.

PTS: 1 REF: p. 96 Governmental Influence OBJ: Cognitive Level: Knowledge

7. Medicaid optional services most often include such things as:

a.

enhanced hospital coverage for intensive care

b.

housekeeping and maintenance services

c.

eyeglasses and speech, hearing, and dental care

d.

income for household expenses if time is lost on the job

ANS: C

Feedback

A

Incorrect. Optional services do not include enhanced hospital coverage for intensive care.

B

Incorrect. Optional medicaid services do not cover housekeeping and maintenance services.

C

Correct. Optional medicaid services are determined by each state, and may include eyeglasses and speech, hearing, and dental care.

D

Incorrect. Medicaid does not cover income for time lost on the job.

PTS: 1 REF: p. 97 Governmental Influences

OBJ: Cognitive Level: Comprehension

8. Healthy People 2010 national health objectives added some new focus areas, two of which are:

a.

starting kindergarten and the reading initiative earlier to ensure reading by age 6

b.

increasing small motor skills in children and reducing the incidence of behavioral problems in children

c.

involving fathers sooner in prenatal care and making certain they have an opportunity to be present at birth

d.

medical products safety and adding children to the maternal and infant safety area

ANS: D

Feedback

A

Incorrect. Headstart programs focus upon early education programs.

B

Incorrect. Heathly People 2010 is not focused upon small motor skills or reduced behavioral problems.

C

Incorrect. Healthy People 2010 did not add this as an objective.

D

Correct. Healthy People 2010 added Medical Products Safety and Access to Quality Health Services and Programs and included children to the maternal and infant priority areas.

PTS: 1 REF: p. 98 Healthy People 2010 Objectives

OBJ: Cognitive Level: Knowledge

9. In the prevention of firearm-related injuries, the public health or community health nurse needs to:

a.

routinely inquire about the presence of firearms in the home and do a firearms safety assessment

b.

report all firearms seen on home visits to local child protective agencies so that agency can do a follow-up

c.

let families know he or she is opposed to keeping firearms in the home and insist they be removed

d.

schedule the family members (including the children in the home) for a gun safety clinic

ANS: A

Feedback

A

Correct. As a key representative for community health, the nurse needs to routinely inquire about the presence of firearms in the home and teach safety to the parents and children.

B

Incorrect. The presence of firearms in the home is not illegal.

C

Incorrect. Individuals retain the right to have firearms in the home; the issue is keeping children safe around them. It is not appropriate for the nurse to express his or her opinion, nor is it appropriate to insist firearms be removed.

D

Incorrect. It is inappropriate for the community health nurse to schedule the family members for a gun safety clinic.

PTS: 1 REF: p. 100 Health Protection

OBJ: Cognitive Level: Comprehension

10. Which of the following tasks do community health nurses most often carry out in their work?

a.

administrating mammograms and teaching routine breast self-exams

b.

screening for venereal diseases and on-site microscopic analysis of samples from persons suspected of having these diseases

c.

assisting in obtaining serum lead levels and administering developmental assessments

d.

administering sonograms of the heart, bladder, uterus, or other organs as ordered by the patients public health care practitioner

ANS: C

Feedback

A

Incorrect. Community health nurses may be involved in screening programs such as teaching routine breast self-exams but would not administer mammograms.

B

Incorrect. Community health nurses do not screen for venereal diseases nor perform on-site microscopic analyses of samples.

C

Correct. Community health nurses have a major role in administering immunizations to children, assisting in measuring serum lead levels, and administering developmental assessments.

D

Incorrect. Community health nurses do not perform sonograms.

PTS: 1 REF: p. 100 Disease Prevention Services

OBJ: Cognitive Level: Comprehension

11. In which of the following areas do community health nurses play a major role?

a.

measuring the quality of air in the home

b.

administering immunizations at clinics

c.

assisting with the identification of additional financial resources for nursing care

d.

informing the clients family of methods they should implement to enhance their standard of living

ANS: B

Feedback

A

Incorrect. Community health nurses do not play a major role in measuring the quality of air in the home.

B

Correct. Community health nurses do play a major role in administering immunizations at clinices.

C

Incorrect. Community health nurses do not play a major role in locating additional resources for nursing care.

