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A visiting nurse is performing the initial assessment and plan for a patient who receives Medicare and was recently discharged from the acute care hospital. Before implementing the plan of care, what follow-up is required by the nurse?
- A. Validating the patient's consent for care
- B. Obtaining the health care provider's signature and approval
- C. Determining how the patient will pay for services
- D. Ensuring that a family member or friend can assist with implementation
Correct Answer: B
Rationale: The nurse assesses the patient eligible for home services and presents the plan to the health care provider for approval. This approval the plan allows for provision of care and reimbursement of services.
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A home care nurse is observing the patient's family member perform a wound irrigation and dressing change for a postoperative wound dehiscence containing purulent drainage. In which situation will the nurse provide additional education?
- A. The family member places the old dressing in a separate bag at the bedside.
- B. The patient takes an analgesic a half-hour prior to the dressing change.
- C. The family member states they washed their hands an hour ago.
- D. The patient returns to bed during the dressing change.
Correct Answer: C
Rationale: The nurse teaches the patient and family to effectively wash their hands before and after having direct contact with the patient, before performing invasive procedures, when handling dressing or touching open wounds, and when administering medications or feeding the patient. All other options are correct.
A discharge nurse is evaluating patients and their families to determine the need referrals to other facilities after hospitalization. Which patients will the nurse recommend for these services? Select all that apply.
- A. Older adult diagnosed with dementia in the hospital
- B. Adult diagnosed with Parkinson disease
- C. Adult woman receiving chemotherapy for breast cancer
- D. Adolescent being discharged with a cast on his leg
- E. New mother who delivered a healthy infant via a cesarean birth
- F. Adult man diagnosed with end-stage cancer
Correct Answer: A,B,F
Rationale: The patients who are most likely to need a formal discharge plan or referral to another facility are those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.
A nurse is caring for a patient who has been hospitalized for dehydration secondary to a urinary tract infection. The patient states, 'I'm leaving. There are too many germs here, and I'll probably get sicker than when I came in.' As this patient has capacity for decision making, which response is most consistent with the nurse's legal accountability?
- A. Only the primary health care provider can authorize your discharge from a hospital.
- B. Let me gather your belongings and prepare the discharge paperwork.
- C. I will inform the health care provider that you want to leave and request a psychiatric consult.
- D. Your choice carries risks for complications, so I must ask you to sign a release form.
Correct Answer: D
Rationale: The patient is legally free to leave the hospital against medical advice (AMA); however, patients who who leave AMA must sign a form releasing the health care provider and hospital from legal responsibility for their health status. This signed form becomes part of the medical record.
A nurse and AP are planning to receive a patient who sustained a traumatic head injury in a motor vehicle accident. Which activity can the nurse safely delegate to the AP?
- A. Collecting information for a health history
- B. Performing a physical assessment
- C. Contacting the health care provider for medical orders
- D. Preparing the bed and collecting needed supplies
Correct Answer: D
Rationale: The nurse may delegate preparation of the bed and collection of needed supplies to assistive personnel but performs the other activities listed, as they require clinical judgment and specialized skills.
A nurse asks the AP to prepare the hospital room for a new ambulatory patient. Which aspect of the room will the nurse ask the AP to correct?
- A. The bed linens are folded back.
- B. A hospital gown is on the bed.
- C. Equipment for taking vital signs is in the room.
- D. The bed is in the highest position.
Correct Answer: D
Rationale: A properly prepared hospital room includes a bed in the lowest position for an ambulatory patient, an open bed with top linens folded back, routine and special equipment and supplies assembled, and the physical environment of the room adjusted.