Nokea
A patient who was in an automobile accident is assigned a nurse as a case manager. Which of the following responsibilities is required of the nurse in this role?
- A. Care for the patient during hospitalization for the injuries.
- B. Assist the patient with home care activities during recovery.
- C. Coordinate the services that the patient receives in the hospital and at home.
- D. Determine the types of medical care the patient needs for optimal rehabilitation.
Correct Answer: C
Rationale: The role of the case manager is to coordinate the patient's care through multiple settings and levels of care to allow the maximal patient benefit at the least cost. The case manager does not provide direct care in either the acute or home setting. The case manager coordinates and advocates for care but does not determine what types of medical care are needed, that is done by the health care provider or other provider.
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A family caregiver tells the home health nurse, 'I feel like I can never get away to do anything for myself.' Which action is the most appropriate for the nurse to take?
- A. Assist the caregiver in finding respite services.
- B. Assure the caregiver that the work is appreciated.
- C. Teach the caregiver that family members provide excellent patient care.
- D. Encourage the caregiver to discuss feelings openly with the nurse as needed.
Correct Answer: A
Rationale: Respite services allow family caregivers to have free time. The other actions also may be helpful, but the caregiver's statement clearly indicates the need for some free time.
An older-adult patient who lives alone was hospitalized for a fractured hip and has recovered from the surgery but needs to continue to work to improve mobility. Which of the following settings would the nurse anticipate that the patient be transferred to?
- A. Another acute care setting
- B. A transitional care setting
- C. A residential care facility
- D. Their own home with home health nursing
Correct Answer: D
Rationale: Home health nursing is appropriate for patients who need continued rehabilitation and can implement this in their own home. The patient is no longer in need of the more continuous assessment and care given in acute care settings. There is no indication that the patient will need the permanent and ongoing medical and nursing services available in intermediate care. The patient is not yet independent enough to transfer to a residential care facility.
The nurse is describing home care services to a patient that requires extended care. Which of the following statements is true related to home care services?
- A. Technologically complex therapies must be managed in the hospital.
- B. The patient's family will be included in planning and the patient's care.
- C. Home care services are limited to visits by registered nurses or home health aides.
- D. In order for insurance to cover the home care, the patient must be contained to bed.
Correct Answer: B
Rationale: Family members who are providing care are included in planning the patient's care and treatments. Other disciplines, such as physical and occupational therapy, also provide appropriate home health services. The patient must be homebound, but not bed bound, to receive reimbursement for home care services. High-tech devices are increasingly accomplished in the home setting where the patient is more comfortable and the risks for complications such as infection are less.
When the home health nurse is caring for a patient who needs to relearn self-care skills such as dressing and self-feeding, which referral will be best?
- A. Dietitian
- B. Speech therapist
- C. Physical therapist
- D. Occupational therapist
Correct Answer: D
Rationale: Occupational therapists assist patients with self-care skills. Physical therapists assist patients with strengthening, transferring, and ambulation. Dietitians assist with nutritional choices. Speech therapists assist with speech and swallowing needs.
Which of these patients should the nurse refer for home health care services?
- A. A 71-year-old with dementia who needs 24-hour care to prevent injury
- B. An 82-year-old whose family has asked for help to organize pills into a pill box
- C. A 63-year-old who requires assistance with shopping, housework, and cooking
- D. A 79-year-old with terminal cancer who needs hospice palliative
Correct Answer: D
Rationale: Hospice palliative care is one aspect of home health care services. Services such as shopping, housework, and cooking are not skilled nursing services and do not require home health care. Institutional care is required for patients who need 24-hour care. Medication assistance can be achieved through the patient's pharmacy when filling medications, request bubble packs.