Deck 2: Community-Based Nursing Practice

Question 1

A community health nurse has scheduled a hypertension clinic in a local shopping mall in which shoppers have the opportunity to have their blood pressure measured and learn about hypertension. This nursing activity would be an example of which type of prevention activity?

A) Tertiary prevention
B) Secondary prevention
C) Primary prevention
D) Disease prevention

Answer 1

Secondary prevention

Question 2

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

Answer 2

Elderly patients

Question 3

A recent nursing graduate has been surprised at the sharp contrast between some patients lifestyles in their homes and the nurses own practices and beliefs. To work therapeutically with the patient, what
Must the nurse do?

A) Request another assignment if there is dissonance with the patients lifestyle.
B) Ask the patient to come to the agency to receive treatment, if possible.
C) Resolve to convey respect for the patients beliefs and choices.
D) Try to adapt the patients home to the norms of a hospital environment.

Answer 3

Resolve to convey respect for the patients beliefs and choices.

Question 4

Infection control is a high priority in every setting where nursing care is provided. When performing a home visit, how should the nurse best implement the principles of infection control?

A) Perform hand hygiene before and after giving direct patient care.
B) Remove the patients wound dressings from the home promptly.
C) Disinfect the patients syringes prior to disposal.
D) Establish a sterile field in the patients home before providing care.

Question 5

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

Question 6

A home health nurse is preparing to make the initial visit to a new patients home. When planning educational interventions, what information should the nurse provide to the patient and his or her family?

A) Available community resources to meet their needs
B) Information on other patients in the area with similar health care needs
C) The nurses contact information and credentials
D) Dates and times of all scheduled home care visits

Question 7

At the beginning of a day that will involve several home visits, the nurse has ensured that the health care agency has a copy of her daily schedule. What is the rationale for the nurses action?

A) It allows the agency to keep track for payment to the nurse.
B) It supports safety precautions for the nurse when making a home care visit.
C) It allows for greater flexibility for the nurse and his or her colleagues for changes in assignments.
D) It allows the patient to cancel appointments with minimal inconvenience.

Question 8

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

Question 9

Your patient has had a total knee replacement and will need to walk with a two-wheeled walker for 6 weeks. He is being discharged home with a referral for home health care. What will the home care nurse need to assess during the initial nursing assessment in the home?

A) Assistance of neighbors
B) Qualification for Medicare and Medicaid
C) Costs related to the visits
D) Characteristics of the home environment

Question 10

A nurse who has an advanced degree in primary care for a pediatric population is employed in a health clinic. In what role is this nurse functioning?

A) Nurse practitioner
B) Case coordinator
C) Clinical nurse specialist
D) Clinic supervisor

Question 11

A nurse is based in an automotive assembly plant and works with the plants employees in the areas of health promotion and basic primary care. What nursing role is this nurse performing?

A) Occupational health nurse
B) Community nurse specialist
C) Nurse clinician
D) Public health nurse

Question 12

A school nurse has been working closely with a student who has cystic fibrosis. The nurse is aware that children with health problems are at major risk for what problem?

A) Mental health disorders
B) Gradual reduction in intelligence
C) Psychological stress due to a desire to overachieve
D) Underachievement in school

Question 13

A community health nurse is aware that restoration of health often depends on appropriate interventions performed early in the course of a disease. Which patient is most likely to seek health care late in the course of his or her disease process and deteriorate more quickly than other patients?

A) A patient who has been homeless for an extended period of time
B) A patient who recently immigrated to the United States
C) A patient who is 88 years old and who has enjoyed relatively good health
D) A teenage boy

Question 14

A recent nursing school graduate has chosen to pursue a community nursing position because of increasing opportunities for nurses in community settings. What changes in the health care system have created an increased need for nurses to practice in community-based settings? Select all that apply.

A) Tighter insurance regulations
B) Younger population
C) Increased rural population
D) Changes in federal legislation
E) Decreasing hospital revenues

Question 15

A nursing student has taught a colleague that nursing practice is not limited to hospital settings, explaining that nurses are now working in ambulatory health clinics, hospice settings, and homeless shelters and clinics. What factor has most influenced this increased diversity in practice settings for
Nurses?

A) Population shift to more rural areas
B) Shift of health care delivery into the community
C) Advent of primary care clinics
D) Increased use of rehabilitation hospitals

Question 16

A nurse is collaborating with a team of community nurses to identify the vision and mission for community care. What is the central focus of community-based nursing?

A) Increased health literacy in the community
B) Distributing ownership for the health of the community
C) Promoting and maintaining the health of individuals and families
D) Identifying links between lifestyle and health

Question 17

You are the community-based nurse who performs the role of case manager for a small town about 60 miles from a major health care center. When planning care in your community, what is the most important variable in community-based nursing that you should integrate into your planning?

A) Eligibility requirements for services
B) Community resources available to patients
C) Transportation costs to the medical center
D) Possible charges for any services provided

Question 18

An urban, community-based nurse is looking for community resources for a patient who has complex rehabilitation needs coupled with several comorbid, chronic health conditions. Where is the best place for the nurse to search for appropriate resources?

