Question 1

Which of the following 66-year-old clients who needs skilled nursing care would be eligible for home health care reimbursement by Medicare?

Accepted Answer

Medicare pays for short-term,skilled health care on a part-time or intermittent-care basis for persons aged 65 years or older who are eligible under Title XVIII of the Social Security Act.If family and caregiver support is available in the home to care for the patient between nurse visits,the patient is eligible.

Question 2

Which of the following is the best use of the nurse's time while en route to the client's home?

Accepted Answer

An environmental assessment begins as the nurse leaves the agency en route to the client's home.The nurse should make specific observations.It would not be appropriate to use a computer or oral recording device while driving.Although the nurse should be conducting an environmental assessment,the nurse should be considering the needs of the client during this assessment and not his/her own needs.The nurse would not want to refer the client to another agency if the client has already selected this agency.

Question 3

Which of the following best describes the documentation that the nurse should expect to complete during the home visit?

Accepted Answer

Home health nurses often identify documentation as a frustration.Medicare holds a prominent position as a home health care payer; therefore,the HCFA's regulations determine the home health industry's documentation.Correct and accurate completion of required Medicare forms is the key to reimbursement.The forms require documentation of the nurse's care given.

Question 4

A nurse is going to visit a client who needs assistance with personal hygiene and feeding.Which of the following suggestions should be made to the family?

Accepted Answer

The only thing the nurse can do if the care needed is maintenance and assistance with activities of daily living is suggest a home health aide if the family can afford it,or teach the family how to help the client.Currently,most reimbursement for nursing services is based on the patient's need for skilled nursing.On each patient visit,the nurse must document that the care provided is of a skilled nature that requires the knowledge and assessment skills of a nurse and must verify that the patient or a family member could not provide the same level of care.

Question 5

Which of the following should be included when the nurse writes a proposed treatment plan for a home health client?

Accepted Answer

There are differences between the treatment plan and the nursing care plan.The plan of treatment includes the type of home health services received,the projected frequency of visits by each discipline,and the necessary interventions.The nursing care plan addresses specific nursing interventions designed to treat the patient's actual or potential problems and includes identified goals with measurable outcomes.

Question 6

Although it was uncomfortable,a home health nurse finally learned to discuss finances with the client and family on the very first visit.Visits had to be reimbursed.Now that she is working for a different agency,funding was no longer such a concern.Which of the following offers the best explanation for this change?

Accepted Answer

Taxpayers fund official (i.e.,public)home health agencies,but they also receive reimbursement from third-party payers such as Medicare,Medicaid,and private insurance companies.This additional taxpayer funding eliminates the stressor as to who will be paying for the nursing visits for both the client and the home health agency.The nurse is not working as an unpaid professional volunteer for this agency.The clients served by the official agency are not likely of a high socioeconomic class and the agency most likely does not have a large foundation to assist with paying for services that are provided.

Question 7

A client was quite ill and the family was doing their best.After careful assessment and diagnosis,the home health nurse was setting priorities for care.Which of the following should be the basis for deciding which intervention to implement first?

Accepted Answer

The plan,including short-term and long-term goals,is developed in consultation with the client and the family.To maximize the plan's success,it is important that the patient and family are involved.If the client expresses a disinterest,the nurse will be limited in possible interventions.Goals are identified that the client is willing to work toward with the nurse's assistance.Thus,it is most important to address the problem that the client and family think should be addressed first.The other problems can be addressed after meeting the immediate needs of the client and family.

Question 8

Which of the following is the major assumption of Albrecht's conceptual model?

Accepted Answer

An underlying premise of Albrecht's conceptual model is that professional satisfaction and effective patient outcomes depend on the education and experience of the home health nurse.Within the Albrecht nursing model,the three major elements for measuring the quality of home health care patient outcomes include structural,process,and outcome elements.Although nurses are usually the case managers,Medicare pays for skilled services,including occupational therapy and physical therapy.If nursing is not involved,the skilled professional would be the case manager.

Question 9

Which of the following is required for an agency to receive reimbursement for care given from Medicare?

Accepted Answer

Certified home health agencies meet federal standards; therefore they are able to receive Medicare payments for services provided to eligible individuals.Not all home health agencies are certified.

Question 10

A nurse was considering self-employment by starting a home health managed care agency.Which of the following risks is the nurse taking,particularly in the beginning?

Accepted Answer

Managed care agencies contract with payers,such as insurance companies,to provide specified services to the enrolled clients at a predetermined price.Managed care agencies receive payment before offering services and are responsible for taking the financial risk of providing care to patients within the budgeted allotment.The nurse will not need to worry about patient referrals or personally knowing the clients before referral as this home care agency is part of a managed care group that has enrolled clients that need services.Envy from other nurses is not a risk faced by the nurse starting this business endeavor.

Question 11

Which of the following actions should the home health nurse take to get in touch with a client if the client apparently has no telephone?

