Test Bank For Medical-Surgical Nursing, Vol. 1 and 2, 12th Edition

Import Settings: Base Settings: Brownstone Default Information Field: Chapter Information Field: Client Needs Information Field: Cognitive Level Information Field: Difficulty Information Field: Integrated Process Information Field: Objective Information Field: Page and Header Highest Answer Letter: E Multiple Keywords in Same Paragraph: No Chapter: Chapter 02: Community-Based Nursing Practice Multiple Choice 1. A community health nurse has scheduled a hypertension clinic. This service would be an example of which type of health care? A) Tertiary prevention B) Secondary prevention C) Primary prevention D) Disease prevention Ans: B Chapter: 2 Client Needs: B Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 15, Community-Based Care Feedback: Secondary prevention centers on health maintenance are aimed at early detection and prevention. Disease prevention is not a form of health care but is a focus with primary prevention. 2. The nursing instructor is preparing her students for their home-care rotation. She discusses the patients that they are likely to care for in the home. Which of the following are the most frequent users of home care services? A) Disabled patients B) Chronically ill patients C) Terminally ill patients D) Elderly patients Ans: D Chapter: 2 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 16, Home Health Care Feedback: The elderly are the most frequent users of home care services. The patient must be acutely ill, home bound, 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. 3. Patients’ lifestyles in the home may vary greatly from the nurse’s own beliefs. To work successfully with the patient, what must the nurse do? A) Ask for another assignment if there is a conflict of interest B) Ask the patient to come to the agency to receive treatment C) Convey respect for the patient’s beliefs D) Adapt the patient’s home to a hospital-like environment Ans: C Chapter: 2 Client Needs: C Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 5 Page and Header: 16, Home Health Care Feedback: To work successfully with patients in any setting, the nurse must be nonjudgmental and convey respect for patients’ beliefs, even if they differ sharply from the nurse’s. This can be difficult when a patient’s lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of alcohol, drug abuse, or overeating. The other answers are incorrect because you do not request another assignment because of a difference in beliefs, nor do you ask for the patient to come to you if you are a home health nurse. It is also inappropriate to convert the patient’s home to a hospital-like environment. 4. Infection control is important in every setting where nursing care is provided. In the home setting, how will the nurse best implement infection control? A) Cleanse the hands before and after giving direct patient care B) Remove the patient’s wound dressings from the home C) Dispose of patient’s syringes in the patient’s garbage D) Disinfect all work areas in the patient’s home Ans: A Chapter: 2 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 17, Home Health Care Feedback: Infection control is as important in the home as it is in the hospital, but it can be more challenging in the home and requires creative approaches. As in any situation, it is important to clean one’s hands before and after giving direct patient care, even in a home that does not have running water. The other answers are incorrect because removing the wound dressings from the home and disinfecting all work areas in the home are not the best implementation of infection control in the home. Disposing of syringes in the patient’s garbage is never done. 5. Your patient is ready to be discharged from the hospital. When should your patient’s discharge planning begin? A) The day prior to discharge B) The day of estimated discharge C) The day the patient is admitted D) Once the nurse determines care needs Ans: C Chapter: 2 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 17, Home Health Care Feedback: Discharge planning begins with the patient’s admission to the hospital and must consider the possible need for follow-up home care. The other answers are incorrect because they are not when discharge planning begins. 6. During the initial visit to a patient’s home, what information is it important to provide to the patient and family? A) Available community resources to meet their needs B) Information on other patients in the area with similar health care needs C) The nurse’s home address and phone number D) Dates and times of all scheduled home care visits Ans: A Chapter: 2 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 17, Home Health Care Feedback: The community-based nurse is responsible for informing the patient and family about the community resources available to meet their needs. During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because it is inappropriate to ever provide information on other patients to a patient; it is equally inappropriate for a nurse to give her patients her home address or phone number. Giving the patient the dates and times of their scheduled home visits is appropriate, but it is more important to provide them with resources available within the community to meet their needs. 