CH 12 CARE COORDINATION & COLLAB PRACTICE

Question 1

1.
A client asks a nurse, “How does ergotamine (Ergostat) relieve migraine headaches?” The nurse should respond that it:
A)
dilates cerebral blood vessels.
B)
constricts cerebral blood vessels.
C)
decreases peripheral vascular resistance.
D)
decreases the stimulation of baroreceptors.

Answer 1

B

Feedback:

Ergotamine relieves migraine headaches by constricting, not dilating, cerebral arterial vessels. The drug’s ability to prevent norepinephrine reuptake may add to this effect. The net result is decreased pulsatile blood flow through the cerebral vessels and symptom relief. Ergotamine doesn’t decrease peripheral vascular resistance or stimulation of baroreceptors.

Question 2

2.
What role will the nurse play in transferring a client to a long-term care facility?
A)
Provide a verbal report to the nurse at the long-term care facility on the client, the hospital care, and the client’s current condition.
B)
Assure that the client’s original chart accompanies the client.
C)
Arrange for the client’s belongings to remain at the hospital until discharge from the long-term care facility.
D)
Inform the client that transferring should be a stress-free situation.

Answer 2

A

Feedback:

The nurse at the hospital will provide a verbal report to the nurse at the long-term facility. The client’s belongings will accompany the client to the long-term facility, and the nurse should assure that this occurs. The original chart will not accompany the client, but copies of the chart or sections of the chart may be sent based upon agency protocols. The nurse should also recognize and inform the client that while a transfer may be a welcome event, it also can be stressful.

Question 3

3.
The nurse recognizes that the goals established for a client’s discharge are more likely to be accomplished when …
A)
the client assists in developing the goals.
B)
the physician develops the goals.
C)
the nurse develops the goals.
D)
the multidisciplinary team develops the goals.

Answer 3

A

Feedback:

If the client is involved in establishing the goals, it is more likely that the expected outcomes of the discharge plan will be met. The client may fail to follow the plan if the goals are not mutually agreed on, or are not based on a complete assessment of the client’s needs.

Question 4

4.
Which of the following phrases best describes continuity of care?
A)
Focusing on acute care in the hospital
B)
Serving the needs of children
C)
Facilitating transition between settings
D)
Providing single-episode care services

Answer 4

C

Feedback:
Continuity of care is a process by which health care providers give appropriate uninterrupted care and facilitate the client’s transition between different settings and levels of care. The other choices do not describe continuity of care.

Question 5

5.
Which of the following nursing diagnoses would be appropriate for almost all clients entering a health care setting?
A)
Impaired Elimination
B)
Dysfunctional Grieving
C)
Fatigue
D)
Anxiety

Answer 5

D

Feedback:

Entering and leaving a health care setting, as well as receiving care at home, are experiences that produce anxiety for both clients and family members. Most clients entering a health care setting do not have impaired elimination, dysfunctional grieving, or fatigue.

Question 6

6.
A nurse is admitting an older woman (Grace Staples) to a long-term care facility. How should the nurse address the woman?
A)
“We will just call you Grace while you live here. Okay?”
B)
“I know you have lots of grandchildren, Grandma.”
C)
“What name do you want us to use for you?”
D)
“I think you will enjoy living here, Sweetie.”

Answer 6

C

Feedback:
The nurse should communicate with the client as an individual so he or she can maintain his or her own identity. Ask clients how you should address them. Do not call older adults Grandma or Grandpa.

Question 7

7.
Which of the following is the major goal of ambulatory care facilities?
A)
To save money by not paying hospital rates
B)
To provide care to clients capable of self-care at home
C)
To perform major surgery in a community setting
D)
To perform tests prior to being admitted to the hospital

Answer 7

B

Feedback:
An individual may receive care in many different kinds of ambulatory facilities, including physician offices, clinics, hospital outpatient services, emergency rooms, and same-day surgery centers. The goal of these facilities is to provide health care services to patients who are able to provide self-care at home. Although this saves money on hospital bills, that is not the major goal of ambulatory facilities. Major surgery and pretesting for surgery are not usually done at these centers.

Question 8

8.
According to established standards, which health care provider should conduct a holistic assessment for all clients admitted to the hospital?
A)
Physician
B)
Admission clerk
C)
Licensed practical nurse
D)
Registered nurse

Answer 8

D

Feedback:
The Joint Commission has established standards for hospital admission. These standards include assessment of each client’s need for nursing care by a registered nurse and biophysical, psychosocial, environmental, self-care, educational, and discharge planning factors. The admission health assessment is not the responsibility of the physician, licensed practical nurse, or admission clerk.

Question 9

9.
Which health care provider is responsible for ensuring the room is prepared for admission and that the client is welcomed?
A)
Nursing assistant
B)
Admitting room clerk
C)
Social worker
D)
Nurse

Answer 9

D

Feedback:
Although the nurse may delegate most of the activities necessary to prepare a room for an admission, it is the nurse’s responsibility to ensure other personnel complete the activities and to welcome the client to the unit.

Question 10

10.
A client has suddenly become very ill, and a nurse is transferring him to the intensive care unit (ICU). How does the nurse provide information to ensure continuity of care?
A)
By giving a verbal report to nurses in the ICU
B)
By ensuring that the chart and all belongings are moved
C)
By delegating a nursing assistant to provide information
D)
By asking the family to provide the information

Answer 10

A

Feedback:
When a client is transferred to another unit, the nurse in the original unit gives a verbal report about the client to the nurse in the new area. Continuity of care is not ensured by moving the chart and belongings, delegating responsibility to a nursing assistant, or asking the family to provide information.