Accepted Answer

Not all clients have a telephone.If that is the case,the nurse should check the referral for a telephone number where messages can be left.It is also worthwhile to contact the health care provider who made the referral to see whether the telephone number was omitted unintentionally.If the client does not have a telephone,the nurse may choose to make a drop-in visit.This type of visit consists of an unannounced visit to the client's home,during which the nurse explains the purpose of the referral,receives the client's permission for the visit,and appoints a time for a future visit with the client.The client may agree to the first visit while the nurse is there.It may be very difficult to determine if the client has family members in the area to relay information to the client.Sending a formal letter would not get to the client who needs services in a timely manner.

Question 12

A nurse shared information with a family concerning a community resource,including a brochure with telephone number.The family agreed to follow up.Which of the following demonstrates to the nurse that the family wants to use those resources?

Accepted Answer

Under the Health Insurance Portability and Accountability Act,it is doubtful any agency would suddenly call to share such information with the nurse.If the family always agrees with the nurse's suggestion,it may be cultural rather than actual interest in the suggestion.Although the family may prefer the nurse do all the work of calling and setting up services,they may do so simply because they are not really that interested and they can always cancel later.However,if the family calls and sets up the service,it demonstrates commitment to the plan to use those resources.

Question 13

A new home health nurse realized that what was being observed and now being said by the client were very inconsistent with what had been documented while the client was hospitalized.Which of the following conclusions should be drawn by the nurse?

Accepted Answer

It is not unusual to find inconsistencies between information the patient provides during hospitalization concerning the amount of physical and emotional support available to the patient in the home and the amount of help actually available to the patient in the home.The nurse validates or modifies the referral information to reflect the actual home situation.The client's perception of support and the actual support provided may be different.Thus,it is unlikely that the client was trying to lie about or was embarrassed by the situation.

Question 14

In addition to factual data such as name,address,and diagnosis,which of the following information is crucial to the nurse when a referral is received?

Accepted Answer

The nurse prepares for the home visit by reviewing the referral form including the purpose of the visit,the geographic residence of the family,and any other pertinent information.

Question 15

Which of the following is the primary task to be accomplished during the initial telephone contact between the home health nurse and the client?

Accepted Answer

The nurse contacts the client and informs him or her about the service referral.The first telephone contact with the client or family consists of an exchange of essential information,including an introduction by the nurse,identification of the agency that received the referral,and the purpose of the visit.After the initial exchange of information,the nurse informs the client of his or her desire to make the home visit,the client gives permission,and the group sets a mutually acceptable time for the visit.The nurse is a guest in the client's home but not in the usual social sense.Public health nurses who are reimbursed by tax dollars may not require evidence of insurance coverage.

Question 16

A client needed a great deal of care.During a morning visit,the nurse shared information with the client's caregiver and demonstrated technical procedures.Which of the following is most important for the nurse to assess?

Accepted Answer

The home health nurse spends much of the visit assessing the skills of the caregiver.The home health nurse instructs the caregiver in the correct procedures for providing care and in recognizing the signs and symptoms of problems that must be reported to the health care provider.The goal of the home health nurse's instruction is to provide the caregiver with the skills necessary to care for the patient successfully in the home without intervention of the nurse.Information not retained can be repeated.

Question 17

Which of the following is the most important task to be accomplished during the initial home visit?

Accepted Answer

Many clients in need of nursing visits do not trust the health care system and are uncomfortable with the representative from an agency visiting their home.The nurse must build a trust relationship early in the visit or the client will not allow additional visits.Beginning with social topics is often a helpful tool to help establish trust and rapport.After rapport and trust have been established,the nurse can assess the client and family and provide education.Discussion of social topics would not be the primary task to accomplish during any nurse-client interaction.

Question 18

Which of the following best explains why home health care agencies that are part of national chains are doing better in the competitive marketplace than individually owned agencies?

Accepted Answer

Agencies within chains have a financial advantage over single agencies.The chains have lower administrative costs because a larger single corporate structure provides many services.For example,a multiagency corporation has greater purchasing power for supplies and equipment because they purchase a larger volume.A single corporate office can provide administrative services such as payroll and employee benefits for all chain employees,thereby reducing duplication of these services.It is unlikely that they are doing better because they receive better media coverage,offer less quality care,or have a more experienced chief executive officer.

Question 19

A nurse had shared a great deal of information with a new client.Time had passed,but the nurse had more to share and was energetically doing so.Which of the following should the nurse use as a guide to determine when to stop teaching and plan the next visit?

Accepted Answer

The average visit should not exceed 1 hour.The client receives a great deal of information during that hour,and the nurse collects a great deal of information.Most clients are tired at the end of a 1-hour visit and often cannot retain additional information.

Question 20

Which of the following best explains the purpose of the Outcome and Assessment Information Set (OASIS)?

Accepted Answer

OASIS is a data set that measures outcomes of adult home care patients to monitor outcome-based quality improvement.These items are used to monitor outcomes,plan patient care,provide reports on patient characteristics for each agency,and evaluate and improve clinical performance.The use of OASIS is mandatory for all Medicare and Medicaid patients receiving skilled care.The primary purpose of OASIS is not to analyze the cost-effectiveness of health agencies.This data set does not publicize hospital data or survey patient satisfaction of care from the health agencies.

Quiz 33: Home Health and Hospice