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A home health nurse has completed a visit to a patient and has immediately begun to document the visit. Accurate documentation that is correctly formatted is necessary for which of the following reasons?
- A. Accurate documentation guarantees that the nurse will not be legally liable for unexpected outcomes.
- B. Accurate documentation ensures that the agency is correctly reimbursed for the visit.
- C. Accurate documentation allows the patient to gauge his or her progress over time.
- D. Accurate documentation facilitates safe delegation of care to unlicensed caregivers.
Correct Answer: B
Rationale: The patients needs and the nursing care provided must be documented to ensure that the agency qualifies for payment for the visit. Medicare, Medicaid, and other third-party payors (i.e., organizations that provide reimbursement for services covered under a health care insurance plan) require documentation of the patients homebound status and the need for skilled professional nursing care. Documentation does not guarantee an absence of liability. Documentation is not normally provided to the patient to gauge his or her progress. Documentation is not primarily used to facilitate delegation to unlicensed caregivers.
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A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles in their homes and the nurses 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 patients lifestyle.
- B. Ask the patient to come to the agency to receive treatment, if possible.
- C. Resolve to convey respect for the patients beliefs and choices.
- D. Try to adapt the patients home to the norms of a hospital environment.
Correct Answer: C
Rationale: 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 nurses. This can be difficult when a patients 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 the agency to receive treatment. It is also inappropriate to convert the patients home to a hospital-like environment.
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 patients income tax paid during the previous year
- C. The specific quality of nursing care that is needed
- D. The patients homebound status and the specific need for skilled nursing care
Correct Answer: D
Rationale: Medicare, Medicaid, and third-party payers require documentation of the patients 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.
A nurse is collaborating with a team of community nurses to identify the vision and mission for community care. What is the central focus of community-based nursing?
- A. Increased health literacy in the community
- B. Distributing ownership for the health of the community
- C. Promoting and maintaining the health of individuals and families
- D. Identifying links between lifestyle and health
Correct Answer: C
Rationale: Community-based nursing practice focuses centrally on promoting and maintaining the health of individuals and families, preventing and minimizing the progression of disease, and improving quality of life. Health literacy is not a goal in itself, but rather a means to promoting health. Distributing ownership and identifying links between lifestyle and health are not the essence of community-based care.
A nurse is based in an automotive assembly plant and works with the plants 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. Public health nurse
Correct Answer: A
Rationale: 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 nurses placement in a manufacturing setting.
A home health nurse is making a visit to a new patient who is receiving home care following a mastectomy. During the visit, the patients husband arrives home in an intoxicated state and speaks to both you and the patient in an abusive manner. What is your best response?
- A. Ignore the husband and focus on the patient.
- B. Return to your agency and notify your supervisor.
- C. Call the police from your cell phone.
- D. Remove the patient from the home immediately.
Correct Answer: B
Rationale: If a dangerous situation is encountered during a visit, the nurse should return to the agency and contact his or her supervisor or law enforcement officials, or both. Ignoring the husband or calling the police while in the home or attempting to remove the patient from the home could further endanger you and the patient.