Question 1

The population nurse is conducting a home visit. Which action should the nurse take during this visit?&#10;A) Continue to validate the accuracy of the assessment and resulting diagnosis.&#10;B) Focus on the plan of care as it is written.&#10;C) Concentrate on the already-identified needs.&#10;D) Plan to write an evaluation.&#10;

Accepted Answer

1. The validity and accuracy of the assessment and resulting diagnosis should always be a factor in the home visit implementation. Additional needs can be added to modify the plan of care, so focusing solely on the plan of care as it is written may not meet the client's needs. Concentrating only on the identified needs may ignore other issues that arise in subsequent home visits. The evaluation is part of every visit and is not something that is done at another time.

Question 2

The home care nurse is using OASIS information to evaluate outcome measurements for client care. Which data should the nurse use for this evaluation?&#10;A) Client's Braden Skin Assessment score is&#10;12)&#10;B) Client has a stage 2 pressure ulcer on the sacrum.&#10;C) Client admission paperwork completed within 24 hours.&#10;D) Client self-administers insulin and changes foot wound dressing independently.&#10;

Accepted Answer

4. Outcome measures include end-result outcomes that reflect the client's status as a result of care. The client being able to self-administer insulin and change a foot wound dressing independently is data for this type of evaluation. Process measures evaluate the performance of the home care agency with respect to specific evidence-based processes of care, such as timeliness of admission, and pressure ulcer assessment. The client's Braden Skin Assessment score and completion of paperwork within 24 hours of admission would be information for a process evaluation. Potentially avoidable events measures address negative outcomes such as pressure ulcer development. The client's stage 2 pressure ulcer on the sacrum would be this type of evaluation.

Question 3

The community has a large number of immigrants. The nurse organizes a home visiting program to this community area to address family health concerns and provide health information. This is considered:&#10;A) Care of the sick.&#10;B) Case finding and referral.&#10;C) Health promotion and illness prevention.&#10;D) Health protection.&#10;

Accepted Answer

3. Visiting the homes of this population to address health concerns is an aspect of health promotion and illness prevention. The client is in a familiar environment and is more comfortable, which makes teaching easier for the nurse. The population is not indicated as sick. Case finding and referral would apply if the nurse was seeking something specific among this population. Health protection is part of health promotion, but is more of a broad-scale activity done to maintain health.

Question 4

The population health care is planning to make a visit to the home of a new community member who is recovering from major surgery. What observations should the nurse identify as advantages to making this home visit? (Select all that apply.)

A) Client's home is neat, clean, and cheerful.
B) Client and spouse sit together in the living room.
C) Client ambulates safely with the use of a walker.
D) Client requests no further visits because the neighbors will know.
E) Client states that no care is needed because insurance won't cover it.

Accepted Answer

1. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.
2. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.
3. Advantages of home visits include obtaining a complete picture of the client situation, identification of environmental influences on health, the ability to view relationships among family members and with the larger community, opportunity to see actual performance of activities of daily living, and better evaluation of intervention effects. The client requesting no further visits because of the neighbors and the concern about payment for services are disadvantages to making home visits.

Question 5

The home health nurse is making the initial assessment visit to a new client. After doing the assessment for treatment, the nurse completes an OASIS assessment form. How will this form be utilized?&#10;A) To ensure that the appropriate diagnosis-related group (DRG) is used for payment.&#10;B) By home health agencies who have certification.&#10;C) For reimbursement purposes in home health agencies with Medicare clients.&#10;D) As a requirement for all home health and hospice agencies.&#10;

Accepted Answer

3. The OASIS assessment form is used when the home health agency is seeing clients who can have their services reimbursed by Medicare. DRGs are not utilized in the OASIS form. Certified home health agencies will be able to receive Medicare and third party reimbursement, but third party reimbursement does not require use of the OASIS. OASIS is not a requirement for all home health and hospice agencies.

Question 6

The nurse receives a referral to visit a client who neighbors fear is being abused by a spouse. The client allows the nurse inside but is obviously reluctant to have the nurse in the home. The nurse could best address the client's concerns by: (Select all that apply.)

A) Tactfully communicating the reason for the visit.
B) Establishing appropriate expectations for the visit for the client and nurse.
C) Starting to establish a rapport with the client.
D) Stating that the neighbors made the referral.
E) Informing the client that her name has been given to a local women's shelter.

Accepted Answer

1. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local women's shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.
2. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local women's shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.
3. Initiating a home visit can present challenges to the nurse and create uncertainty and fear in the client. It is important for the nurse to state the reason for the visit and establish expectations from both perspectives. This allows the start of building a relationship with the client and establishes rapport. Revealing that the neighbors made the referral could be negative, and the nurse needs to respect this as a confidential source. Informing the client that her name has been given to a local women's shelter could irreparably damage any relationship the nurse has with the client and halt any progress the nurse may have made in making the client feel sufficiently at ease to speak of any potential abuse.

Question 7

The population health nurse visits a new mother and infant at home. During the visit, the nurse and mother discuss how the postpartal course is going and how the infant is doing with feeding and sleeping. The nurse provides information and answers any questions the mother may have and performs teaching as needed. In what role is the nurse functioning?

A) Case finding and referral.
B) Care of the sick.
C) Health promotion and illness prevention.
D) Home health nursing.

