Deck 4: Community and Home Health Nursing

Question 1

The largest percentage of community health nurses work in:

A) state and local health departments
B) U.S. Department of Veterans Affairs
C) school health nursing
D) home health

Answer 1

home health

Question 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

Answer 2

health promotion and disease prevention

Question 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
B) the well-being of the community
C) the financial well-being of the family
D) the well-being of the chronically ill

Answer 3

the well-being of the community

Question 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
B) advocate
C) collaborator
D) consultant

Question 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) "It's really not charity. You have paid taxes and will pay more taxes some day when you have a job."
B) "If you don't 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."

Question 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
B) WECM
C) CSHCN Title V
D) WIC

Question 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

Question 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

Question 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

Question 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 patient's public health care practitioner

Question 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 client's family of methods they should implement to enhance their standard of living

Question 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, child's family, any caregivers, and the school
D) child, family, neighborhood, school, peer group, and community

Question 13

A major goal of the community health nurse's 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 child's and family's 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

Question 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

Question 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

Question 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

Question 17

The community health nurse knows that radon can enter homes:

A) through air-conditioning ducts
B) through floors, cracks, and walls
C) by being tracked in on shoes
D) by animals carrying it

Question 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 child's asthma?

A) air pollution and secondhand cigarette smoke
B) the child's height and weight
C) the amount of exclusion the child is experiencing
D) the educational level of the child's caregivers

Question 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 child's bedroom
C) lead in paint and contaminated drinking water
D) level of mold and dust mites in the child's play and sleeping areas

Question 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
B) 6 months and 6 years
C) 7 and 10 years
D) 11 and 18 years

Question 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.

Question 22

When the nurse discovers that a child has been exposed to lead and the child's 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

Question 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

Question 24

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

A) light therapy
B) chelation therapy
C) blood exchanges
D) forcing of fluids

Question 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

Question 26

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

A) home infant phototherapy
B) home antibiotic referral services
C) pediatric hospice services
D) teaching new mothers infant care

Question 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

Question 28

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

A) minor problems
B) clinically apparent disease
C) short-term needs
D) problems in mobility

Question 29

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

A) quality of care
B) satisfaction of recipients of care
C) cost containment
D) quick referrals to specialists

Question 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

Question 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

Question 32

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

A) authoritarian
B) collaborative
C) supervisory
D) friendship

Question 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

Question 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

Question 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 can't play games."
C) "Let me ask your mother if she will have time to play a game with you later."
D) "Let's see if we can finish the treatment and still have time to play a short game."

Question 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
B) under-involvement
C) burnout
D) noncaring

Question 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
B) over-involvement
C) zone of helplessness
D) burnout zone

Question 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 nurse's working conditions easier
D) likely to help the child deal with the trust issue more easily

Question 39

The home health nurse is assigned to make home visits to a child. During the initial assessment, the nurse learns the child's 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

Question 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

Question 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 children in the caseload. The family requests the care be done after lunch because it fits their schedule better. Select the best response by the nurse.

A) "I'm sorry. It is impossible for me to do this in the afternoon. I wish I could, but I cannot."
B) "If I give the care in the afternoon, it means that six other children's schedules have to be rearranged and that is not fair to them."
C) "Let's look at what time is in the child's best interest and then at what you and I can change to better accommodate that."
D) "I will see if the home health agency can find another nurse who can meet your preferred schedule."

Question 42

The home health nurse would accurately describe his or her practice compared to a nursing practice in the acute hospital as:

A) very similar
B) somewhat similar
C) the same
D) very different

Question 43

Home health care for children is becoming increasingly more complex requiring nurses to:

A) have more continuing education requirements
B) have five or more years of acute care prior to entry
C) be competent in high-technology care
D) provide intensive care for only one or two clients

Question 44

The case management approach to home health care includes which relationship among the health care practitioner, family, home care providers, and case managers?

A) directive
B) authoritative
C) free exchange
D) collaborative

Question 45

Hitchcock et al. (2003) described the three phases of the home visit of a nurse as:

A) contact, interact, and react
B) preinteraction, engagement and active participation, and termination
C) learning, application of what is learned, and point of evaluation
D) focusing, planning, and resolution

Question 46

What preparation should the home health nurse do prior to making the first home visit to the family of a child assigned to him or her?

A) identification of the location of the home and available parking
B) determination of what equipment is needed
C) contact with the health care practitioner and family, review of family data, and neighborhood assessment for environmental factors
D) criminal background checks on the neighbors, property values in the neighborhood, and a financial assessment of family

Question 47

You are the nurse assigned to make several home visits in one day. What would you do with your valuables (e.g., purse or wallet and jewelry) and medical supplies during the day?

A) lock valuables and all supplies not needed (for any one visit) in the trunk of your car and leave jewelry at home
B) get a lockable suitcase on wheels to put the valuables in and wheel everything around with you
C) carry all valuables with you in a disclosed location and request that the head of household escort you to and from your car
D) call the local police station and arrange for a police escort to the family home if you have any concerns about your valuables

Question 48

In a home visit to the family of an active 15-month-old, the home health nurse's priority in giving anticipatory guidance would be which of the following?

A) providing instructions about potty training
B) selecting a day-care center or in-home nanny so the mother can return to work
C) locking low cabinets and getting gates on the stairways to the second floor
D) selecting educational toys and materials for this developmental age

Question 49

You are assigned to make a home visit to the family of a 7-year-old boy. You learn from reading the child's file that the family practices the orthodox Jewish faith. Your best course of action would be to:

A) let the family know you are not of this faith so the family will be understanding if you breach the family customs
B) research the orthodox Jewish faith prior to the family visit and inquire of the family about their practices and expectations of you prior to the visit
C) share with the family that you don't know much about their religious faith but you respect them
D) start attending a synagogue so you can become enculturated in the Jewish faith

Question 50

A pediatric client has hearing and vision testing completed at school. Such assessments are examples of which of the following? Select all that apply.

A) health protection
B) disease prevention
C) Healthy People 2010 objectives
D) health promotion

Question 51

Which of the following activities would be considered part of the engagement and active participation phase of home care nursing? Select all that apply.

A) review of the client's previous records
B) assessment of the safety of the general living environment
C) evaluation of the caretaker's ability to assume responsibility for the child
D) evaluation of electrical sources, including a backup electrical source if the client is ventilator-dependent