D

Incorrect. Community health nurses do not play a role in informing families about methods to improve their standard of living.

PTS: 1 REF: p. 100 Disease Prevention Services

OBJ: Cognitive Level: Comprehension

12. The community health nurse would include in his or her assessments the:

a.

child and caregivers

b.

child, immediate family, and church

c.

child, childs family, any caregivers, and the school

d.

child, family, neighborhood, school, peer group, and community

ANS: D

Feedback

A

Incorrect. A community assessment must include more than the child and caregivers.

B

Incorrect. Headed in the right direction, but requires more still.

C

Incorrect. Headed in the right direction, but requires more still.

D

Correct. A community assessment must include the child, the family, the neighborhood, the school, peer groups, the community, resources and agencies.

PTS: 1 REF: p. 101 Community Assessment OBJ: Cognitive Level: Knowledge

13. A major goal of the community health nurses community assessment is to determine:

a.

how affluent the community is and how the family compares to the average in terms of income

b.

the influences of the larger environment on the childs and familys health and development

c.

how many churches and of what type are in the community and how the spiritual needs of the family are met

d.

how to get health care practitioners to accept nurse practitioners and to take Medicare assignment

ANS: B

Feedback

A

Incorrect. Affluence or lack of affluence is part of the consideration, but not a major goal.

B

Correct. The nurses goal is to use knowledge gained during the community assessment to determine how the larger environment influences the childs and familys health and development.

C

Incorrect. The churches are part of the larger environment, but are not a major goal of community assessment.

D

Incorrect. This is not a major goal of the community health nurse.

PTS: 1 REF: p. 101 Community Assessment

OBJ: Cognitive Level: Application

14. The community health nurse can perform a type of community assessment called a windshield survey in some texts. This survey is a(n):

a.

systematic assessment the nurse makes while driving through the community

b.

count of all the broken and cracked windshields in the community

c.

snapshot of people in the community in cars without seat belts fastened

d.

informal count of the number of babies not in properly positioned car seats

ANS: A

Feedback

A

Correct. A windsheld survey is a systematic assessment that is performed while the nurse travels through the community.

B

Incorrect. The nurse should pay attention to the environment to assess risk factors for safety but this option is not included in the survey.

C

Incorrect. The nurse should pay attention to the environment to assess risk factors for safety but this option is not included in the survey.

D

Incorrect. The nurse should pay attention to the environment to assess risk factors for safety but this option is not included in the survey.

PTS: 1 REF: p. 101 Community Assessment OBJ: Cognitive Level: Knowledge

15. The community health nurse assesses the community for exposure to environmental toxins including radon, which is a:

a.

waste by-product of medical supplies not properly burned

b.

mold caused by a particularly deadly type of fungus

c.

groundwater contaminant derived from petroleum

d.

radioactive gas caused by decaying uranium

ANS: D

Feedback

A

Incorrect. Radon is not a waste by-product of medical supplies that have not properly burned.

B

Incorrect. Radon is not a mold caused by a particularly deadly type of fungus.

C

Incorrect. The community health nurse may assess the community for toxins which contaminate groundwater, but radon is not a groundwater contaminate derived from petroleum.

D

Correct. The community health nurse assesses the community for environmental toxins including radon which is a radioactive gas caused by decaying uranium.

PTS: 1 REF: p. 101 Environmental Toxins OBJ: Cognitive Level: Knowledge

16. The community health nurse, in assessing for radon, keeps in mind that radon can cause:

a.

an increase in respiratory symptoms

b.

rare forms of cancer of the limbic system

c.

dwarfism

d.

loss of vision

ANS: A

Feedback

A

Correct. The community health nurse watches for all illnesses associated with environmental hazards such as radon which can result in the increase of respiratory symptoms and distress.

B

Incorrect. Radon does not cause rare forms of cancer of the limbic system but may be implicated in lung cancer.

C

Incorrect. Radon does not cause dwarfism.

D

Incorrect. Radon does not cause loss of vision.

PTS: 1 REF: p. 101 Environmental Toxins OBJ: Cognitive Level: Knowledge

17. The community health nurse knows that radon can enter homes:

a.

through air-conditioning ducts

c.

by being tracked in on shoes

b.

through floors, cracks, and walls

d.

by animals carrying it

ANS: B

Feedback

A

Incorrect. Radon does not enter the home through the air-conditioning ducts.