Accepted Answer

The nurse is functioning in the role of health promotion and illness prevention by providing education and support to the mother and infant on how to maintain their health and well-being. The nurse is not focused on finding a specific case or providing care to the sick, nor is this visit specifically a home health nursing visit.

Question 8

The population nurse is planning to make a home visit. What should the nurse take into consideration for this visit? (Select all that apply.)&#10;A) Reason for the visit and age of the client.&#10;B) Surrounding neighborhood.&#10;C) Support systems employed by the client.&#10;D) Client's ability to pay for services.&#10;E) Preliminary client treatment goals.&#10;

Accepted Answer

1. The reason for the visit, age of the client, neighborhood, and client's support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
2. The reason for the visit, age of the client, neighborhood, and client's support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
3. The reason for the visit, age of the client, neighborhood, and client's support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.
5. The reason for the visit, age of the client, neighborhood, and client's support systems are all considerations in planning a home visit. The reason for the visit sets the tone for the home visit, and the age of the client allows the nurse to perform any health teaching and intervention at an appropriate level. Knowing the surrounding neighborhood for safety allows the nurse to plan an appropriate time for the home visit. In the planning phase, the nurse needs to have some preliminary treatment goals in mind for the client based on the information received prior to the visit but remain aware that these may be modified or amended when the assessment is completed. The ability of the client to pay for services is important but is not a necessary step for planning the visit.

Question 9

The population health nurse is reviewing the long- and short-term criteria for a home visit to a client. The nurse completes this evaluation because it:&#10;A) Indicates whether reimbursement will be provided to the agency.&#10;B) Allows for tracking utilization of supplies for home visits.&#10;C) Determines the effectiveness and appropriateness of the interventions and the client's response.&#10;D) Determines whether the interventions are at the primary, secondary, or tertiary level.&#10;

Accepted Answer

3. Unless there are evaluative criteria, the client's response cannot be determined nor whether the interventions were effective and appropriate. Evaluative criteria can be used for reimbursement and supplies can be tracked with such criteria, but effectiveness of the visit cannot be determined without evaluative criteria. Evaluative criteria can be at any level of prevention.

Question 10

After several home visits, the nurse and the client have agreed to improve the client's overall nutritional status. In order to achieve this outcome, the nurse should:&#10;A) Assess the client's food preferences and methods of food preparation.&#10;B) Plan menus for the client to prepare.&#10;C) Accompany the client when food shopping.&#10;D) Refer the client to a Meals-on-Wheels program.&#10;

Accepted Answer

1. In implementing a home visit, goals are agreed upon for the overall health of the client. In this instance, the improvement of the client's overall nutritional status cannot be achieved unless the nurse assesses the client's food preferences and methods of food preparation. Otherwise, if the nurse plans meals without these considerations, the outcome will not be achieved. Accompanying the client when food shopping will not necessarily guarantee this outcome, nor will a referral to a Meals-on-Wheels program.

Question 11

During a visit to the home of a client newly diagnosed with diabetes the nurse notes that the client constantly answers the cell phone and has conversations with those callers, which interrupts teaching. The client apologizes after each call. What action should the nurse take?

A) Request that the client not answer the cell phone.
B) Leave some pamphlets for the client to read.
C) Have the client repeat back the information the nurse has given.
D) Ask the client if another time would be better to complete this teaching.

Accepted Answer

The answer of During a visit to the home of...

Question 12

A client receiving telephonic care visits with a population health nurse asks why a home visit is needed after hospitalization. What should the population health nurse explain to the client?&#10;A) Home care is a subspecialty of population health care.&#10;B) The home care nurse reports to the population health nurse.&#10;C) A home visit is the only way that the population health nurse will be paid.&#10;D) The client is extremely ill and the population health nurse needs someone to make an assessment.&#10;

Accepted Answer

The answer of A client receiving telephonic care visits with...

Question 13

The population health nurse is working with a client who is receiving hospice care. In which areas should the nurse collaborate with other health care team members in the care of this client? (Select all that apply.)

A) Management of pain control.
B) Assisting the family in adjusting to the eventual death of the client.
C) Ensuring that all services provided are able to be reimbursed.
D) Obtaining additional services for identified client needs.
E) Ensuring the client has arrangements made for burial.

Accepted Answer

The answer of The population health nurse is working with...

Question 14

The population health nurse is planning to terminate continuing home visits with a community member. Which actions should the nurse take to prepare the client for this termination? (Select all that apply.)

A) Review goals accomplished with the client.
B) Make referrals for continuing care if needed.
C) Plan for termination beginning with the first visit.
D) Explain to the client the length of time visits that will be provided.
E) Establish mutual goals with the client to meet identified needs.

Accepted Answer

The answer of The population health nurse is planning to...

Question 15

The nurse is making a home visit to a new client. The client is very friendly and welcomes the nurse into the home; however, the nurse sees that the client has a gun on the coffee table. The nurse hurriedly goes through the visit and leaves. What should the nurse do prior to the next visit?

A) Call the police prior to making the visit.
B) Call the client prior to the visit and state that there cannot be a visible firearm present during the visit.
C) Cancel future visits to this client.
D) Refer the client to another agency for visitation.

Accepted Answer

The answer of The nurse is making a home visit...

Deck 13: Home Visits As a Population Health Nursing Strategy