Home Care Patient Assessment

MULTIPLE CHOICE

     1.   For which of the following conditions (which is the third most common cause of death in the United States) are both mortality rates and prevalence rates increasing?

a.
Chronic obstructive pulmonary disease (COPD)
b.
Asthma
c.
Pneumonia
d.
Heart failure

ANS:  A

COPD is a common cause of death in the United States.

REF:   pg. 455           OBJ:   1

     2.   In which of the following skills is it most important for a home care respiratory therapist (RT) to be proficient?

a.
Decision making.
b.
Time management.
c.
Patient assessment.
d.
Communication and teaching skills.

ANS:  C

Patient assessment is the key to success for an RT who is providing home care.

REF:   pg. 455           OBJ:   4

     3.   Which of the following is not true of respiratory home care?

a.
It reduces the number of future hospitalizations.
b.
It provides a higher quality of life for the patient.
c.
It decreases overall expenditures for medical care.
d.
It decreases a patient’s ability to independently manage his or her care.

ANS:  D

Respiratory home care has been shown to reduce the number of future hospitalizations, reduce the costs of medical care, help a patient become more independent, and enhance a patient’s quality of life.

REF:   pg. 455           OBJ:   1

     4.   Which of the following conditions is least likely to be seen and treated by an RT in the home care setting?

a.
COPD
b.
Pulmonary fibrosis
c.
Sleep-disordered breathing
d.
Burns

ANS:  D

Burn victims are not likely to be treated at home.

REF:   pg. 455           OBJ:   3

     5.   What is the most common respiratory care modality applied in the home care setting?

a.
Intermittent positive pressure breathing (IPPB)
b.
Oxygen therapy
c.
Nebulizer therapy
d.
Continuous positive airway pressure (CPAP)

ANS:  B

Oxygen therapy is the most common respiratory care modality used in the home.

REF:   pg. 455           OBJ:   3

     6.   How many patients are expected to need home care in the United States by the year 2016?

a.
5 million
b.
12 million
c.
25 million
d.
50 million

ANS:  B

About 12 million patients are expected to need home care in the United States by the year 2016.

REF:   pg. 455           OBJ:   1

     7.   The primary tools used to conduct a home care patient assessment include all of the following except a:

a.
stethoscope.
b.
pulse oximeter.
c.
peak flowmeter.
d.
bronchoscope.

ANS:  D

The bronchoscope is not used in the home care setting.

REF:   pg. 455           OBJ:   5

     8.   What is the name of the primary organization that accredits home care companies?

a.
Health Care Committee
b.
The Joint Commission
c.
Medical Examiner’s Office
d.
Committee for Health Care

ANS:  B

The Joint Commission accredits most home care companies.

REF:   pg. 457           OBJ:   2

     9.   What is the primary role of an RT in home care?

a.
Communicate with other team members
b.
Do the paper work associated with home care
c.
Provide education and equipment setup
d.
Give treatments as needed

ANS:  C

The primary role of the home care RT is to teach the patient and set up needed equipment.

REF:   pg. 457           OBJ:   4

   10.   Which of the following staff members is least likely to be a member of the home health care team?

a.
Occupational therapist
b.
Physical therapist
c.
Social worker
d.
Radiation technologist

ANS:  D

Radiation technology is not needed in the home care setting.

REF:   pg. 457           OBJ:   4

   11.   Which of the following is a true statement related to reimbursement for RT services in the home care setting?

a.
Only oxygen therapy orders allow the RT to be paid.
b.
The HME cannot bill for RT hours.
c.
All RT time spent in the home can be billed.
d.
Only time spent setting up equipment can be reimbursed.

ANS:  B

Current reimbursement laws do not allow HMEs to bill for the time an RT spends in the home teaching and treating the patient.

REF:   pg. 457           OBJ:   2

   12.   Which of the following should be identified by an RT during the initial home care interview of the patient and caregivers?

a.
Patient smoking history
b.
Current list of medications
c.
Pulmonary risk factors
d.
All of the above

ANS:  D

The home care RT will need to interview the patient to identify numerous issues. The patient’s smoking history, current list of medications, and pulmonary risk factors such as animals in the home are just a few of the issues that must be identified.

REF:   pg. 460           OBJ:   6 | 7

   13.   Which of the following should be done only with a physician’s order?

a.
Chest auscultation
b.
Pulse oximetry
c.
Check of blood pressure
d.
Check of body temperature

ANS:  B

Pulse oximetry should be done only after a physician order has been written.

REF:   pg. 460           OBJ:   8

   14.   Your home care patient has a chronic neuromuscular disease, and ventilation is a concern. Which of the following tests would be most helpful in evaluating this?

a.
Chest auscultation
b.
Pulse oximetry
c.
ETCO2
d.
Peak flow

ANS:  C

End-tidal carbon dioxide (ETCO2) levels reflect the degree of effective ventilation.

