Nursing Care of Patients at Home

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____ 1. The nurse is making a home health visit to a patient and needs to contact the case manager of the patient’s home-care team. Which person should the nurse contact?
a. Physician
b. Social worker
c. Registered nurse (RN)
d. Home health agency administrator
____ 2. The nurse is to see a patient who requires dressing changes. Which staff member obtains the required supplies to be used during the home health care visit?
a. Nurse
b. Physician
c. Social worker
d. Home health aide
____ 3. During a home visit, the nurse notes that an older patient is sitting in a poorly lit room listening to the radio. When the nurse turns on a light before starting to evaluate the patient and change a dressing on a wound, the patient says, “Oh, you don’t need that light. I try to keep the lights off. Electricity is too expensive.” Which response by the nurse is most appropriate?
a. “Oh, I didn’t realize you were pinching pennies. I’ll use my flashlight.”
b. “I will turn off the light as soon as I finish changing the dressing on your wound.”
c. “It sounds like it would be helpful for you to talk with the social worker who can identify financial programs that could help you.”
d. “If you can’t afford electricity, you may need to consider a new residence. I can set up a visit to a nice assisted living complex near here.”
____ 4. During a home visit, the nurse documents arrival and departure time, patient vital signs, data collected for the patient, and a narrative note of the patient’s response to medications and understanding of care being given. Which action does the nurse need to take prior to submitting this documentation?
a. Obtain signature of case manager.
b. Obtain signature of patient or caregiver.
c. Comment about patient’s home surroundings.
d. Record the time of documentation submission.
____ 5. During a home health visit, the nurse learns that the family member who is the primary caregiver of the patient is exhausted and tense. Which nursing diagnosis should the nurse recommend for the patient’s plan of care?
a. Social Isolation
b. Caregiver Role Strain
c. Altered Role Performance
d. Ineffective Therapeutic Regimen Management
____ 6. While traveling to a patient’s home for a visit, the home-care nurse becomes lost in an unfamiliar part of town and sees a group of teenagers hanging around a boarded-up building. Which action should the nurse take?
a. Proceed to the next appointment.
b. Pull over to the curb to look at a map.
c. Seek assistance from one of the teens.
d. Drive to a familiar area and call the patient for directions.
____ 7. The nurse is completing the home-care flow sheet. When should the nurse plan to return this sheet to the home health agency?
a. In 2 days
b. Within 6 hours
c. Within 24 hours
d. Before the patient is discharged
____ 8. An older patient requires intravenous medication to be infused three times a day. The nurse instructs the spouse to provide these infusions. How frequently should the nurse plan to make home-care visits to this patient?
a. Daily
b. Never
c. Twice a week
d. Every 2 weeks
____ 9. During a home visit, the patient asks if his spouse could take one of the patient’s prescribed pain pills for a severe headache. How should the nurse respond to this request?
a. Explain that only 1 dose is permitted to be taken.
b. Suggest the spouse use an over-the-counter pain medication instead.
c. Discuss how frequently the spouse can safely take the prescribed pain medication.
d. Ask the spouse to contact the health care provider for a prescription for the medication.
____ 10. Prior to leaving a patient’s home after a visit, the nurse makes a note in the patient’s home-care folder. Why did the nurse write a note to be kept in the patient’s home?
a. Explains the amount of time each visit takes to complete
b. Provides a reminder to the patient of what care is needed
c. Serves as communication between HCPs who are visiting the patient
d. Provides information to justify the type and level of skilled care the patient requires
Multiple Response
Identify one or more choices that best complete the statement or answer the question.