A) A hospital directory
B) The hospital intranet
C) A community directory
D) The nurses own personal network

Question 19

You are a community-based care manager in a medium-sized community that does not have an up-todate resource directory available. As a result, you have been given the task of beginning to compile such a directory. What would be important to include in this directory? Select all that apply.

A) Links to online health sciences journals
B) Lists of social service workers in the community
C) Eligibility requirements for services
D) Lists of the most commonly used resources
E) Costs associated with services

Question 20

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.

Question 21

A nurse is comparing some of the similarities and differences between the care that is provided in community- and hospital-based settings. What type of care is provided in both of these settings?

A) Dieticians
B) Ambulatory health care
C) Occupational health care
D) Hospice care

Question 22

A community-based case manager is sending a community nurse to perform an initial home assessment of a newly referred patient. To ensure safety, the case manager must make the nurse aware of which of the following?

A) The potential for at-risk working environments
B) Self-defense strategies
C) Locations of emergency services in the area
D) Standard precautions for infection control

Question 23

A home health nurse is making a visit to a new patient who is receiving home care following a mastectomy. During the visit, the patients husband arrives home in an intoxicated state and speaks to both you and the patient in an abusive manner. What is your best response?

A) Ignore the husband and focus on the patient.
B) Return to your agency and notify your supervisor.
C) Call the police from your cell phone.
D) Remove the patient from the home immediately.

Question 24

The community-health nurse has received a referral for a new patient who resides in a high-crime area. What is the most important request that the nurse should make of the agency to best ensure safety?

A) An early morning or late afternoon appointment
B) An assigned parking space in the neighborhood
C) A colleague to accompany the nurse on the visit
D) Someone to wait in the car while the nurse makes the visit

Question 25

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

Question 26

You are admitting two new patients to your local home health care service. These patients live within two blocks of each other and both homes are in a high-crime area. What action best protects your personal safety?

A) Drive a car that is hard to break into.
B) Keep your satchel close to you at all times.
C) Do not leave anything in the car that might be stolen.
D) Do not wear expensive jewelry.

Question 27

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

Question 28

A home health nurse is conducting a home visit to a patient who receives wound care twice weekly for a diabetic foot ulcer. While performing the dressing change, the nurse realizes that she forgot to bring the adhesive gauze specified in the wound care regimen. What is the nurses best action?

A) Phone a colleague to bring the required supplies as soon as possible.
B) Improvise, if possible, using sterile gauze and adhesive tape.
C) Leave the wound open to air and teach the patient about infection control.
D) Schedule a return visit for the following day.

Question 29

Discharge planning is an integral part of community-health nursing and home health. Which of the following is prioritized in the discharge-planning process?

A) Identifying the patients specific needs
B) Making a social services referral
C) Getting physical therapy involved in care
D) Notifying the pharmacy of the discharge date

Question 30

Within the public health system there has been an increased demand for medical, nursing, and social services. The nurse should recognize what phenomenon as the basis for this increased demand?

A) Increased use of complementary and alternative therapies
B) The growing number of older adults in the United States
C) The rise in income disparity in the United States
D) Increasing profit potential for home health services

Question 31

Nursing care is provided in an increasingly diverse variety of settings. Despite the variety in settings, some characteristics of professional nursing practice are required in any and every setting. These characteristics include which of the following?

A) Advanced education
B) Certification in a chosen specialty
C) Cultural competence
D) Independent practice

Question 32

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

Question 33

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

Question 34

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.

Question 35

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.

Question 36

A home health nurse is collaborating with a hospice nurse in order to transfer the care of a woman who has a diagnosis of lung cancer. To qualify for hospice care, the patient must meet what criterion?

A) The patient must be medically inappropriate for hospital care.
B) The patient must be in the final six months of his or her life.
C) The patients family must demonstrate that they are unable to provide care.
D) The patient must have a diagnosis that is associated with high morbidity and mortality.

Question 37

A home health nurse has completed a scheduled home visit to a patient with a chronic sacral ulcer. The nurse is now evaluating and documenting the need for future visits and the frequency of those visits. What question can the nurse use when attempting to determine this need?

A) How does the patient describe his coping style?
B) When was the patient first diagnosed with this wound?
C) Is the patients family willing to participate in care?
D) Is the patient willing to create a plan of care?

Question 38

A home health nurse is conducting an assessment of a patient who may qualify for Medicare. Consequently, the nurse is utilizing the Outcome and Assessment Instrument Set (OASIS). When performing an assessment using this instrument, the nurse should assess which of the following domains of the patients current status?

A) Psychiatric status
B) Spiritual state
C) Compliance with care
D) Functional status

Question 39

A community health nurse in a large, urban setting is participating in a pilot project that will involve the establishment of a community hub. On what population should the nurse focus?

A) Postsurgical patients
B) Individuals with vulnerable health
C) Community leaders
D) Individuals motivated to participate in health education