Medical-Surgical Nursing 14 Edition TEST BANK.

Medical-Surgical Nursing 14 Edition TEST BANK. The nursing instructor is preparing a group of students for their home care rotation. In preparation, the group discusses the patients that they are most likely to care for in the home. Which of the following groups are the most common recipients of home care services? A) Mentally ill patients B) Patients receiving rehabilitation after surgery C) Terminally ill and palliative patients D) Elderly patients Ans: D Feedback: The elderly are the most frequent users of home care services. The patient must be acutely ill, home bound, and in need of skilled nursing services to be eligible for this service. The other answers are incorrect because it is the elderly who are seen most frequently in the home health setting, though each of the other listed groups may sometimes receive home care. 3. A recent nursing graduate has been surprised at the sharp contrast between some patients' lifestyles in their homes and the nurse's own practices and beliefs. To work therapeutically with the patient, what must the nurse do? A) Request another assignment if there is dissonance with the patient's lifestyle. B) Ask the patient to come to the agency to receive treatment, if possible. C) Resolve to convey respect for the patient's beliefs and choices. D) Try to adapt the patient's home to the norms of a hospital environment. Ans: C Feedback: To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respect for patients' beliefs, even if they differ sharply from the nurse's. This can be difficult when a patient's lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of alcohol, drug abuse, or overeating. The nurse should not request another assignment because of a difference in beliefs, nor do nurses ask for the patient to come to you at the agency to receive treatment. It is also inappropriate to convert the patient's home to a hospital-like environment. 4. Infection control is a high priority in every setting where nursing care is provided. When performing a home visit, how should the nurse best implement the principles of infection control? A) Perform hand hygiene before and after giving direct patient care. B) Remove the patient's wound dressings from the home promptly. C) Disinfect the patient's syringes prior to disposal. D) Establish a sterile field in the patient's home before providing care. Ans: A Feedback: Infection control is as important in the home as it is in the hospital, but it can be more challenging in the home and requires creative approaches. As in any situation, it is important to clean one's hands before and after giving direct patient care, even in a home that does not have running water. Removing the wound dressings from the home and disinfecting all work areas in the home are not the best implementations of infection control in the home. Used syringes are never disinfected and a sterile field is not always necessary. 5. An adult patient is ready to be discharged from the hospital after undergoing a transmetatarsal amputation. When should your patient's discharge planning begin? A) The day prior to discharge B) The day of estimated discharge C) The day that the patient is admitted D) O nc e th e nu rsi ng ca re pl an ha s be en fi na liz ed A ns : C Feedback: Discharge planning begins with the patient's admission to the hospital and must consider the possible need for follow-up home care. Discharge planning should begin prior to the other listed times. 6. A home health nurse is preparing to make the initial visit to a new patient's home. When planning educational interventions, what information should the nurse provide to the patient and his or her family? A) Available community resources to meet their needs B) Information on other patients in the area with similar health care needs C) The nurse's contact information and credentials D) D ates and times of all sched uled home care visits Ans: A Feedback: The community-based nurse is responsible for informing the patient and family about the community resources available to meet their needs. During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because it is inappropriate to ever provide information on other patients to a patient. The nurse's credentials are not normally discussed. Giving the patient the dates and times of their scheduled home visits is appropriate, but may not always be possible. It is more important to provide them with resources available within the community to meet their needs. 7. The home health nurse receives a referral from the hospital for a patient who needs a home visit for wound care. After obtaining the referral, what would be the first action the nurse should take? A) Have community services make contact with the patient. B) Obtain a physician's order for the visit. C) Call the patient to obtain permission to visit. D) Arrange for a home health aide to initially visit the patient. Ans: C Feedback: After receiving a referral, the first step is to call the patient and obtain permission to make the visit. Then the nurse should schedule the visit and verify the address. A physician's order is not necessary to schedule a visit with the patient. The nurse may identify community services or the need for a home health aide after assessing the patient and the home environment during the first visit with the patient. This would not be delegated to a home health aide. 8. At the beginning of a day that will involve several home visits, the nurse has ensured that the health care agency has a copy of her daily schedule. What is the rationale for the nurse's action? A) It allows the agency to keep track for payment to the nurse. B) It supports safety precautions for the nurse when making a home care visit. C) It allows for greater flexibility for the nurse and his or her colleagues for changes in assignments. D) It allows the patient to cancel appointments with minimal inconvenience. Ans: B Feedback: Whenever a nurse makes a home visit, the agency should know the nurse's schedule and the locations of the visits. The other answers are incorrect because providing the agency with a copy of the daily schedule is not for the purpose of correctly paying the nurse or for the ease of the nurse in changing assignments. It is also not intended for the patient's ease in canceling appointments. 