7. The home health nurse receives a referral from the hospital for a patient who needs a home visit. After reading the referral, what would be the first action the nurse should take? A) Identify community services to initiate for the patient B) Obtain a physician’s order for the visit C) Call the patient to obtain permission to visit D) Schedule a home health aide to visit the patient Ans: C Chapter: 2 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 17, Home Health Care Feedback: After receiving a referral, the first step is to call the patient and obtain permission to make the visit. Then the nurse should schedule the visit and verify the address. A physician’s order is not necessary to schedule a visit with the patient. The nurse may identify community services or the need for a home health aide after she assesses the patient and the home environment during the first visit with the patient. 8. Why is it important for the nurse to inform the health care agency of her daily schedule? A) Allows the agency to keep track for payment of the nurse B) Supports suggested safety precautions for the nurse when making a home care visit C) Allows easy accessibility of the nurse for changes in assignments D) Allows the patient to cancel appointments with minimal inconvenience Ans: B Chapter: 2 Client Needs: D-3 Cognitive Level: Application Difficulty: Moderate Integrated Process: Nursing Process Objective: 6 Page and Header: 17, Home Health Care Feedback: Whenever a nurse makes a home visit, the agency should know the nurse’s schedule and the locations of the visits. The other answers are incorrect because providing the agency with a copy of the daily schedule is not for the purpose of correctly paying the nurse or for the ease of the nurse in changing assignments or for the patient’s ease in canceling appointments. 9. There are specific guidelines and regulations for documentation related to home care that the nurse must consider and follow. For those patients with Medicaid, what is most important for the nurse to document to assure reimbursement for services? A) The medical diagnosis and supplies needed to care for the patient B) Directions to the patient’s home C) Quality of nursing care needed D) The patient’s homebound status and the need for skilled professional nursing care Ans: D Chapter: 2 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 5 Page and Header: 18, Home Health Care Feedback: Medicare, Medicaid, and third-party payers require documentation of the patient’s 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, directions to the patient’s home, or the quality of care needed. 10. Your patient has had a total knee replacement and will need to walk with crutches 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 her initial assessment? A) Assistance of neighbors B) Previous health status C) Costs of the visits D) Home environment Ans: D Chapter: 2 Client Needs: D-3 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 18, Home Health Care Feedback: The initial assessment includes evaluating the patient, the home environment, the patient’s self-care abilities or the family’s ability to provide care, and the patient’s need for additional resources. There is no assessment made of assistance on the part of neighbors, the previous health status, or the costs of the visit. 11. 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 cocoordinator C) Clinical nurse specialist D) Clinic supervisor Ans: A Chapter: 2 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 19, Other Community-Based Health Care Settings Feedback: Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on gerontology, pediatrics, family or adult health, or women’s health. Case cocoordinators and clinic supervisors do not require an advanced degree, and a clinical nurse specialist is not educated in primary care. 12. A nurse working in a large meat-packaging plant sees patients for work-related issues. What is the role of the nurse? A) Occupational health nurse B) Staff nurse C) Nurse clinician D) Nurse educator Ans: A Chapter: 2 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 20, Other Community-Based Health Care Settings Feedback: Occupational health nurses may provide direct care to patients who are ill, conduct health education programs for the industry staff, or set up health programs. The other answers are incorrect because they are not consistent with a nurse’s placement in a manufacturing setting. 13. A school nurse is concerned about a fourth grade student with cystic fibrosis. The nurse is aware that children with health problems are at major risk for what? A) Sports injuries B) Attention disorders C) Experiencing school-related stress due to a desire to overachieve D) Underachieving or failing in school Ans: D Chapter: 2 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 20, Other Community-Based Health Care Settings Feedback: School-aged children and adolescents with health problems are at major risk for underachieving or failing in school. The other answers are incorrect because they are not at major risk for sports injuries, attention disorders, or a desire to overachieve. 