Chapter 6: Community-Based Nursing and Home Care My Nursing Test Banks

Lewis: Medical-Surgical Nursing, 8th Edition

Chapter 6: Community-Based Nursing and Home Care

Test Bank

MULTIPLE CHOICE

1. A family caregiver tells the home health nurse, I feel like I can never get away to do anything for myself. Which action will be best for the nurse to take?

a.

Assist the caregiver in finding respite services.

b.

Assure the caregiver that the work is appreciated.

c.

Teach the caregiver that family members provide excellent patient care.

d.

Encourage the caregiver to discuss feelings openly with the nurse as needed.

ANS: A

Respite services allow family caregivers to have free time. The other actions also may be helpful, but the caregivers statement clearly indicates the need for some free time.

DIF: Cognitive Level: Application REF: 88

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

2. A patient who was in an automobile accident is assigned a nurse as a case manager. The responsibilities of the nurse in this role are to

a.

care for the patient during hospitalization for the injuries.

b.

assist the patient with home care activities during recovery.

c.

coordinate the services that the patient receives in the hospital and at home.

d.

determine the types of medical care the patient needs for optimal rehabilitation.

ANS: C

The role of the case manager is to coordinate the patients care through multiple settings and levels of care to allow the maximal patient benefit at the least cost. The case manager does not provide direct care in either the acute or home setting. The case manager coordinates and advocates for care but does not determine what types of medical care are needed, which is done by the health care provider or other provider.

DIF: Cognitive Level: Comprehension REF: 83

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

3. A patient who has just moved to a long-term care facility has a nursing diagnosis of relocation stress syndrome. Which action should the nurse include in the plan of care?

a.

Remind the patient that making changes is usually stressful.

b.

Discuss the reason for the move to the facility with the patient.

c.

Restrict family visits until the patient is accustomed to the facility.

d.

Have staff members write notes welcoming the patient to the facility.

ANS: D

Having staff members write notes will make the patient feel more welcome and comfortable at the long-term care facility. Discussing the reason for the move and reminding the patient that change is usually stressful will not decrease the patients stress about the move. Family member visits will decrease the patients sense of stress about the relocation.

DIF: Cognitive Level: Application REF: 84 TOP: Nursing Process: Planning

MSC: NCLEX: Psychosocial Integrity

4. A 78-year-old patient hospitalized for a fractured hip has recovered from the surgery but needs to work with physical therapy to improve mobility before returning home. The nurse will anticipate transferring the patient to

a.

an acute care setting.

b.

a transitional care setting.

c.

a residential care facility.

d.

an intermediate care facility.

ANS: B

Transitional care settings are appropriate for patients who need continued rehabilitation before discharge to home or to long-term care settings. The patient is no longer in need of the more continuous assessment and care given in acute care settings. There is no indication that the patient will need the permanent and ongoing medical and nursing services available in intermediate care. The patient is not yet independent enough to transfer to a residential care facility.

DIF: Cognitive Level: Application REF: 83 TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

5. In describing home care services to a patient requiring extended care, the nurse tells the patient that

a.

technologically complex therapies must be managed in the hospital.

b.

the patients family will be included in planning and the patients care.

c.

home care services are limited to visits by registered nurses or home health aides.

d.

in order for insurance to cover the home care, the patient must be confined to bed.

ANS: B

Family members who are providing care are included in planning the patients care and treatments. Other disciplines, such as physical and occupational therapy, also provide appropriate home health services. The patient must be homebound, but not bed bound, to receive reimbursement for home care services. High-tech services are increasingly accomplished in the home setting where the patient is more comfortable and the risks for complications such as infection are less.

DIF: Cognitive Level: Comprehension REF: 84-86

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

6. Which of these patients being discharged by the acute care nurse meets the requirements for Medicare reimbursement for home health services?

a.

A 71-year-old who needs weekly blood sampling for monitoring of clotting times

b.

A 70-year-old who receives daily intravenous antibiotics for an infected leg wound

c.

A 68-year-old diabetic patient who needs teaching about a diabetic diet and lifestyle

d.