B

Correct. Radioactive uranium can exist in small quantities in the gravel used to make concrete. Where concrete is present in the floors and walls, cracks in the concrete provide a path for radon to enter the living spaces.

C

Incorrect. Radon is not tracked in on shoes.

D

Incorrect. Radon is not introduced into living spaces being carried by animals.

PTS: 1 REF: p. 101 Environmental Toxins OBJ: Cognitive Level: Knowledge

18. A community health nurse visits a child with exacerbation of asthma. The nurse would most likely assess for which one of the following in determining what is exacerbating the childs asthma?

a.

air pollution and secondhand cigarette smoke

b.

the childs height and weight

c.

the amount of exclusion the child is experiencing

d.

the educational level of the childs caregivers

ANS: A

Feedback

A

Correct. Air quality is most often damaged by smog (air pollution) and secondhand cigarette smoke which can exacerbate asthma.

B

Incorrect. Asthma is not affected by the childs height and weight.

C

Incorrect. Exclusion does not affect the childs asthma.

D

Incorrect. The educational level of the childs caregivers may affect the childs asthma, but this is not the best option.

PTS: 1 REF: p. 101 Environmental Toxins

OBJ: Cognitive Level: Application

19. When visiting a family in the community, the nurse finds that a toddler has some developmental delays. When looking for a cause or contributing factor, which of the following environmental factors would the nurse identify as being the most important to assess?

a.

presence of asbestos in the home

b.

animals in the home, particularly in the childs bedroom

c.

lead in paint and contaminated drinking water

d.

level of mold and dust mites in the childs play and sleeping areas

ANS: C

Feedback

A

Incorrect. Asbestos is implicated in respiratory issues, not developmental delays.

B

Incorrect. Presence of animals is implicated in respiratory issues and other issues, not developmental delays.

C

Correct. Developmental delays are caused by lead in paint and contaminated drinking water.

D

Incorrect. Presence of mold and dust mites are implicated in respiratory issues, not developmental delays.

PTS: 1 REF: p. 101 Environmental Toxins

OBJ: Cognitive Level: Application

20. Families who are in the priority group for lead poisoning screening include those with children between the ages of:

a.

birth and 5 months

c.

7 and 10 years

b.

6 months and 6 years

d.

11 and 18 years

ANS: B

Feedback

A

Incorrect. Lead paint poisoning requires ingestion, and infants from birth to 5 months are unlikely to be able to ingest the paint chips because teething does not begin until 5 to 7 months of age.

B

Correct. Lead poisoning is most prevalent between the ages 6 months to 6 years. Lead enters a childs body most commonly by ingestion of loose lead-based paint chips or hand to mouth behaviors via contaminated hands, fingers, toys, pacifiers, etc.

C

Incorrect. Lead enters a childs body most commonly by ingestion of loose lead-based paint chips or hand to mouth behaviors via contaminated hands, fingers, toys, pacifiers, etc.These behaviors are typically not seen in 7 to 10 years olds.

D

Incorrect. Lead enters a childs body most commonly by ingestion of loose lead-based paint chips or hand to mouth behaviors via contaminated hands, fingers, toys, pacifiers, etc.These behaviors are not seen in 11 to 18 years olds.

PTS: 1 REF: p. 102 Environmental Toxins

OBJ: Cognitive Level: Comprehension

21. When doing a household environmental assessment, the community health nurse discovers that the family has a closet full of chemicals. The nurse would teach the family to do which of the following things?

a.

Discard all the chemicals, as the safety of children supersedes any need for chemical use.

b.

Use the chemicals only if the children are taken out of the area where the chemicals are being used.

c.

Minimize the number of chemicals, lock the closet, and use proper ventilation when any chemicals are used in the house.

d.

Have the children and pets checked for chemical poisoning immediately.

ANS: C

Feedback

A

Incorrect. It is not necessary to discard the chemicals, but keep them out of reach of the children.

B

Incorrect. Proper ventilation is adequate in most cases to use chemicals in the presence of the children.

C

Correct. Use chemicals and pesticides infrequently, reduce the number in the house, keep them locked away, and always use proper ventilation when using chemicals in the presence of children.

