Nokea
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
- D. Changes in federal legislation
- E. Decreasing hospital revenues
Correct Answer: A,D,E
Rationale: Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, and alternative health care delivery systems have also affected the ways in which health care is delivered. Our country does not have an increased rural population nor is our population younger.
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You are assessing a new patient and his home environment following the patients referral for community-based care. Which of the following is the most important responsibility that you, as a community-based nurse, have at this initial visit?
- A. Encourage the patient and his family to become more involved in their community.
- B. Encourage the patient and his family to delegate someone to contact community resources.
- C. Encourage the patient and his family to focus primarily on online supports.
- D. Encourage the patient and his family to connect with appropriate community resources.
Correct Answer: D
Rationale: During initial and subsequent home visits, the nurse helps the patient and family identify community services and encourages them to contact the appropriate agencies. This is preferable to delegating another person to make contact. When appropriate, nurses may make the initial contact. A home-health nurse would not normally encourage the patient to become more involved in the community as a means of promoting health. Online forms of support can be useful, but they are not the sole form of support that most patients need.
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 community-based case manager is sending a community nurse to perform an initial home assessment of a newly referred patient. To ensure safety, the case manager must make the nurse aware of which of the following?
- A. The potential for at-risk working environments
- B. Self-defense strategies
- C. Locations of emergency services in the area
- D. Standard precautions for infection control
Correct Answer: A
Rationale: Based on the principle of due diligence, agencies must inform employees of at-risk working environments. Agencies have policies and procedures concerning the promotion of safety for clinical staff, and training is provided to facilitate personal safety. The physical location of emergency services is not important, though methods for contacting emergency services are a priority. Infection control is part of the nurses own professional responsibility. Self-defense strategies are not always addressed and are not legally mandated.
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
Correct Answer: D
Rationale: The elderly are the most frequent users of home care services. The patient must be acutely ill, homebound, 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.
The community-health nurse has received a referral for a new patient who resides in a high-crime area. What is the most important request that the nurse should make of the agency to best ensure safety?
- A. An early morning or late afternoon appointment
- B. An assigned parking space in the neighborhood
- C. A colleague to accompany the nurse on the visit
- D. Someone to wait in the car while the nurse makes the visit
Correct Answer: C
Rationale: When making visits in high-crime areas, visit with another person rather than alone. A person who is waiting in the car is of little benefit. An early morning or late afternoon appointment would not necessarily guarantee safety. Similarly, assigned parking would not guarantee the nurses safety while performing the visit.