Question 1

A client will receive hospice care under the Medicare Hospice Benefit. The nurse understands which is true?

Accepted Answer

The Medicare Hospice Benefit requires that a client, who has a prognosis of 6 months or less, must sign up for the comfort-focused hospice benefit and waive the regular hospice benefit. This mandates that the client acknowledge a terminal prognosis and choose comforting care instead of life-extending care. When this choice is made, the hospice coordinates care in all settings, functioning both as clinical and financial case manager.

Question 2

When describing the role of hospice nurses to a group of students, a hospice nurse identifies which action as most important?

Accepted Answer

Although speaking the truth, encouraging choice, and strengthening the family are key interventions of a hospice nurse, sustaining oneself is the priority. Effective hospice nurses understand that to care for others, they must care for themselves because without a healthy nurse, the client cannot thrive.

Question 3

Which Medicare policy prevents people who could benefit from hospice services from receiving those services, even when it would be most cost-effective for the client to receive hospice rather than inpatient interventions?

Accepted Answer

The Medicare requirement that clients receiving hospice benefits must have discontinued treatment in order to receive hospice service. It is not appropriate for there to be controlled cost at the expense of assuring quality of life and comfort. Education and support for clients and family caregivers is important, and homemaking and personal care might keep a person at home as long as possible that would reflect a cost savings in the long run.

Question 4

The nurse is planning to make a home visit to a client who has Medicare as a primary payer. The client has been receiving home care for 60 days. The nurse would select which assessment to complete during the home visit?

Accepted Answer

Medicare requires that clients receiving home health care must be recertified every 60 days to validate the need for continued skilled care. An OASIS-1 is completed during the initial assessment. The discharge assessment is completed when terminating home care. The transfer assessment is completed when the client is rehospitalized or transferred to another agency for care.

Question 5

The home health nurse is discussing home health nursing practice with a student nurse. Which statement made by the student nurse summarizes the home care nursing?

Accepted Answer

Home health nurses must be able to coordinate a variety of services, such as physical therapy, occupational therapy, and speech therapy, and work with other professional caregivers, such as social workers, in order to manage client's complex health problems. If after 60 days a client still needs skilled nursing care, the nurse must complete a recertification OASIS to validate care. There is no 60-day calendar limit. The social worker does not coordinate clients' care; the nurse does. The nurse does not transport clients; however, the nurse would notify the physician of the client decline and may need to call 911 if circumstances warrant.

Question 6

The home health nurse is synthesizing evidence and clinical data and theory during an initial home visit. The home health nurse is operating within which standard of practice?

Accepted Answer

The home health nurse is operating within the consultation standard of practice. Consultation includes synthesizing evidence and clinical data and theory, involves clients/families in determining role responsibilities and in making decisions, and offers education to the team of health care workers. Health Teaching & Health Promotion includes developmentally and culturally sensitive health promotion/teaching that promotes client engagement with self-care and utilizes information and health care technologies as appropriate. Assessment includes family dynamics, knowledge of caregivers, and client values/goals/health beliefs. Planning includes collaborating with client/family on an individualized plan of care, strategies to address health promotion and restoration, prevention of injury/illness, pain relief/palliative care, interprofessional collaboration regarding care, and planning for transitions to and from home health care.

Question 7

The home health nurse is working with a client and the family during care transition. The home health nurse is operating within which standard of practice?

Accepted Answer

The home health nurse is operating within the coordination of care standard of practice. Coordination of care includes collaborating with team members, helping clients/families recognize alternative care options when plan of care no longer meets client needs, and works closely with clients/families during care transitions. Consultation includes synthesizing evidence and clinical data and theory, involves clients/families in determining role responsibilities and in making decisions, and offers education to the team of health care workers. Collaboration includes partnering with others to promote change, helping to build consensus, applying negotiation skills and group process techniques with clients/families/health care team, and building teamwork. Communication includes assessment of client's preferences/literacy/language skills and communicating effectively with interpreters.

Question 8

A nurse is asking about care needed for an older home bound client. The client's caregiver states that the client needs help with daily morning care and meal preparation. Which type of care does the nurse seek to coordinate?

Accepted Answer

Home health agencies are organizations that provide home health care services and equipment to clients in their homes, including skilled health care, custodial or unskilled care, high-technology pharmacy services, and durable medical equipment (DME). Custodial care involves unskilled or nonprofessional services, such as cleaning and assistance with daily living, and DME. Skilled home health care is care provided by specialists with licenses, certifications, or specific qualifications.

Question 9

The nurse has presented on the history of home health to new RNs hired by the organization. Which statement validates that the teaching was effective?

Accepted Answer

The teaching about the history of home health is best summarized in the statement that the home health nurse has assumed more roles including the coordinator of care by managing and providing a plan of care for the client. Home health nursing has evolved over the years to include more interventions that involve monitoring the progress of the client, which include making referrals as necessary, assessing for home safety, providing care such as dressing changes or blood pressure, coordinating communication with the health care team and family members, reviewing the medication regimen, and educating and advocating of the client and family. Today's home health care system requires nurses to employ a greater understanding of health care cost and reimbursement, a population focus for improving health, and inclusion of quality and satisfaction in the care provided. Home health nursing combines the client needs to the availability of resources, which may not include holistic care options.

Question 10

A nurse is caring for a client who has a skin ulcer. The client was a member of the armed services. Which type of health service does the client qualify for?

Accepted Answer

The client is eligible for veterans administration due to military service. Other services are eligible such as home-based primary health care, homemaker, and home health aide care. Medicare covers skilled nursing care and therapy services provided to clients in their own residences and must be deemed "homebound." Medicaid varies by state and is a generally broader benefit that proves home health services and transportation care. Home care is a broad term that encompasses all care provided to a person in the residence.

Question 11

A nurse is caring for a client receiving hospice care and the client's caregiver. Which is the most important factor the nurse should facilitate in this nurse-client relationship?

Accepted Answer

In speaking the truth in hospice care, the nurse should be instrumental in dealing with the issues related to care to keep the client comfortable. The nurse should not ignore the family's thoughts related to death but rather guiding the family to let go. The nurse should encourage the family to connect with other loved ones to allow for connecting and letting go. The nurse and family should provide physical and emotional comfort.

Quiz 30: Home Health and Hospice Care