Chapter 43. Nursing in Home Care My Nursing Test Banks

Chapter 43. Nursing in Home Care

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A patient was involved in a motor vehicle accident that resulted in multiple traumatic injuries. He was hospitalized for 8 days in the intensive care unit and 3 days on the surgical floor. He has been discharged home with home health support. Identify the primary goal of his home care:

1)

Provide comprehensive direct care

2)

Promote rest and relaxation for healing

3)

Teach the patient and family how to provide care

4)

Explain how home care differs from hospital care

____ 2. Today is the last day of work on the medical-surgical unit for a nurse who has decided to work in home care. A patient asks her why she is going to home care. Select a response that best illustrates the advantages of home care.

1)

Care is much more comprehensive and unhurried in the home; it is more enjoyable for nurses to work in home care.

2)

Home care is much more organized than hospital care; you have access to the whole team, and there is less interference from others.

3)

A home health nurse has more autonomy and skills than a hospital nurse; Ill get to do more.

4)

In home care I can see my patients in their personal environment; this will help me understand them more and allow me to give personalized care.

____ 3. A 56-year-old man is hospitalized because of poorly controlled diabetes and a leg ulcer that developed as a complication of diabetes. He is awake, alert, and oriented but fatigued and in need of wound care. In the hospital, he was placed on insulin and started on a variety of oral medications. He is learning how to check his blood sugar and administer insulin. He has never given himself insulin and he does not understand how to interpret his blood sugar readings. The physician has prescribed discharge from the hospital with home health follow-up. Is this an appropriate referral?

1)

Yes; the patient is in need of skilled services and, therefore, eligible for home care services.

2)

Yes; the patient has been unable to control his diabetes, is noncompliant, and needs to be monitored.

3)

No; the patient should remain hospitalized; he has too many needs for home care services.

4)

No; the patient is relatively young and oriented; he should be able to provide his own care.

____ 4. A home health nurse is working with a physical therapist and home health aides to work out a schedule for their visits that will best address the patients needs. Which nursing role does this demonstrate?

1)

Direct care provider

2)

Client and family educator

3)

Client advocate

4)

Care coordinator

____ 5. A home health nurse has called his patient to arrange an initial home visit and has driven to the home. What is the nurses objective in the first few minutes of the visit?

1)

Develop rapport and trust with the patient and family.

2)

Gather demographic data and complete the referral form.

3)

Assess the patients most important health needs.

4)

Determine the patients needs for ongoing care.

____ 6. Documentation in home healthcare may take many forms. Some nurses use NANDA-I terminology for diagnoses, whereas others use the Clinical Care Classification (CCC) system. The chief benefit of the CCC system is that it:

1)

Contains diagnoses specific to home care, whereas NANDA-I does not.

2)

Is simpler to use and more readily understood by other disciplines.

3)

Is linked to the OASIS reporting forms required by Medicare.

4)

Uses standardized terminology, whereas NANDA-I does not.

____ 7. A 56-year-old woman provides care to her 91-year-old widowed father. She says she is frequently fatigued and that she no longer socializes with her friends. Im so busy taking care of my dad. Its really hard work because he is bedridden. Sometimes it breaks my heart when I have to feed and bathe him. He always seemed so strong when I was a child. The most appropriate nursing diagnosis for this woman is:

1)

Caregiver Role Strain.

2)

Impaired Home Maintenance.

3)

Interrupted Family Processes.

4)

Risk for Caregiver Role Strain.

____ 8. The nurse is visiting a patient who lives in a single-room occupancy hotel. The patient requires wound care and medication management. There is no running water in the room, and the bathroom down the hall is in disrepair and filthy. The patients room is not clean. What supplies would be essential for the nurse to bring with him when visiting this client?

1)

All wound care supplies needed for the duration of the care

2)

Reclosable plastic bags for disposal of old dressings

3)

Small, biohazard sharps container to be left in the room

4)

Waterless, antibacterial hand sanitizer solution

____ 9. Which of the following unique aspects of home care do Medicare reimbursement regulations require that the nurse include in documentation?

1)

Patient assessment data and interventions performed

2)

Patient response to care and assessment of environment

3)

Evidence of homebound status and continued need for skilled care

4)

Skilled care delivered and communication with other providers

____ 10. At a home visit, the nurse asks the patient, Have you taken your blood pressure medicine today? The patient replies, I dont remember. Maybe. On the table are several bottles of medication, some open, some not. They have all been prescribed for the patient. The patient cannot say how often to take each one, when asked. A compartmentalized medication organizer is on the table, with a few capsules in it, and some compartments left open. What should the nurse do?

1)

Show the patient how to put the medications in the organizer for the next 2 days, and observe while he fills the rest of the organizer.

2)

Arrange for a home health aide to come each day to show the patient which pills to take.

3)

Administer todays medications and arrange for the pharmacy to put medications in easy-to-open containers in the future.