D

Incorrect. Having the children and pets checked for chemical poisoning is not necessary.

PTS: 1 REF: p. 101 Environmental Toxins

OBJ: Cognitive Level: Comprehension

22. When the nurse discovers that a child has been exposed to lead and the childs lead levels are elevated, the nurse will first:

a.

tell the family to seek medical attention for the child immediately

b.

discover the source of the lead poisoning and keep the child from getting more

c.

give the child the universal antidote for lead poisoning

d.

call the state health department and seek information

ANS: A

Feedback

A

Correct. The nurses first action is to tell the family to seek immediate medical attention if the child has been exposed and lead levels are elevated because lead can be removed from the body.

B

Incorrect. Locating the source and keeping the child away from it is a very important action but not the first.

C

Incorrect. There is not a universal antidote for lead poisoning.

D

Incorrect. Seeking medical attention immediately is the first action. Calling the state health department and seeking further information would be done later.

PTS: 1 REF: p. 102 Nursing Alert

OBJ: Cognitive Level: Application

23. The presence of lead in the central nervous system will cause:

a.

bleeding in the ventricles of the brain

b.

the release of large amounts of adrenocorticotropic hormone (ACTH) by the anterior pituitary, which leads to systemic dysfunction

c.

an increase in membrane permeability causing a fluid shift into brain tissue

d.

seizures and the risk for status epilepticus

ANS: C

Feedback

A

Incorrect. Lead causes a fluid shift into the brain tissues, not bleeding in the ventricles.

B

Incorrect. Lead in the central nervous system causes serious damage in the brain, some say irreversible damage. The pituitary is not affected.

C

Correct. Lead causes an increase in membrane permeability, causing a fluid shift into brain tissue, producing increased intracranial pressure, ischemia, and cellular destruction.

D

Incorrect. Seizures may result, but not to be confused with status epilepticus.

PTS: 1 REF: p. 102 Nursing Alert

OBJ: Cognitive Level: Comprehension

24. Only which of the following methods can remove lead from the body?

a.

light therapy

c.

blood exchanges

b.

chelation therapy

d.

forcing of fluids

ANS: B

Feedback

A

Incorrect. Light therapy cannot remove lead from the body.

B

Correct. Lead can be removed from the body only by chelation therapy, which must be performed under the care of a specialist.

C

Incorrect. Blood exchange cannot separate the lead from the brain tissue or central nervous system.

D

Incorrect. Forcing of fluids cannot separate the lead from the brain tissue or central nervous system.

PTS: 1 REF: p. 102 Nursing Alert OBJ: Cognitive Level: Knowledge

25. Agents that impact the future of community health care for children and families are demographics, science, and:

a.

the stock market and recession periods

b.

hospital administrative policies and health care reimbursement

c.

market-driven economic policy, and technology

d.

the amount of influence the public has on legislators and the political party in power

ANS: C

Feedback

A

Incorrect. The stock market and recession periods may benefit or undermine funding for community health care, but are not major change agents.

B

Incorrect. Hospital administrative policies and health care reimbursement may affect community health care, but are not major change agents.

C

Correct. The major change agents that impact the future of community health care for children and families are market-driven economic policy, technology, demographics, and science.

D

Incorrect. The amount of influence the public has upon the party in power or legislators is not a major change agent.

PTS: 1 REF: p. 102 Future Trends OBJ: Cognitive Level: Knowledge

26. Which of the following activities by the home health nurse best exemplifies primary prevention?

a.

home infant phototherapy

c.

pediatric hospice services

b.

home antibiotic referral services

d.

teaching new mothers infant care

ANS: D

Feedback

A

Incorrect. Home infant phototherapy is secondary prevention in which the goal is to reverse or reduce the severity of diseases.

B

Incorrect. Home antibiotic referral services is an example of secondary prevention.

C

Incorrect. A pediatric hospice means the client has been removed from the home for care in a health care facility which infers long term services. Pediatric hospice services are an example of tertiary prevention.

D

Correct. Primary prevention involves interventions for children that promote health and prevent disease processes from developing. Teaching new mothers how to perform infant care best exemplifies primary prevention.