14. Which patients seek health care late in the course of their disease process and deteriorate more quickly than other patients? A) Homeless B) Immigrants C) Elderly D) Adolescents Ans: A Chapter: 2 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 7 Page and Header: 20, Other Community-Based Health Care Settings Feedback: Because of numerous barriers, the homeless seek health care late in the course of a disease and deteriorate more quickly than patients who are not homeless. Many of their health problems are related in large part to their living situation. The other answers are incorrect because these populations do not seek care late in the course of their disease process and deteriorate quicker than other populations. Multiple Selection 15. What changes in the health care system have created an increased need for nurses to practice in community-based settings? (Mark all that apply.) A) Tighter insurance regulations B) Younger population C) Increased rural population D) Changes in federal legislation E) Decreasing hospital revenues Ans: A, D, E Chapter: 2 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 15, Introduction Feedback: Changes in federal legislation, tighter insurance regulations, decreasing hospital revenues, and alternative health care delivery systems have also affected the ways in which health care is delivered. Our country does not have an increased rural population nor is our population younger so these answers are incorrect. Multiple Choice 16. Nurses are now working in ambulatory health clinics, hospice settings, and homeless shelters and clinics. What has influenced this increase 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 Ans: B Chapter: 2 Client Needs: A-1 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 15, Introduction Feedback: As health care delivery shifts into the community, more nurses are working in a variety of community-based settings. These settings include public health departments, ambulatory health clinics, long-term care facilities, hospice settings, industrial settings (as occupational nurses), homeless shelters and clinics, nursing centers, home health agencies, urgent care centers, same-day surgical centers, short-stay facilities, and patients’ homes. The other answers are incorrect because our population has not shifted to more rural area, and the use of primary care clinics has not influenced an increase in practice settings or the use of rehabilitation hospitals. 17. What is the focus of community-based nursing? A) Community health B) Maintaining and improving the health of the community C) Promoting and maintaining the health of individuals and families D) Family health Ans: C Chapter: 2 Client Needs: A-1 Cognitive Level: Knowledge Difficulty: Easy Integrated Process: Caring Objective: 7 Page and Header: 15, Community-Based Care Feedback: This nursing practice focuses on promoting and maintaining the health of individuals and families, preventing and minimizing the progression of disease, and improving quality of life. Its focus is not really community health, maintaining or improving the health of a community, or family health per se. 18. You are the community-based nurse who acts as case-manager for a small town about 60 miles from a major health care center. What is the most important factor of community-based nursing you should be knowledgeable about? 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 Ans: B Chapter: 2 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 17, Home Health Care Feedback: A community-based nurse must be knowledgeable about community resources available to patients as well as services provided by local agencies, eligibility requirements, and any possible charges for the services. The other answers are incorrect because they are not the most important factor for a community-based nurse to be knowledgeable about. 19. A new community-based nurse is looking for community resources for one of her clients. Where would be the best place to look? A) Hospital directories B) Telephone book C) Community directories D) Church directories Ans: C Chapter: 2 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 17, Home Health Care Feedback: Most communities have directories of health and social service agencies that the nurse can consult. The other answers are incorrect because hospital directories usually only include people affiliated with the hospital, and neither telephone books nor church directories are meant to be directories of community resources. Multiple Selection 20. You are a community-based care manager in a community that does not have a resource directory available. One of your goals is to compile such a directory. What would be important to include in this directory? (Mark all that apply.) A) Nearby medical facilities B) List of social service workers in the community C) Eligibility requirements for services D) Commonly used resources E) Costs of services Ans: C, D, E Chapter: 2 Client Needs: A-1 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 17, Home Health Care Feedback: If a community does not have a resource booklet, an agency may develop one for its staff. It should include the commonly used community resources that patients need, as well as the costs of the services and eligibility requirements. The other answers are incorrect because a community resource booklet would not always include nearby medical facilities, and it would not identify specific social service workers, only agencies. Multiple Choice 21. You are assessing a new patient and his home environment. What is a responsibility that you, as a community-based nurse, have at this initial visit? A) Encourage the patient and his family to use local stores to support their community. B) Encourage the patient and his family to contact their church as a