9. There are specific legal guidelines and regulations for the documentation related to home care. When providing care for a patient who is a Medicaid recipient, what is most important for the nurse to document? A) The medical diagnosis and the supplies needed to care for the patient B) A summary of the patient's income tax paid during the previous year C) The specific quality of nursing care that is needed D) The patient's homebound status and the specific need for skilled nursing care Ans: D Feedback: Medicare, Medicaid, and third-party payers require documentation of the patient's homebound status and the need for skilled professional nursing care. The medical diagnosis and specific detailed information on the functional limitations of the patient are usually part of the documentation. The other answers are incorrect because nursing documentation does not include needed supplies, tax information, or the quality of care needed. 10. Your patient has had a total knee replacement and will need to walk with a two- wheeled walker for 6 weeks. He is being discharged home with a referral for home health care. What will the home care nurse need to assess during the initial nursing assessment in the home? A) Assistance of neighbors B) Qualification for Medicare and Medicaid C) Costs related to the visits D) C h a r a c t e r i s t i c s o f t h e h o m e e n v i r o n m e n t A n s : D Feedback: The initial assessment includes evaluating the patient, the home environment, the patient's self-care abilities or the family's ability to provide care, and the patient's need for additional resources. Normally an assessment is not made of assistance on the part of neighbors or the costs of the visit. Medicare and Medicaid qualifications would normally be determined beforehand. 11. A nurse who has an advanced degree in primary care for a pediatric population is employed in a health clinic. In what role is this nurse functioning? A) Nurse practitioner B) Case coordinator C) Clinical nurse specialist D) C l i n i c s u p e r v i s o r A n s : A Feedback: Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on gerontology, pediatrics, family or adult health, or women's health. Case coordinators and clinical supervisors do not necessarily require an advanced degree, and a clinical nurse specialist is not educated in primary care. Primary care is the specific focus of CNPs. 12. A nurse is based in an automotive assembly plant and works with the plant's employees in the areas of health promotion and basic primary care. What nursing role is this nurse performing? A) Occupational health nurse B) Community nurse specialist C) Nurse clinician D) P u b l i c h e a l t h n u r s e A n s : A Feedback: Occupational health nurses may provide direct care to patients who are ill, conduct health education programs for the industry staff, or set up health programs. The other answers are incorrect because they are not consistent with a nurse's placement in a manufacturing setting. 13. A school nurse has been working closely with a student who has cystic fibrosis. The nurse is aware that children with health problems are at major risk for what problem? A) Mental health disorders B) Gradual reduction in intelligence C) Psychological stress due to a desire to overachieve D) U n d e r a c h i e v e m e n t i n s c h o o l A n s : D Feedback: School-aged children and adolescents with health problems are at major risk for underachieving or failing in school. These students do not necessarily have a high risk of mental health disorders or a desire to overachieve. Health problems do not normally cause a progressive decline in intelligence. 14. A community health nurse is aware that restoration of health often depends on appropriate interventions performed early in the course of a disease. Which patient is most likely to seek health care late in the course of his or her disease process and deteriorate more quickly than other patients? A) A patient who has been homeless for an extended period of time B) A patient who recently immigrated to the United States C) A patient who is 88 years old and who has enjoyed relatively good health D) A t e e n a g e b o y A n s : A Feedback: Because of numerous barriers, the homeless seek health care late in the course of a disease and deteriorate more quickly than patients who are not homeless. Many of their health problems are related in large part to their living situation. The other answers are incorrect because these populations do not as often seek care late in the course of their disease process and deteriorate quicker than other populations. 15. A recent nursing school graduate has chosen to pursue a community nursing position because of increasing opportunities for nurses in community settings. What changes in the health care system have created an increased need for nurses to practice in community-based settings? Select all that apply. A) Tighter insurance regulations B) Younger population C) Increased rural population.