4)

Fill the organizer for each day of the week, explain how to use it, and return in a day or two to evaluate

____ 11. A family caregiver is learning to administer insulin injections to her homebound sister. What should the nurse advise her to do with the used needles?

1)

Discard the needle and syringe in a thick plastic milk jug with a lid.

2)

Securely recap them and place them a paper bag in the household trash.

3)

Remove the needle and put it in a coffee can with a lid; put the syringe in the trash.

4)

Do not recap the needle; break it by bending it on the table top.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Which of the following clients would most likely require home health services? Choose all that apply.

1)

A 45-year-old man with an injured rotator cuff that requires surgery

2)

A 32-year-old terminally ill woman with a supportive family

3)

A 92-year-old man living independently with multiple medical problems

4)

A 6-year-old with a fractured hip requiring a leg and pelvic cast

____ 2. Which of the following services are provided by home health agencies? Choose all that apply.

1)

Direct care of clients in the home, performing treatments

2)

Indirect care such as provision of medication and supplies

3)

Acute care services for clients with complex diseases

4)

Respite care of clients to relieve family caregivers

____ 3. Home healthcare and home hospice care are two different types of home health services. What are the differences between these services? Choose all that apply.

1)

Home healthcare promotes independence in clients; home hospice care promotes comfort and quality of life.

2)

Home healthcare promotes comfort and symptom management; hospice care promotes self-care.

3)

Home healthcare is focused on teaching self-care; home hospice care is focused on teaching skilled care to caregivers.

4)

Home hospice care is focused on managing symptoms; home healthcare is focused on fostering independence.

____ 4. The nurse has been assigned to a caseload of home health clients. Before making home visits, which two planning activities must she perform first?

1)

Order supplies for the home care services.

2)

Review the cases to determine the reasons for the visits.

3)

Contact the clients to arrange for the visits.

4)

Develop a schedule for the day so that all visits can be made.

____ 5. The nurse is visiting a client who resides in a single-room occupancy hotel. Groups of people are leaning against the building and smoking on the steps. There is obvious drug use occurring in the lobby and halls of the building. There is no running water in the room, and the bathroom down the hall is in disrepair and filthy. A primary concern that the nurse must consider when making this visit is safety. Which of the following actions are appropriate safety measures? Choose all that apply.

1)

Notify the police that the nurse plans to visit this site.

2)

Carry something that can be used as a weapon if necessary.

3)

Inform the home health agency of the nurses route and time of visit.

4)

Do not visit if the nurse senses danger when he arrives at the site.

____ 6. The nurse is visiting a patient who lives alone in a two-room house. The patient requires wound care and medication management, but his health is not expected to improve much, even with care. There is no running water in the house, and the bathroom is in disrepair and filthy. The house is not clean: dirty dishes are in the sink, the trash cans are full. At the first home visit, which of the following should the nurse assess? Choose all that apply.

1)

Wound status

2)

Patient concerns

3)

Ability to perform care independently

4)

End-of-life planning

Chapter 43. Nursing in Home Care

Answer Section

MULTIPLE CHOICE

1. ANS: 3

The primary goal in home healthcare is to promote self-care. Nursing activities are directed at fostering independence or teaching the family or other caregivers to assist the client with ongoing needs. Care continues to be comprehensive; however, rather than providing direct care for all needs, the emphasis shifts toward fostering independence.

PTS: 1 DIF: Moderate REF: V1, p. 1070

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application

2. ANS: 4

The home is the clients personal environment: a window into the patients life. The nurse is able to see how the patient lives, interacts, and negotiates the world. Care, in the home and hospital, is comprehensive. In both locations, the nurse has obligations to other patients and will need to watch her schedule. The level of enjoyment a nurse has with her job is dependent on many factors. A disadvantage to home care is the lack of immediate assistance from other members of the health team. Home care nurses may be more autonomous than hospital nurses; however, their scope of practice is identical.

PTS: 1 DIF: Moderate REF: V1, p. 1071

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

3. ANS: 1

A client must require skilled services in order to be eligible for home care services. This patient needs wound care, to be taught about diabetes care, and to be monitored. These are all skilled services. All of these needs can be met with home care services. He is alert and oriented, which is important for planning teaching sessions.

PTS: 1 DIF: Difficult REF: V1, p. 1071

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Synthesis

4. ANS: 4

A care coordinator manages and coordinates the services of members of the healthcare team and develops a plan of care that addresses the clients needs. Direct care involves hands-on tasks, such as dressing wounds and administering medications. The educator role involves communicating with clients and families to help them develop the skill involved to administer self-care. A client advocate supports the clients right to make decisions and protects the client from harm if he is unable to make decisions.

PTS: 1 DIF: Easy REF: V1, p. 1073

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

5. ANS: 1

All of these objectives are appropriate for the home health visit. However, the first few minutes of the initial visit set the tone for the relationship among client, nurse, family, and agency. In that time, the nurse focuses on developing rapport and trust. Once rapport and trust have been developed, the nurse can gather data, assess the client, and determine the need for ongoing care.