PTS: 1 REF: p. 103 Home Health Nursing

OBJ: Cognitive Level: Comprehension

27. Which of the following activities by the home health nurse best exemplifies secondary prevention?

a.

short-term home visits to teach diabetes care to a person who is diabetic and has a small foot ulcer

b.

immunizations of infants and preschool children

c.

private duty nursing at night for an elderly couple who manages alone during the day

d.

nursing care for children who are technologically dependent

ANS: A

Feedback

A

Correct. Secondary prevention aims to detect disease in the early stages before clinical signs and symptoms manifest in order to intervene with early diagnosis and treatment. The goal is to reduce the severity of the disease or provide a cure. Short-term nursing visits to teach diabetes care to a diabetic with a small foot ulcer best exemplifies secondary prevention.

B

Incorrect. Immunizations are intended to prevent diseases, hence is an example of primary prevention.

C

Incorrect. A private agency can provide this service, community home health care does not.

D

Incorrect. Nursing care for children who are technologically dependent is an example of tertiary preventive care.

PTS: 1 REF: p. 103 Home Health Nursing OBJ: Cognitive Level: Knowledge

28. Tertiary care by the home health nurse is directed toward children with:

a.

minor problems

c.

short-term needs

b.

clinically apparent disease

d.

problems in mobility

ANS: B

Feedback

A

Incorrect. Tertiary prevention aims to improve the course of a disease, reduce disability from a disease or rehabilitate. These are not minor problems.

B

Correct. Tertiary prevention is directed toward children with clinically apparent disease.

Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate.

C

Incorrect. Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate. These are long-term needs.

D

Incorrect. Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate. Problems in mobility may arise, but solutions for mobility are not central to tertiary care.

PTS: 1 REF: p. 103 Home Health Nursing

OBJ: Cognitive Level: Comprehension

29. Managed care systems are most concerned with which of the following areas of interest?

a.

quality of care

c.

cost containment

b.

satisfaction of recipients of care

d.

quick referrals to specialists

ANS: C

Feedback

A

Incorrect. Managed care systems measure quality of care, but this is not the highest concern.

B

Incorrect. Managed care systems measure satisfaction of recipients of care, but this is not the highest concern.

C

Correct. Managed care systems are most concerned with cost-effective delivery of health care services, i.e., cost containment.

D

Incorrect. Quick referrals to specialists is not a path to cost containment.

PTS: 1 REF: p. 103 Home Care Agencies and Managed Care

OBJ: Cognitive Level: Knowledge

30. The need for comprehensive home care programs for children was largely created by:

a.

caregivers demanding that children be cared for at home whenever possible

b.

health care practitioners and nurses who felt the hospital was likely to create more infections than the home

c.

managed care supporting early discharges as a cost-effective measure

d.

the Joint Commission because of the understaffing of nurses in hospitals

ANS: C

Feedback

A

Incorrect. Most caregivers prefer that their children be cared for away from home.

B

Incorrect. The incidence of infections from the hospital is not the driver for expanding comprehensive home care programs for children.

C

Correct. Managed care, by supporting early discharges from hospitals, has created a need for comprehensive home care programs for children.

D

Incorrect. Comprehensive home care programs have increased the demand for nurses and added to the understaffing in hospitals.

PTS: 1 REF: p. 103 Home Care Agencies and Managed Care

OBJ: Cognitive Level: Comprehension

31. The children who receive the majority of hours of service by home health nurses are those who are:

a.

technologically dependent and those who require hospice care

b.

in need of medications through intravenous lines

c.

on tube feedings requiring the nurse to teach this skill to caregivers at home

d.

in need of cast care, dressing changes, tracheostomy care, or other nursing skills

ANS: A

Feedback

A

Correct. Children who are dependent on technology and those who need hospice care receive the majority of home care nursing hours.

B

Incorrect. The majority of hours of service by home health nurses are not to those in need of medications through intravenous lines.

C

Incorrect. The majority of hours of service by home health nurses are not to those on tube feedings requiring the nurse to teach this skill to caregivers at home.

D

Incorrect. The majority of hours of service by home health nurses are not to those in need of cast care, dressing changes, tracheostomy care, or other nursing skills.

