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A nurse is comparing some of the similarities and differences between the care that is provided in community- and hospital-based settings. What type of care is provided in both of these settings?
- A. Dieticians
- B. Ambulatory health care
- C. Occupational health care
- D. Hospice care
Correct Answer: B
Rationale: Ambulatory health care is provided for patients in community or hospital-based settings. The types of agencies that provide such care are medical clinics, ambulatory care units, urgent care centers, cardiac rehabilitation programs, mental health centers, student health centers, community outreach programs, and nursing centers. Dieticians are not generally community-based and hospice care is not generally provided in hospital settings. Occupational health care is situated in workplaces.
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A home health nurse is conducting a home visit to a patient who receives wound care twice weekly for a diabetic foot ulcer. While performing the dressing change, the nurse realizes that she forgot to bring the adhesive gauze specified in the wound care regimen. What is the nurses best action?
- A. Phone a colleague to bring the required supplies as soon as possible.
- B. Improvise, if possible, using sterile gauze and adhesive tape.
- C. Leave the wound open to air and teach the patient about infection control.
- D. Schedule a return visit for the following day.
Correct Answer: B
Rationale: Improvise, if possible, using sterile gauze and adhesive tape. Improvisation is a necessity in many home health situations. It would be logistically difficult to have the supplies delivered and leaving the wound open to air may be contraindicated. A return visit the next day does not resolve the immediate problem.
A nursing student has taught a colleague that nursing practice is not limited to hospital settings, explaining that nurses are now working in ambulatory health clinics, hospice settings, and homeless shelters and clinics. What factor has most influenced this increased diversity in practice settings for nurses?
- A. Population shift to more rural areas
- B. Shift of health care delivery into the community
- C. Advent of primary care clinics
- D. Increased use of rehabilitation hospitals
Correct Answer: B
Rationale: As health care delivery shifts into the community, more nurses are working in a variety of community-based settings. These settings include public health departments, ambulatory health clinics, long-term care facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics, nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay facilities, and patients homes. The other answers are incorrect because our population has not shifted to a more rural base, and the use of primary care clinics has not influenced an increase in practice settings or the use of rehabilitation hospitals.
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.
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. Characteristics of the home environment
Correct Answer: D
Rationale: The initial assessment includes evaluating the patient, the home environment, the patients self-care abilities or the familys ability to provide care, and the patients 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.
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.