A 65-year-old patient with a spinal cord injury and paralysis who needs dressing changes

ANS: D

The patient with paralysis meets the standard because it would require considerable effort for the patient to leave the home for the dressing changes. The diabetic patient is able to obtain transportation to an ambulatory setting for diabetic teaching. The patient with the leg wound is able to receive daily antibiotics in an outpatient setting. Weekly blood samples can be obtained in a laboratory and do not require home health services.

DIF: Cognitive Level: Application REF: 86

TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care Environment

7. When the home health nurse is caring for a patient who needs to relearn self-care skills such as dressing and self-feeding, which referral will be best?

a.

Dietitian

b.

Speech therapist

c.

Physical therapist

d.

Occupational therapist

ANS: D

Occupational therapists assist patients with self-care skills. Physical therapists assist patients with strengthening, transferring, and ambulation. Dietitians assist with nutritional choices. Speech therapists assist with speech and swallowing needs.

DIF: Cognitive Level: Comprehension REF: 87 TOP: Nursing Process: Planning

MSC: NCLEX: Safe and Effective Care Environment

8. When making an initial home visit, the most appropriate approach by the nurse is to

a.

ask the patient and family what their expectations are.

b.

tell the patient and family all of the planned interventions.

c.

instruct the family members that they will need to participate in care.

d.

discuss the importance of following through with health care provider orders.

ANS: A

The nurse is a visitor in the home setting, and the most effective initial approach is to determine the expectations of the patient and family for the home health experience. The other approaches indicate that the nurse or health care team is in charge of care, which is not the case in this setting.

DIF: Cognitive Level: Application REF: 86

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. Which of these patients should the nurse refer for Medicare-reimbursed home health services?

a.

A 71-year-old with dementia who needs 24-hour care to prevent injury

b.

An 82-year-old whose family has asked for respite care for a few days a month

c.

A 67-year-old who requires assistance with shopping, housework, and cooking

d.

A 79-year-old who needs to have medications placed in a marked pillbox weekly

ANS: D

Medicare will reimburse for intermediate skilled nursing care, such as setting up medications once weekly. Services such as shopping, housework, and cooking are not skilled nursing services and are not reimbursed by Medicare or most insurers. Medicare reimburses for intermittent care; care that is needed 24 hours daily does not meet the Medicare requirements. Respite care is not skilled nursing and does not meet the requirement for home health services.

DIF: Cognitive Level: Application REF: 86

TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care Environment

10. The family of an 85-year-old with chronic health problems and increasing weakness is considering placing the patient in a long-term care (LTC) facility. Which action by the nurse will be most helpful in assisting the patient to make the transition?

a.

Have the family select an LTC facility that is relatively new.

b.

Obtain the patients input about the choice of LTC facility.

c.

Ask that the patient be placed in a private room at the facility.

d.

Explain the reasons for the need to live in LTC to the patient.

ANS: B

The stress of relocation is likely to be less when the patient has input into the choice of facility. The age of the long-term care facility does not indicate a better fit for the patient or better quality of care. Although some patients may prefer a private room, others may adjust better when given a well-suited roommate. The patient should understand the reasons for the move but will make the best adjustment when involved with the choice to move and choice of facility.

DIF: Cognitive Level: Application REF: 84

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

11. Which of the following nursing activities is appropriate for the home care RN who is caring for a newly diagnosed diabetic patient to delegate to a home health aide?

a.

Assist the patient to choose an appropriate diet.

b.

Check the patients feet for signs of breakdown.

c.

Help the patient with a daily bath and oral care.

d.

Teach the patient how to monitor blood glucose.

ANS: C

Assisting with patient hygiene is included in home health-aide education and scope of practice. Assessment of the patient and instructing the patient in new skills, such as diet and blood glucose monitoring, are complex skills that are included in RN education and scope of practice.

DIF: Cognitive Level: Application REF: 87

OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation

MSC: NCLEX: Safe and Effective Care Environment

Mosby items and derived items 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.

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