PTS: 1 REF: p. 104 Family Needs OBJ: Cognitive Level: Knowledge

32. In working with a child and the childs family, the nurse has an interpersonal relationship with the child and family that is best described as:

a.

authoritarian

c.

supervisory

b.

collaborative

d.

friendship

ANS: B

Feedback

A

Incorrect. The nurses interpersonal relationship in working with the child and family is not best described as authoritarian.

B

Correct. Interpersonal relationships among the home care nurse, the child, and family can best be described as collaborativewhere mutual sharing and working together help to achieve common goals such that all persons or groups are recognized and growth is enhanced.

C

Incorrect. The nurses interpersonal relationship in working with the child and family is not best described as supervisory.

D

Incorrect. The nurses interpersonal relationship in working with the child and family is not best described as friendship.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Knowledge

33. Which of the following activities by the home health nurse will help in maintaining professional boundaries?

a.

avoiding sharing of any personal information

b.

alternating home visits with another nurse

c.

discussing the case with an unbiased nursing colleague

d.

clarifying roles early in the home visits

ANS: D

Feedback

A

Incorrect. Maintaining professional boundaries does not require the avoidance of sharing of any personal information. A boundary is crossed when self-disclosure is excessive.

B

Incorrect. Each nurse must maintain professional boundaries separately, and this is not affected by alternating home visits with another nurse.

C

Incorrect. Maintaining professional boundaries does not disallow discussing the case with an unbiased nursing colleague.

D

Correct. Professional boundaries are defined as the space between the nurses power and the clients vulnerability. Clarifying roles early can assist the home care nurse to ensure these boundaries are maintained.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Knowledge

34. Which of the following behaviors by the nurse would lead you to suspect the nurse had crossed the professional boundaries with a family in his or her caseload?

a.

disclosing personal details such as being single and available

b.

establishing house rules such as where to store belongings and where to park and defining routines

c.

listening to various family members talk about their needs and feelings

d.

letting the family have their wishes, being flexible, and encouraging the family to participate in care

ANS: A

Feedback

A

Correct. Home health care nurses should recognize signs that they have crossed boundaries, including excessive self-disclosure, secretive behavior, super nurse behavior, selective communication, flirtations, and failure to protect the client.

B

Incorrect. To ensure the establishment of professional boundaries, house rules should be established such as where to store belongings and where to park and defining routines.

C

Incorrect. To ensure the establishment of professional boundaries, the nurse will insist upon listening to various family members talk about their needs and feelings.

D

Incorrect. Letting the family have their wishes, being flexible, and encouraging the family to participate in care will facilitate and maintain a professional working relationship.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Knowledge

35. A child asks the home health nurse to skip (omit) one of his treatments and play a game with him. The nurse visit is scheduled for one hour and that is all that he or she is being paid for by the home health agency. The best response by the nurse is which of the following?

a.

Yes, I can do that, as you are far more important to me than this treatment.

b.

I am the home health nurse. I give treatments and I cant play games.

c.

Let me ask your mother if she will have time to play a game with you later.

d.

Lets see if we can finish the treatment and still have time to play a short game.

ANS: D

Feedback

A

Incorrect. The treatment comes first, and, if time allows, a game is permitted as long as the scheduled time is maintained.

B

Incorrect. To be thought, perhaps, but left unsaid, harsh and inhuman.

C

Incorrect. The child has asked you the nurse to play the game, not the mother.

D

Correct. Home care nurses are professionals who are there to help maintain health. If the home care nurse can set up a schedule that ensures treatment protocols are being carried out, it may be possible to have some time to play a game.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Application

36. Each nurse-client relationship can be plotted on a continuum of professional behavior according the National Council of State Boards of Nursing (1996). One end of the continuum is over-involvement, such as boundary crossings, and the other end of the continuum is referred to by the National Council of State Boards of Nursing as:

a.

professionalism

c.

burnout

b.

under-involvement

d.

noncaring

ANS: B

Feedback

A

Incorrect. Between over-involvement and under-involvement, professionalism may be found. It is not on the ends, but in the center.

B

Correct. The continuum of professional behavior ranges from under-involvement (distancing, disinterest, and neglect) to over-involvement (boundary crossings and boundary violations). The zone of helpfulness is in the center of the continuum.

