Question 1

A patient who belongs to an HMO is assigned a nurse as a case manager after being in an automobile accident. The actions of the nurse in this role are to&#10;A) care for the patient during hospitalization for the injuries.&#10;B) assist the patient with home care activities during recovery.&#10;C) coordinate the services that the patient receives in the hospital and at home.&#10;D) determine the types of medical care the patient needs for optimal rehabilitation.

Accepted Answer

The role of the case manager is to coordinate the patient's 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.

Question 2

Which of these 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?&#10;A) Assisting the patient to choose an appropriate diet.&#10;B) Checking the patient's feet for signs of breakdown.&#10;C) Taking the patient's vital signs before a daily bath.&#10;D) Teaching the patient how to monitor blood glucose.

Accepted Answer

Taking vital signs 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.

Question 3

The ambulatory care nurse explains to an individual scheduled for an initial clinic appointment after joining an HMO that assigns an RN case manager to every patient in the HMO. The nurse will further explain that

A) the case manager will coordinate the care given to the patient by various members of the health care team.
B) one nurse will be responsible for planning all the interventions needed for the patient in acute and community settings.
C) the ambulatory care nurse is responsible for collaboration with other health care disciplines to plan all future patient care.
D) a health care provider will manage the patient's care with the assistance of nursing and other professional staff members.

Accepted Answer

When the managed care approach is used, the patient's care is coordinated across multiple settings and various disciplines. Plans of care are developed by the nurses in the acute and community settings based on patient assessments in those settings. Although the ambulatory care nurse does collaborate with other health care disciplines, this nurse will not plan all future care. The health care provider management of the patient's medical care does not describe case management, which refers to various services needed by the patient.

Question 4

When practicing as a home health care nurse, the RN (Select all that apply.)&#10;A) plans for the health needs of community groups.&#10;B) provides direct care for an individual patient.&#10;C) participates in group screening for common health problems such as hypertension.&#10;D) teaches patients' family members how to provide care such as giving medications.&#10;E) administers chemotherapy and antibiotics through long-term intravenous catheters.&#10;F) instructs groups about special health care needs such as contraception or baby care.

Accepted Answer

The home health care nurse provides community-based nursing to an individual patient and/or family. Care for community groups or populations is considered public health nursing or community health nursing.

Question 5

In describing home care services to a patient requiring extended care, the nurse tells the patient that&#10;A) home care services are limited to visits by registered nurses or home health aides.&#10;B) in order for Medicare or insurance to cover the expenses of home care, the patient must be confined to bed.&#10;C) the patient's family will be included in planning and teaching about the patient's care.&#10;D) technologically complex therapies, such as mechanical ventilators, are better managed in the hospital.

Accepted Answer

Family members who are providing care are included in teaching about the patient's care and treatments. Other disciplines 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.

Question 6

The home health nurse visits a diabetic patient who has an infected heel wound to perform daily dressing changes and wound assessment. The nursing diagnosis of impaired tissue integrity is developed for the patient. To evaluate the patient outcome, the nurse will collect data about

A) the patient's daily capillary blood glucose level.
B) the presence or absence of complications of diabetes.
C) the wound appearance and patient temperature.
D) the patient's appraisal of the nursing services provided.

Accepted Answer

Because the patient's nursing diagnosis is impaired tissue integrity, the evaluation of outcomes is based on wound appearance and patient temperature. The blood glucose, the presence of complications of diabetes, and the patient's evaluation of nursing services are important data to collect, but they are not helpful in evaluating outcomes for this nursing diagnosis.

Question 7

Which of these patients being discharged by the acute care nurse meets the requirements for Medicare reimbursement for home health services?&#10;A) A 65-year-old patient with multiple sclerosis and severe weakness who requires sacral dressing changes&#10;B) A 68-year-old diabetic patient who is unable to drive and needs teaching about a diabetic diet and lifestyle&#10;C) A 70-year-old who receives daily intravenous antibiotics for an infected leg wound&#10;D) A 71-year-old who needs weekly blood sampling for monitoring of prothrombin times

Accepted Answer

The patient with severe weakness meets the standard because it would require considerable effort to leave the home for the complex sacral dressing changes. The diabetic patient is able 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.

Question 8

A 78-year-old patient hospitalized for surgical repair of a fractured hip has recovered from the surgery but continues to have a nursing diagnosis of impaired physical mobility related to decreased muscle strength. 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.

Accepted Answer

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.

Question 9

When making an initial home visit, the most appropriate approach by the nurse is to&#10;A) tell the patient and family all of the planned interventions.&#10;B) ask the patient and family what their expectations are.&#10;C) discuss the importance of following through with health care provider orders.&#10;D) instruct the family members that they will need to participate in care.

Accepted Answer

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.

Question 10

A patient tells the nurse, &#34;I have to be insured through a health maintenance organization (HMO) now. I don't understand what a health maintenance organization is.&#34; The best response by the nurse includes the information that&#10;A) HMOs provide care in community settings, but hospitals are still used for acute care.&#10;B) HMOs are designed to provide more cost-effective health care.&#10;C) HMOs are better equipped to provide the care for aging patients.&#10;D) HMOs are preferred by most consumers because the services offer more flexibility.

Accepted Answer

HMOs evolved to provide cost-effective health care. They provide for care in both community and acute settings. HMOs do cover many older adults, but they are not necessarily better equipped to provide care. HMOs have less flexibility than some other plans because they may offer less choice in providers, medications, etc.

Question 11

Which of these patients should the nurse refer for Medicare-reimbursed home health services?&#10;A) A 67-year-old who requires assistance with shopping, housework, and cooking&#10;B) A 71-year-old with dementia who needs 24-hour care to prevent injury&#10;C) A 79-year-old who needs to have medications placed in a marked pillbox weekly&#10;D) An 82-year-old whose family has asked for respite care for a few days a month

Accepted Answer

The answer of Which of these patients should the nurse...

Deck 7: Community-Based Nursing and Home Care