resource. C) Encourage the patient and his family to use the Internet to find local resources. D) Encourage the patient and his family to contact appropriate community resources. Ans: D Chapter: 2 Client Needs: D-4 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 4 Page and Header: 17, Home Health Care Feedback: During initial and subsequent home visits, the nurse helps the patient and family identify these community services and encourages them to contact the appropriate agencies. When appropriate, nurses may make the initial contact. The other answers are incorrect because a home-health nurse would not encourage the patient to support the community, nor would she necessarily encourage the patient to use the church as a resource or to use the Internet to find his own local resources. The nurse would provide the patient with the applicable local resources. 22. What type of health care is most likely to be available in both community and hospital-based settings? A) Dieticians B) Ambulatory health care C) Physical therapy D) Hospice care Ans: B Chapter: 2 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Caring Objective: 2 Page and Header: 19, Other Community-Based Health Care Settings Feedback: Ambulatory health care is provided for patients in community or hospital-based settings. The types of agencies that provide such care are medical clinics, ambulatory care units, urgent care centers, cardiac rehabilitation programs, mental health centers, student health centers, community outreach programs, and nursing centers. Dieticians are not generally community based, physical therapy is usually agency based, and hospice care is not generally provided in hospital settings. 23. Every home health agency, based on the principle of due diligence, must inform its employees of what? A) B) C) D) At-risk working environments OSHA requirements Available training for personal safety Policies and procedures about clinical safety Ans: A Chapter: 2 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 6 Page and Header: 17, Home Health Care Feedback: Based on the principle of due diligence, agencies must inform employees of at-risk working environments. Agencies have policies and procedures concerning the promotion of safety for clinical staff, and training is provided to facilitate personal safety. Home health agencies are not required to inform their staff of OSHA requirements, available training, or the policies and procedures regarding personal safety. They are required to inform someone before she is sent into a risky working environment. 24. A home health nurse is making a visit to a new patient. During the visit, the patient’s husband arrives home in an intoxicated condition. He speaks to both you and the patient in an abusive and threatening manner. What should you do? 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 Ans: B Chapter: 2 Client Needs: A-2 Cognitive Level: Application Difficulty: Moderate Integrated Process: Caring Objective: 6 Page and Header: 18, Home Health Care Feedback: If a dangerous situation is encountered during the visit, the nurse should return to the agency and contact his or her supervisor or law enforcement officials, or both. The other answers are incorrect. Ignoring the husband or calling the police while in the home or attempting to remove the patient from the home could further endanger you and the patient. 25. You have been notified by your agency of a new patient in your community. The agency tells you that this patient resides in a high-crime area. What is the most important request you should make of the agency? A) A cell phone B) Directions to the home C) Someone to accompany you on the visit D) Someone to wait in the car while you make your visit Ans: C Chapter: 2 Client Needs: A-2 Cognitive Level: Analysis Difficulty: Difficult Integrated Process: Caring Objective: 6 Page and Header: 18, Home Health Care Feedback: When making visits in high-crime areas, visit with another person rather than alone. Answer D is incorrect because that possibly endangers both you and the person waiting in the car. Answers A and B are incorrect because they are not the most important request to the agency. 26. What level of care do home health nurses often focus on? A) Preventative care B) Primary prevention C) Secondary prevention D) Tertiary prevention Ans: D Chapter: 2 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 6 Page and Header: 20, Other Community-Based Health Care Settings Feedback: 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. Answers B and C are incorrect because, while addressed, they are not usually the focus of home care nurses, and preventive care is an umbrella for all three levels of care. 27. You are admitting two new patients to your home health care service. These patients live within two blocks of each other, and both homes are in a high-crime area. What is recommended for your personal safety? A) Drive a car that is hard to break into. B) Keep your purse close to you at all times. C) Don’t leave anything in the car that might be stolen. D) Do not wear expensive jewelry. Ans: D Chapter: 2 Client Needs: A-2 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 6 Page and Header: 18, Home Health Care Feedback: Do not drive an expensive car or wear expensive jewelry when making visits. While all of these answers might be wise precautions to take, the only recommendation for your personal safety is answer