C

Incorrect. Burnout may lead to under-involvement, but burnout is not the other end of the continuum with overinvolment.

D

Incorrect. Noncaring is a serious issue for nursing professionalism and may lead to under-involvement, but noncaring is not the other end of the continuum with over-involment.

PTS: 1 REF: p. 105 Interpersonal Relationships

OBJ: Cognitive Level: Knowledge

37. When the home health nurse engages in distancing, disinterest, or neglect in interactions with the children and families in his or her assigned caseload, the nurse is said to be in what location on the continuum of professional behavior?

a.

under-involvement

c.

zone of helplessness

b.

over-involvement

d.

burnout zone

ANS: A

Feedback

A

Correct. Under-involvement is signified by distancing, disinterest or neglect in interactions with the children and families in his or her assigned caseload.

B

Incorrect. Over-involvement is described as excessive self-disclosure, casual, social conversations, and the family incorporating the nurse as a member of the family. This can be a serious problem for home health nurses.

C

Incorrect. The zone of helpfulness is midway between under-involvement and over-involvement.

D

Incorrect. Over-involvement can put the home care nurse at risk for burnout, requiring the nurse to withdraw for personal care.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Knowledge

38. The home health nurse is doing home visits with a child whose family seems to be reducing the stress of having a stranger in the home by treating the nurse like a member of the family. This situation is:

a.

very therapeutic to the family

b.

placing the nurse at risk for boundary violation

c.

going to make the nurses working conditions easier

d.

likely to help the child deal with the trust issue more easily

ANS: B

Feedback

A

Incorrect. Without maintaining healthy professional boundaries, therapy cannot be provided to the client or the family.

B

Correct. A nurse may become overninvolved, and lose professional status when being treated like just another member of the family.

C

Incorrect. The working conditions may seem easier, but the conditions required for a therapeutic professional nursing relationship cease to exist.

D

Incorrect. The trust issue depends upon the therapeutic professional nursing relationship.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Comprehension

39. The home health nurse is assigned to make home visits to a child. During the initial assessment, the nurse learns the childs family needs a service that can be provided by a company that the nurse and his or her significant other own. The best action on the part of the nurse is to:

a.

advise the family of this company the nurse owns and suggest they try it

b.

advise the family of the company and suggest they compare services and prices with similar companies

c.

say nothing to the family about the company the nurse owns and leave their choice up to chance

d.

avoid any separate business dealings with the family in addition to the relationship of home health nurse

ANS: D

Feedback

A

Incorrect. The blurring of professional boundaries, combining home care nursing with a referral to your partners business will cause over-involvement and violate the zone of helpfulness.

B

Incorrect. The blurring of professional boundaries, combining home care nursing with a referral to your partners business will cause over-involvement and violate the zone of helpfulness.

C

Incorrect. Better, but the blurring of professional boundaries, combining home care nursing with a referral to your partners business will cause over-involvement and violate the zone of helpfulness.

D

Correct. The nurse should always act in the best interests of the child and family, and avoid any separate business dealings with the family in addition to the relationship of home health nurse.

PTS: 1 REF: p. 104 Interpersonal Relationships

OBJ: Cognitive Level: Application

40. The home health nurse assesses the needs of a family that is caring for an ill child at home and finds the family needs respite care. Which of the following descriptions best defines respite care?

a.

short-term temporary relief for the caregiver(s) so they can get rest and renewed energy

b.

a type of group home care that allows the client a break from the family

c.

care in a rehabilitation center so the client can be rehabilitated

d.

a type of relief care that permits the home health nurse to use personal benefits, such as vacation, while not burdening the family

ANS: A

Feedback

A

Correct. Respite care is short-term, temporary care that is normally provided in the home for a child who requires specialized care; it provides relief for caregivers, which may help to prevent burnout and increase the caregivers ability to cope with stress.

B

Incorrect. The respite care occurs in the childs home.

C

Incorrect. The respite care occurs in the childs home.

D

Incorrect. The respite care is provided for the primary caregivers, not the nurse.

PTS: 1 REF: p. 105 Respite Care OBJ: Cognitive Level: Knowledge

41. The nurse has been caring for a child in the home who has a tracheostomy and is oxygen dependent. The nurse wants to do the care in the morning due to the geographic location of the seven

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