University of Colorado, Boulder - NUR 109

Chapter 30: The Nurse in Home Health and Hospice

Stanhope: Foundations of Population Health for Community/Public Health Nursing, 5th Edition

MULTIPLE CHOICE

1)Which of the following statements best describes the most essential difference between home health care and acute client care?

1. 1. Acute client care is individualized for the client and family.
   2. Home health care is provided in the client’s environment.
   3. Reimbursement for home health care varies from that of care provided in institutions.
   4. The focus of acute client care is on community health.

2. A nurse has just received word that Medicaid will reimburse for care provided to a homeless man with schizophrenia who is afraid to come to the clinic to receive health care. Which of the following best describes this type of nursing?
   1. Community-oriented nursing

1. 2. Home health nursing
   3. Hospice nursing
   4. Private duty nursing

3. A hospital nurse wants to know why home health nurses often take more time with assessment than nurses do in the hospital. Which of the following is the best explanation for this?
   1. Home care assessment includes not only the client but the supplies and equipment the family may have available for use.
   2. The home environment is less organized and equipped for the nurse’s use.
   3. Family members must also be assessed for possible problems that could interfere with the primary client’s recovery.
   4. To be effective, the home health nurse must earn the family’s trust and work in partnership with them.

4. Which of the following events led to the emphasis on home care nurses caring for acutely ill clients and the increased demands for extensive documentation?
   1. Advances in medical technology and pharmacology
   2. Increased number of lawsuits for substandard care
   3. Introduction of Medicare
   4. Social Security Act of the 1930s

5. In the agency, one of the nurses spent all available time visiting a group of persons with mental health problems who were trying to remain functional in the community. Which of the following types of assignments did the nurse likely  have?
   1. Home-based primary care
   2. Population-focused home care
   3. Proprietary home care
   4. Transitional care

6. A new client has just been released from the hospital after intensive treatment for multiple injuries following a motorcycle accident. Which of the following types of care will he most likely receive?
   1. Home-based primary care
   2. Population-focused home care
   3. Proprietary home care

1. 4. Transitional care

7. Which of the following types of home health agencies emphasizes health promotion and illness prevention?
   1. Combination agencies
   2. Hospital-based agencies
   3. Official agencies
   4. Proprietary agencies
8. Which of the following is a potential advantage of hospital-based home health agencies over other types of home care agencies?
   1. Administration and management benefits are gained from the expertise of two boards of experts.
   2. Continuity of care is enhanced.
   3. Health promotion and illness prevention concerns take precedence over acute care and rehabilitation.
   4. They are eligible for tax exemptions through affiliated agencies.

9. Which of the following is the primary focus of hospice care?
   1. Curing or controlling the client’s chronic disease

1. 2. Decreasing the waste of acute care (hospital) resources
   3. Providing palliative care to maintain comfort until death
   4. Teaching the client and family how to care for themselves

10. Which of the following best describes why it is more challenging for most nurses to meet the needs of a dying child and his or her family than to meet the needs of a dying adult?
    1. Children don’t understand what it means to die.
    2. A child’s death is harder for anyone to accept.
    3. Society does not expect death to occur in children.
    4. Families are not prepared to deal with death.
11. When meeting with a client and family, the home health nurse says, “We have discussed your health problems and limitations. Now tell me what level of health and function you hope to achieve.” In which of the following phases of the nursing process is the nurse engaging?
    1. Assessment
    2. Diagnosis
    3. Outcome identification
    4. Planning

12. A home health nurse asks a client with arthritis to attend a demonstration in which an assistive device is used to put on shoes. Which phase of the nursing process is the nurse’s current focus?
    1. Outcome identification
    2. Planning
    3. Implementation

1. 4. Evaluation

13. A home health nurse is caring for a client who has right-sided paresis secondary to a stroke. Which of the following would be the best approach for the nurse to take?
    1. Arrange for private duty nurses to assist the client with daily needs.
    2. Assist the client with activities of daily living.
    3. Teach the client to participate in self-care activities.
    4. Teach the family how to care for the client.

