Nokea
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.
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A home health nurse has been assigned to the care of an 82 year-old woman who has been discharged home following hip replacement surgery. At what level of care is this nurse most likely practicing?
- A. Preventative care
- B. Primary prevention
- C. Secondary prevention
- D. Tertiary prevention
Correct Answer: D
Rationale: Nurses in community-based practice provide preventive care at three levels: primary, secondary, and tertiary. Tertiary prevention focuses on minimizing deterioration and improving quality of life, including rehabilitation to assist patients in achieving their maximum potential by working through their physical or psychological challenges. Home care nurses often focus on tertiary preventive nursing care, although primary and secondary prevention are also addressed. Preventive care is an umbrella term for all three levels of care.
In two days you are scheduled to discharge a patient home after left hip replacement. You have initiated a home health referral and you have met with a team of people who have been involved with this patients discharge planning. Knowing that the patient lives alone, who would be appropriate people to be on the discharge planning team? Select all that apply.
- A. Home health nurse
- B. Physical therapist
- C. Pharmacy technician
- D. Social worker
- E. Meal-on-Wheels provider
Correct Answer: A,B,D
Rationale: The development of a comprehensive discharge plan requires collaboration with professionals at both the referring agency and the home care agency, as well as other community agencies that provide specific resources upon discharge. The pharmacy technician does not participate in discharge planning and there is no indication that Meals-on-Wheels are necessary.
A home health nurse has been working for several months with a male patient who is receiving rehabilitative services. The nurse is aware that maintaining the patients confidentiality is a priority. How can the nurse best protect the patients right to confidentiality?
- A. Avoid bringing the patients medical record to the home.
- B. Discuss the patients condition and care only when he is alone in the home.
- C. Keep the patients medical record secured at all times.
- D. Ask the patient to avoid discussing his home care with friends and neighbors.
Correct Answer: C
Rationale: If the nurse carries a patients medical record into a house, it must be put in a secure place to prevent it from being picked up by others or from being misplaced. This does not mean, however, that it must never be brought to the home. It is not normally necessary to limit discussions to times when the patient is alone. The patient has the right to decide with whom he will discuss his condition and care.
You are a school nurse who will work with an incoming kindergarten student who has a diagnosis of cerebral palsy. Why would you make a home visit before school starts?
- A. To provide anticipatory guidance to the family
- B. To assess the safety of the childs assistive devices
- C. To arrange for a teaching aide to work with the child
- D. To provide follow-up care after the childs clinic visit
Correct Answer: A
Rationale: Public health, parish, and school nurses may make visits to provide anticipatory guidance to high-risk families and follow-up care to patients with communicable diseases. The other answers are incorrect because they are not functions of the school nurse.
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.