PTS: 1 DIF: Moderate REF: V1, p. 1076 | V2, p. 1044

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Synthesis

6. ANS: 3

Home care nurses more commonly use the CCC because it is linked to the OASIS reporting forms required by Medicare. The CCC was developed for use in home care; however, the diagnoses themselves are not specific to home care. They can be used in any setting. NANDA-I, NIC, and NOC all use standardized language that may be used in any setting, including home healthcare. NIC and NOC have some interventions and outcomes that are specific to home care use.

PTS: 1 DIF: Moderate REF: V1, p. 1078

KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Comprehension

7. ANS: 1

This caregiver is experiencing fatigue, isolation, and difficulty adjusting to role changes. These are signs of Caregiver Role Strain. Because symptoms exist, this is an actual problem as opposed to a potential problem. There is no evidence of Impaired Home Maintenance. Although family processes have been altered, this is not the best nursing diagnosis based on the defining characteristics given.

PTS: 1 DIF: Moderate REF: V1, p. 1077 | V2, pp. 1044-1045

KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Application

8. ANS: 4

The nurse should use a waterless antibacterial hand sanitizer in place of soap and water because there is no sink and conditions are filthy. The nurse should limit the supplies brought into the home if the conditions are not clean. Wound care supplies, for example, would be ordered and kept in the home. Old dressings should be double-bagged to prevent leakage, and discarded in the home. There is no evidence that a sharps disposal container is needed.

PTS: 1 DIF: Moderate REF: V1, p. 1075 | V2, p. 1039

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application

9. ANS: 3

All of the aspects mentioned should be documented. However, the unique requirements of home care include documentation of homebound status and the continued need for skilled care.

PTS: 1 DIF: Moderate REF: V1, pp. 1073-1074

KEY: Nursing process: Evaluation | Client need: SECE | Cognitive level: Application

10. ANS: 4

From the cues given, it seems likely the patient would not be able to accurately load the medication organizerand, in fact, may not be able to use it properly to take the correct medications at the correct time. The nurse would need to return every day or so until he is certain that the patient can actually administer his own meds after someone else loads the organizer. Showing the patient how to load the organizer solves part of the problem; however, this would not allow the nurse to evaluate whether the patient would then know to take the medications each day. Home health aides cannot be responsible for patient medications. There is no indication that the patient is having difficulty opening his medication containers, so there is no need to talk to the pharmacy.

PTS: 1 DIF: Difficult

REF: V1, p. 1080; critical thinking needed to answer question | V2, p. 1045; critical thinking needed to answer question

KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Application

11. ANS: 1

The caregiver should discard the syringe and needle in a thick plastic milk jug with a lid, a metal coffee can with a lid, or a commercial sharps container. Patients and caregivers should not recap used needles. They should not remove the needle from the syringe or attempt to break it because this increases the risk of needlestick injury.

PTS: 1 DIF: Moderate REF: V2, p. 1039

KEY: Nursing process: Implementation | Client need: SECE | Cognitive level: Application

MULTIPLE RESPONSE

1. ANS: 2, 3

Home care is appropriate for a client with health needs that exceed the abilities of family and friends. Older adults who wish to avoid placement in a skilled nursing facility, those who require ongoing skilled care after discharge from the hospital, the terminally ill, and persons with chronic illness that must be monitored to avoid hospitalization are the most likely home health clients.

PTS: 1 DIF: Moderate

REF: V1, p. 1070; critical thinking item requires synthesis of knowledge acquired from passage

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application

2. ANS: 1, 2, 4

Home care agencies provide direct, indirect, and respite care in the home. Acute care services are provided in the hospital.

PTS: 1 DIF: Moderate REF: V1, p. 1072

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Recall

3. ANS: 1, 4

The purpose of home healthcare is to promote self-care and foster independence. The purpose of home hospice care is to promote comfort and quality of life by managing symptoms.

PTS: 1 DIF: Moderate REF: V1, p. 1073 | V2, p. 1044

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

4. ANS: 2, 3

All of these interventions are appropriate. However, it is essential to determine the nature of the visits and to secure permission for visiting before the nurse can order supplies and plan her day.

PTS: 1 DIF: Difficult REF: V1, p. 1075 | V2, p. 1044 | V2, p. 1046

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Application

5. ANS: 3, 4

Safety is a primary consideration in home care. The nurse should file a route and planned schedule with the agency. In addition, he should not enter the building if he feels he may be in danger. He should notify the police if he senses danger, but not to tell them of a planned visit. The nurse should always carry a cell phone to alert police when security is threatened. It is not recommended that the nurse carry a weapon.

PTS: 1 DIF: Moderate REF: V1, pp. 1075-1076

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

6. ANS: 1, 2, 3

The nurse should assess the patients status, condition of the wound, concerns, and ability to perform care independently. End-of-life care is a topic the nurse may wish to explore after a relationship has developed.

PTS: 1 DIF: Easy

REF: V1, pp. 1076-1077; critical thinking item requiring synthesis of previously acquired knowledge

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Application

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