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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.
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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.
Medicare is a federal program that finances many Americans home health care expenses. The Medicare program facilitates what aspect of home health care?
- A. Providing care without the oversight of a physician
- B. Writing necessary medication orders for the patient
- C. Ordering physical, occupational, and speech therapy if needed
- D. Managing and evaluating patient care for seriously ill patients
Correct Answer: D
Rationale: Many home health care expenditures are financed by Medicare, which allows nurses to manage and evaluate patient care for seriously ill patients who have complex, labile conditions and are at high risk for rehospitalization. Home health nurses, despite who funds their visits, do not provide care without the oversight of a physician; they do not normally write medication orders; nor do they order the services of ancillary specialists such as physical, occupational, or speech therapists.
An adult patient is ready to be discharged from the hospital after undergoing a transmetatarsal amputation. When should your patients discharge planning begin?
- A. The day prior to discharge
- B. The day of estimated discharge
- C. The day that the patient is admitted
- D. Once the nursing care plan has been finalized
Correct Answer: C
Rationale: Discharge planning begins with the patients admission to the hospital and must consider the possible need for follow-up home care. Discharge planning should begin prior to the other listed times.
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 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.