____ 11. The nurse completes the OASIS form upon a patient’s admission to a home health care program. For which reasons does the nurse complete this form? (Select all that apply.)
a. To determine per-visit payments
b. To collect information about patient outcomes
c. To document skills used in a specific home visit
d. To develop a plan of care that meets the patient’s needs
e. To generate information about the home health care agency
f. To identify relatives who will be trained as patient caregivers
____ 12. The nurse is visiting the home of an 80-year-old patient who has hypertension and diabetes. In addition to obtaining vital signs and blood glucose levels, what other actions would be appropriate for the nurse to do? (Select all that apply.)
a. Inspect bathroom cupboards for contents.
b. Search the kitchen for high-salt or sugar foods.
c. Ask why the bed has not been made or the dishes washed.
d. Check the bathroom for safety bars in the tub/shower area.
e. Note the presence of scatter rugs or other impediments to free movement.
f. Ask the patient about lighting at night when getting up to use the bathroom.
____ 13. The nurse is making a third home health visit. Which observations indicate that the patient and family have understood safety instructions and recommendations made by the nurse on an earlier visit? (Select all that apply.)
a. The patient is wearing an emergency response call device.
b. The family has removed scatter rugs and installed wall-to-wall carpeting.
c. The bathtub has no nonslip mat, and there is no grab bar near the shower.
d. The patient’s telephone, eyeglasses, and TV remote are near the patient’s seat.
e. The patient reports getting up frequently at night, but there is no visible night-light.
f. The patient’s medications are in labeled bottles with a checklist for medication times.
____ 14. The nurse is identifying care that a home-care patient requires. For which patient needs should the nurse seek assistance from the social worker? (Select all that apply.)
a. Setting up Meals on Wheels
b. Helping the patient obtain a prescription card
c. Identifying agencies that offer respite care services
d. Assisting the family with long-term placement of the patient
e. Helping the patient use assistive devices such as canes and walkers
f. Assisting the patient with an exercise program to regain strength and mobility
____ 15. The family of a home-care patient asks the nurse to explain private duty nursing. How should the nurse respond to this question? (Select all that apply.)
a. “It is covered by Medicare.”
b. “It is covered by Medicaid.”
c. “It is considered an out-of-pocket expense.”
d. “Most duties focus on companionship and respite care.”
e. “Specific licensure is required to become a private duty nurse.”
f. “Either licensed nurses or unlicensed assistive personnel may be used.”
____ 16. The nurse is making a first home-care visit to a patient recently discharged after hip replacement surgery. Which home observations should the nurse document as safety concerns? (Select all that apply.)
a. The patient’s recliner faces the television.
b. A safety bar has been installed in the shower.
c. A bathmat towel is on the floor in front of the tub.
d. Smoke detectors are located in the kitchen and near the bedrooms.
e. The patient has a large birdcage sitting on the floor in the middle of the living room.
f. The hallway between the bedroom and bathroom is partially blocked by a cedar chest.
____ 17. The nurse is preparing to make a telehealth visit to a patient with a foot wound. Which types of technology will the nurse use to complete this visit? (Select all that apply.)
a. E-mail
b. Telephone
c. Fax machine
d. Blood pressure cuff
e. Video conferencing
____ 18. The nurse is planning to make home-care visits throughout the day. What tasks should the nurse perform before beginning these visits? (Select all that apply.)
a. Place a map in the door sleeve.
b. Plug the cell phone into the charger.
c. Check that the car’s gas tank is full.
d. Check the home-care bag for a whistle.
e. Check the wallet for at least $50 in cash.
____ 19. After entering a patient’s home for a visit, the nurse notes that the living room floor is littered with trash, and pet hair is on furniture and table stands. What should the nurse do to maintain a clean home-care bag? (Select all that apply.)
a. Take the bag back to the car.
b. Wear the bag as a shoulder bag.
c. Place the bag on a disposable pad.
d. Cleanse the bag after leaving the home.
e. Place the bag on the nearest un-upholstered chair.

Chapter 16. Nursing Care of Patients at Home
Answer Section

MULTIPLE CHOICE

1. ANS: C
C. The RN is the case manager while the patient is receiving home health care. A. The physician prescribes orders and receives information to determine the patient’s care needs. B. The social worker evaluates community resources to assist the patient. D. The home health agency administrator oversees the business activities of the agency.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

2. ANS: A
A. In the home, the nurse making the visits is responsible for bringing supplies to ensure safe care. The nurse carries extra common supplies, such as various sizes of urinary catheters, sterile dressing gauze, different types of tape, and alcohol wipes, to be prepared for whatever care the patient may need. B. C. D. The physician, social worker, and home health aide are not responsible for ensuring supplies are available when providing patient care in the home.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

3. ANS: C
C. The case manager can relay concerns of the home-care team to the physician and obtain an order for a social service visit. Social workers help the patient with financial assistive services. A. Good lighting is important to provide safe care associated with the dressing change. B. This option does not recognize the potential financial hardship faced by the patient. D. Identifying the patient’s wishes and financial options would be necessary before exploring alternative living arrangements.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

4. ANS: B
B. Items generally included in all home health documentation are the arrival and departure times of the nurse, assessment findings, vital signs, a narrative note, and the patient’s signature verifying the nurse was present in the home. A. The case manager does not need to sign the nurse’s documentation. C. Information about the patient’s home surroundings is not necessary. D. The time of submission is not a part of the home-care documentation note.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

5. ANS: B
B. Caregiver role strain is related to the management of a chronic illness and lack of understanding of resources available. The caregiver is exhibiting signs of role strain: exhaustion and being tense. A. B. D. The caregiver is not demonstrating signs of social isolation, altered role performance, or ineffective management of the therapeutic regimen.