14. Which of the following do community-based nurses typically use to organize, sort, and document pertinent client data?
    1. NANDA
    2. NIC & NOC
    3. Nursing Diagnosis Taxonomy
    4. The Omaha System

15. Which of the following should be the minimum requirement for a nurse to be prepared for home health nursing?
    1. An RN license and a baccalaureate degree in a health-related field
    2. A baccalaureate degree in nursing and RN licensure
    3. An associate’s degree in nursing and RN licensure
    4. Eligibility for certification as a home health nurse

16. A nurse orienting to the home health role states, “I don’t understand why we have to collaborate with so many other disciplines; this conflicts with the concept of nurses providing all direct care to the client in the home?” Which of the following would be the best response?
    1. The nurse still provides direct care for the client; however, interdisciplinary collaboration is necessary to prevent fragmentation of care.
    2. Direct nursing care is a concept applied to care in tertiary facilities, such as hospitals, where materials are centrally located in one facility. In home health, this is not possible.
    3. Even though home health nursing does not provide as much direct care as other nursing specialties in the community, each discipline contributes to client needs from its special knowledge base.
    4. Yes, it does create conflict, but Medicare mandates interdisciplinary collaboration.

17. A nurse completes a self-assessment of performance as part of the home health nurse’s annual evaluation. Which of the following terms best describes this activity?
    1. Collaboration
    2. Quality of care
    3. Performance appraisal
    4. Resource utilization

18. Which of the following best describes when the home health nurse must document required Outcome and Assessment Information Set (OASIS-C2) data?
    1. Before any episode of hospitalization
    2. After each home health visit
    3. For all incidences of error or mistake in care
    4. On first admission to home health care

19. The board of directors is examining various submitted reports concerning its home health agency. Which of the following reports represents an example of benchmarking?
    1. A report by the administrator regarding how the home health agency’s performance compares with that of other local and national home health agencies
    2. A report by the chief financial officer regarding a cost-benefit analysis related to technological advances
    3. A report by the chief nursing officer regarding client outcomes
    4. A report by the medical director regarding implementation of evidence-based practice into standards of care.

20. Which of the following comments was most likely stated by a home health nurse?
    1. “Every time I see a client, it costs $80.”
    2. “Health care costs are killing our economy.”
    3. “I can’t believe how much clients are charged for things.”
    4. “Medicaid costs are such a large portion of our state’s budget.”

21. Which of the following best describes one of the outcomes of the incentives and pressures for cost control and improved health outcomes?
    1. Expansion in alternative health care agencies
    2. Improvements in client teaching materials
    3. Public pressure to improve health professionals’ education
    4. Development and increased use of telehealth technology

22. Which of the following is a primary requirement for a client to be eligible for home health

nursing and Medicare reimbursement of services?

1. Must be homebound
2. Must be living in a medically underserved area
3. Must be indigent
4. Must be insured or eligible for Medicare or Medicaid

23. Which of the following clients over 65 years of age meets the criteria for Medicare reimbursement for home health nursing?
    1. The client who needs assistance with bathing and meal preparation
    2. The client who needs assistance with house cleaning and meal preparation
    3. The client who needs sitter services because she wanders from home and becomes lost
    4. The client whose family members need to learn how to care for his surgical wound

24. Which of the following best explains why the home health nurse would essentially repeat the same information given to the client by the nurse in the hospital?
    1. Clients find it difficult to learn in the midst of the stress of the acute care setting and often don’t remember what the hospital nurse taught.
    2. Hearing something from a different person, using different words and examples, can help ensure that learning is retained.
    3. Home health nurses often don’t know what hospital-based nurses have already taught.
    4. Learning depends on receiving information more than once.
25. A family member asks a home health nurse to explain the concept of hospice care. Which of the following would the nurse need to include as the fundamental underlying philosophy of hospice?
    1. Enabling the client to die at home
    2. Ensuring that the client’s living will is upheld
    3. Placing experts in the position of power of attorney
    4. Providing comfort measures before death

26. Which of the following practices in the home is most crucial?
    1. Using good handwashing procedures
    2. Obtaining a puncture-resistant container for family to use for needles
    3. Putting all contaminated material directly into a trash bag
    4. Washing all surfaces with disinfectant