D. Multiple Selection 28. In two days you are scheduled to discharge a patient home status post 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 patient’s discharge planning. Who would be appropriate people to be on the discharge planning team? (Mark all that apply.) A) Home health nurse B) Physical therapist C) Patient’s pastor D) Social service worker E) Meal-on-Wheels provider Ans: A, B, D Chapter: 2 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 17, Home Health Care Feedback: The development of a comprehensive discharge plan requires collaboration with professionals at both the referring agency and the home care agency, as well as other community agencies that provide specific resources upon discharge. The patient’s pastor and the Meals-on-Wheels provider are not appropriate people to be part of a discharge-planning team. 29. Which type of agencies provides documented home health care services? (Mark all that apply.) A) Unofficial neighborhood groups B) Private businesses C) Proprietary chains D) Off-duty neighborhood nurses E) Hospital-based agencies Ans: B, C, E Chapter: 2 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 2 Page and Header: 15, Home Health Care Feedback: Home health care services are provided by official, publicly funded agencies; nonprofit agencies; private businesses; proprietary chains; and hospital-based agencies. Unofficial neighborhood groups and off-duty neighborhood nurses are not agencies that provide documented home health services. Multiple Choice 30. Discharge planning begins with the patient’s admission to the hospital. What is involved in the discharge-planning process? A) Identifying the patient’s needs B) Making a social services referral C) Getting physical therapy involved D) Notifying the speech therapist of the discharge date Ans: A Chapter: 2 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 3 Page and Header: 17, Home Health Care Feedback: The process involves identifying the patient’s needs and developing a thorough plan to meet them. Answers B, C and D might be appropriate for some patients, but they are not all appropriate for every patient; therefore, these answers are wrong. 31. Within the public health system there has been an increased demand for medical, nursing, and social services. What is the basis for this increased demand? A) A shift from hospital to community-based health care B) The growing number of older adults in the United States C) The rise in poverty in the United States D) The decreasing revenues in health care Ans: B Chapter: 2 Client Needs: A-1 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 1 Page and Header: 15, Introduction Feedback: The growing number of older adults in the United States increases the demand for medical, nursing, and social services within the public health system. While there has been a shift from hospital-based to community-based health care, it is not the main reason for the increased need for public health services. Answers C and D are incorrect because they are not used as the basis for the increased demand for professionals within the public health system. 32. Nursing care, no matter where it is delivered, has many consistencies. One of these consistencies is the need for what? A) Advanced education B) Certification in a specialty C) Cultural competence D) Independent practice Ans: C Chapter: 2 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Easy Integrated Process: Caring Objective: 2 Page and Header: 15, Introduction Feedback: Nurses in community settings must be culturally competent, as culture plays a role in the delivery of care. Culture can be structured within the context of care through the utilization of a theoretical framework involving cultural competence. The other answers are incorrect because an advanced education, specialty certification, and the ability to practice independently are not consistencies between nursing care delivery settings. 33. Medicare finances many home health care expenses. What does this allow nurses to do? A) Provide care without the oversight of a physician B) Write necessary medication orders for the patient C) Order physical, occupational, and speech therapy if needed D) Manage and evaluate patient care for seriously ill patients Ans: D Chapter: 2 Client Needs: D-4 Cognitive Level: Comprehension Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 16, Home Health Care Feedback: 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 write medication orders; nor do they order the services of ancillary specialists such as physical, occupational, or speech therapists. 34. You are a school nurse who is concerned about an incoming kindergartner with muscular dystrophy. Why would you make a home visit before school starts? A) To provide anticipatory guidance to the family B) To measure the child’s wheelchair to make sure it fits through the school doors C) To set up home teachers for the child D) To provide follow-up care after the child’s clinic visit Ans: A Chapter: 2 Client Needs: D-4 Cognitive Level: Analysis Difficulty: Moderate Integrated Process: Caring Objective: 7 Page and Header: 20, Other Community-Based Health Care Settings Feedback: Public health, parish, and school nurses may make visits to provide anticipatory guidance to high-risk families and follow-up care to patients with communicable diseases. The other answers are incorrect because they are not functions of the school nurse.