PTS: 1 DIF: Moderate
KEY: Client Need: Psychosocial Integrity | Cognitive Level: Application

6. ANS: D
D. If lost in an unknown area, the home-care nurse should leave, go to a familiar place, and contact the patient for directions. The agency also can be contacted with any concerns about home safety. A. Skipping the appointment could jeopardize the patient’s health and welfare. B. C. Pulling over to the curb to look at a map and asking for help could jeopardize the nurse’s safety.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

7. ANS: C
C. In most situations, a flow sheet documenting a home health care visit should be returned to the home health care facility or agency within 24 hours of the visit. A. D. The sheet needs to be returned before 2 days or before the patient is discharged. B. It would be unrealistic to expect the checklist to be returned to the agency within 6 hours.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

8. ANS: B
B. If the patient can manage the care either independently or with help from a family member, the services of a home health nurse may not be required. A. C. D. Since the family member is able to provide the medication, services of a home-care nurse would not be needed daily, twice a week, or every 2 weeks.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

9. ANS: D
D. Nurses are not able to prescribe medications. The best response would be for the spouse to contact the HCP and ask for a prescription for pain medication. A. B. C. The nurse cannot prescribe medication therefore explaining the number of doses to be taken, suggesting the use of over-the-counter pain medication, and discussing the frequency of taking the medication are all outside of the nurse’s scope of practice, could jeopardize the nurse’s license, and should not be done.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

10. ANS: C
C. A folder with information is kept at the patient’s residence. It usually consists of relevant patient information and a communication form that all staff members complete at each visit. Similar to hospital charting, this documentation is important to ensure continuity of care. It is even more vital in the home setting, because staff members do not receive verbal report. A. The communication note is not used to explain the amount of time each visit takes to complete. B. The communication note is not used by the patient. D. The communication note is not used to establish homebound status or skill level required when providing patient care.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Analysis

MULTIPLE RESPONSE

11. ANS: B, D, E
B. D. E. Outcome and Assessment Information Set (OASIS) is used to generate information about the home health agency and patient outcomes and to help develop a plan of care that best meets the patient’s problems. A. C. F. The OASIS form is not used to determine payment structures, document skills used during the visit, or identify relatives to train as caregivers for the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

12. ANS: D, E, F
D. E. F. Checks that the nurse should do during a home visit to promote safety for the patient include checking the bathroom for safety bars, noting the presence of scatter rugs or other hazards that impede movement, and checking for adequate lighting. A. Searching the bathroom is not appropriate. B. Education related to appropriate dietary measures is important, but searching the kitchen is not appropriate. C. Housekeeping is not within the realm of the nurse unless it is noted to endanger the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

13. ANS: A, B, D, F
A. B. D. F. Observations that promote home safety include the patient wearing an emergency response call device; removal of scatter rugs throughout the home; personal items, such as eyeglasses and the remote for the TV, located in the patient’s seating area; and medications being appropriately labeled with a checklist. C. E. A lack of safety devices in the bathroom and insufficient lighting indicate that additional teaching is required by the nurse.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Analysis

14. ANS: A, B, C, D
A. B. C. D. Social workers work closely with community resources and assist the patient with obtaining community assistance, such as obtaining a prescription card, setting up Meals on Wheels, and assisting the family with long-term care placement, respite care, homemaker services, living wills, and financial assistive services. E and F would be provided by a physical therapist.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

15. ANS: C, D, F
C. D. F. Private duty nursing consists of scheduled care to assist the patient with personal and homemaking needs that often focus more on companionship and respite care. Either licensed nurses or unlicensed assistive personnel may be used. A. B. Private duty is not covered by Medicare and Medicaid. E. No specific licensure is required. It is an out-of-pocket expense.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

16. ANS: C, E, F
C. E. F. The home health nurse should always assess the patient’s safety in the home. Safety concerns would include an obstruction on the floor, such as a birdcage, and a walkway being blocked by a cedar chest. The bathmat towel needs to be replaced with a non-skid mat. A. B. D. The recliner facing the television is not a safety risk. A safety bar in the shower is not a safety risk. Smoke detectors support home safety.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

17. ANS: A, B, C, E
A. B. C. E. Telenursing, a branch of telehealth, uses information technology and telecommunication to provide nursing care. Various types of technology can be used, including telephone, fax, e-mail, and video/audio conferencing. D. A blood pressure cuff would not be used during a telehealth visit, because the nurse is not in the same room as the patient.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Management of Care | Cognitive Level: Application

18. ANS: A, B, C, D
A. B. C. D. Safety tips for the nurse preparing to conduct home-care visits includes having a map in the car, having a cell phone, making sure the car’s gas tank is full, and having a whistle in case help is needed. E. Carrying a large sum of money is not required while conducting home-care visits.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application

19. ANS: C, D
C. D. Disposable pads can be put on the floor and the home health bag placed on these. After the visit, the nurse should disinfect the bag before the next visit. A. The nurse might need something from the bag during the visit, so taking the bag back to the car is not safe nursing care. B. Wearing the bag as a shoulder bag could limit the nurse’s ability to provide safe nursing care. E. Placing the bag on an un-upholstered chair could expose the bag to environmental hazards.

PTS: 1 DIF: Moderate
KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application