REF:   pg. 456           OBJ:   6 | 7

   15.   Which of the following may cause cognitive impairment of the home care patient and may impede education efforts by an RT?

a.
Acute hypoxemia
b.
Stroke
c.
Certain medications
d.
All of the above

ANS:  D

Acute hypoxemia, stroke, and the use of certain medications such as sleeping pills have been known to impair cognitive function in patients.

REF:   pg. 461           OBJ:   7

   16.   What should the home care RT do if a patient cannot demonstrate proper use of his metered-dose inhaler (MDI)?

a.
Contact the physician.
b.
Switch the patient to a small-volume nebulizer.
c.
Discontinue the use of the MDI.
d.
Call the patient’s nurse.

ANS:  A

Contacting the patient’s physician is a good idea if the patient cannot use the MDI correctly.

REF:   pg. 461           OBJ:   8

   17.   What is the role of the RT in evaluating psychosocial issues with the home care patient?

a.
The home care RT should not get involved in psychosocial issues.
b.
The home care RT should observe and document any psychosocial issues.
c.
Any such issues that are observed should be communicated to the physician.
d.
Both b and c are correct.

ANS:  D

The home care RT should observe and document any psychosocial issues that are present, such as anxiety or depression. These observations must be communicated to the patient’s attending physician.

REF:   pg. 461           OBJ:   4 | 6

   18.   What is a common reason why patients with COPD may suffer acute dyspnea during meal preparation?

a.
They have bronchospasm from the odors.
b.
They remove their oxygen cannula during cooking.
c.
They become nervous about gaining weight.
d.
They are afraid of losing their balance.

ANS:  B

Patients who cook are often afraid that their oxygen may explode around heat, so they often remove the oxygen cannula.

REF:   pg. 462           OBJ:   8

   19.   Which of the following should the RT assess during environmental evaluation of the home care patient’s living place?

a.
The presence of smoke detectors
b.
An emergency exit route
c.
Sources for triggers of bronchospasm
d.
All of the above

ANS:  D

The home care RT does an environmental assessment of the patient’s living place to evaluate the safety and capabilities of the home.

REF:   pg. 463           OBJ:   8

   20.   A visit by a home care RT is required for a patient who is using any of the following types of equipment except:

a.
An oximeter.
b.
A bland aerosol therapy equipment.
c.
A pneumatic nebulizer.
d.
Oxygen therapy equipment.

ANS:  C

Patients who are using a pneumatic nebulizer do not have to be visited by the RT.

REF:   pg. 463           OBJ:   4 | 9

   21.   After teaching the patient to perform a specific skill for his or her home care, what should the RT do?

a.
Document the demonstration.
b.
Repeat the demonstration.
c.
Ask for a return demonstration.
d.
Ask the patient if he or she understands.

ANS:  C

Asking the patient for a return demonstration is an excellent way to make sure that the patient understands the procedure.

REF:   pg. 465           OBJ:   11

   22.   What may cause pedal edema in the home care patient?

a.
Fluid overload
b.
Liver failure
c.
Pneumonia
d.
Use of diuretics

ANS:  A

If the patient has too much fluid in the cardiovascular system, he or she often develops pedal edema. Pedal edema also is seen in patients with heart failure.

REF:   Table 20-2, pg. 466                        OBJ:   3 | 10

   23.   The home care RT notices that the patient is producing more sputum than usual. What is the most likely cause?

a.
Improved vital capacity
b.
An allergic reaction
c.
A respiratory infection
d.
Heart failure

ANS:  C

An increase in sputum production most often is a sign of airway infection.

REF:   Table 20-2, pg. 466                        OBJ:   10

   24.   If the home care patient is suffering from a poor appetite, what could be the cause?

a.
Depression
b.
Dyspnea
c.
Infection
d.
All of the above

ANS:  D

A poor appetite can be caused by many conditions such as depression, shortness of breath, and infection.

REF:   Table 20-2, pg. 466                        OBJ:   3 | 10

   25.   Which of the following tools should be provided by the healthcare team for a patient to effectively manage his or her own care?

a.
Equipment and training in how to use it
b.
A knowledge base about disease and care needs
c.
The ability to monitor oneself and knowledge about when to notify members of the team
d.
All of the above

ANS:  D

The ultimate goal of respiratory home care is to provide a patient with the tools to manage his or her own care. These tools include a knowledge base about the general situation and the equipment and procedures to be used, and capability in self-monitoring.

REF:   pg. 466           OBJ:   12

   26.   The RT who assesses the patient to qualify him or her for home oxygen therapy should do all of the following except:

a.
Be aware of the guidelines and criteria for qualifying the patient for oxygen therapy.
b.
Communicate the process for qualifying for oxygen to the patient.
c.
Be directly involved in assessing the patient to qualify the patient for oxygen therapy.
d.
Be aware of the physical and function limitations the patient has and assess oxygen needs with activity.

ANS:  C

The RT should be aware of the guidelines pertaining to qualifying a patient for home oxygen therapy reimbursement under Centers for Medicare and Medicaid Services (CMS) and should never be directly involved in the assessment process if affiliated with the home oxygen company.

REF:   pg. 466           OBJ:   9