Question 11

11.
At what point during hospital-based care does planning for discharge begin?
A)
Upon admission to the hospital
B)
After the patient is settled in a room
C)
Immediately before discharge
D)
After leaving the hospital

Answer 11

A

Feedback:
Planning for discharge begins on admission to the hospital, when admission information about the client is collected and documented.

Question 12

12.
A nurse, preparing for a client’s discharge after surgery, is teaching the client’s wife to change the dressing. How can the nurse be certain the wife knows the procedure?
A)
Tell the wife exactly how to do it.
B)
Give the wife information about supplies.
C)
Have the wife demonstrate the procedure.
D)
Ask another nurse to reinforce teaching.

Answer 12

C

Feedback:

All steps of a procedure should be demonstrated, practiced, and provided in writing. The client or caregiver should then perform the procedure in the presence of the nurse to demonstrate understanding. Simply stating the information, providing information about supplies, or asking another nurse to reinforce teaching does not mean the caregiver knows the information.

Question 13

13.
What is required of a client who leaves the hospital against medical advice (AMA)?
A)
Nothing. The hospital has no legal concerns.
B)
Full reimbursement of any medical expenses
C)
Providing contact phone numbers if needed
D)
Signing a form releasing legal responsibility

Answer 13

D

Feedback:
A client is legally free to leave the hospital, but must sign a form that releases the physician and health care institution from any legal responsibility for his or her health status. The client’s signature must be witnessed, and the form becomes part of the client’s medical record.

Question 14

14.
A home health care agency providing care in a local community is supported by the United Way and local donations. What type of agency is this?
A)
Voluntary
B)
Public
C)
Proprietary
D)
Institution-based

Answer 14

A

Feedback:
Home care agencies differ in the way they are organized and administered. They may be official or public (operated by state or local governments and primarily financed by tax funds), voluntary or not-for-profit (supported by donations, endowments, charities, and insurance reimbursements), proprietary (for-profit organizations governed by individual owners or national corporations), or institution-based (operate under a parent organization, such as a hospital).

Question 15

15.
Why would a home health care agency choose to be certified by Medicare?
A)
To remain open and offer services
B)
To ensure that all available services can be provided
C)
To receive reimbursement for Medicare-covered services
D)
To be able to admit clients without a physician’s order

Answer 15

C

Feedback:

There are two types of home health care agencies: those certified by Medicare and those that are not. An agency must be certified by Medicare in order to receive reimbursement for Medicare-covered services.

Question 16

16.
In addition to a physician’s order, what is one of the eligibility requirements for Medicare-covered home health care?
A)
The client must have transportation to the physician’s office.
B)
The family must be willing to meet health care needs.
C)
The client must be essentially homebound.
D)
The client must be able to leave the home unassisted.

Answer 16

C

Feedback:
To be eligible for Medicare-covered home health care services, the client must meet certain criteria. One is that the client must be homebound or normally unable to leave the home unassisted. The client may leave home for medical treatment or short, infrequent trips, but leaving the home must require considerable effort.

Question 17

17.
What is the goal of nurses who provide home health care?
A)
Helping clients achieve maximum independence and health
B)
Collaborating with other health care providers and services
C)
Minimizing the manifestations of disease processes
D)
Encouraging clients’ dependence on family members

Answer 17

A

Feedback:

The essential components of home health care include the client, the family, and health care professionals from various disciplines. The goal of nursing care in the home is to help clients reach maximum independence and health. Although nurses collaborate with other health care providers, they do so to meet this goal. Home health care is not provided to minimize disease manifestations or to encourage clients’ dependence on family members.

Question 18

18.
Which of the following health care professionals prescribes home care and certifies the plan of care for the client?
A)
Social worker
B)
Discharge nurse
C)
Home healthcare nurse
D)
Physician

Answer 18

D

Feedback:

The physician certifies the client has a health problem so that the client may receive home health care services. The physician also prescribes and certifies a plan of care for the client. The plan is not certified by a social worker, discharge nurse, or home health care nurse.

Question 19

19.
Although all of the following components are important, which two components of nursing care are identified by home health care nurses asmostimportant when caring for clients in the home?
A)
Computer knowledge, cultural diversity
B)
Physical assessment, infection control
C)
Communications, technical skills
D)
Documentation, problem solving

Answer 19

B

Feedback:
Home health care nurses have identified the following areas of knowledge as most important: legal regulations, physical assessment, body mechanics, nursing diagnoses, and infection control.

Question 20

20.
A client is having problems with insurance reimbursement. The home health care nurse discusses the client’s need for home health services with the insurance company. What role is the nurse demonstrating?
A)
Direct care provider
B)
Coordinator of services
C)
Educator
D)
Advocate

Answer 20

D

Feedback:
Patients often need help understanding the complex health care system, including handling insurance problems. Advocacy (the protection and support of another’s rights) is an important role of the home health care nurse. By convincing the insurance company of the client’s continued need for home care services, the nurse is acting as an advocate.

Question 21

21.
Which one of the following roles of the home health care nurse illustrates the role of coordinator of services?
A)
Providing certification for home care
B)
Providing direct physical care to the client
C)
Providing information about community resources
D)
Educating the client and caregiver about wound care

Answer 21

C

Feedback:
The home health care nurse is generally the coordinator of all other health care providers visiting the client. He or she is also responsible for coordinating community resources needed by the client. The nurse does not provide certification. Providing direct care is a part of the caregiver role, whereas educating about wound care is part of the educator role.

Question 22

22.
Which of the following is recommended to ensure safety for the home health care nurse?
A)
Traveling with another nurse
B)
Carrying a cell phone
C)
Talking to family members
D)
Refusing assignments

Answer 22

B

Feedback:
The nurse must evaluate the safety of the neighborhood before making the first home visit. Guidelines for safety of the nurse include carrying a cell phone programmed with emergency numbers. In most instances, it is not economically feasible to travel with another nurse. Talking to family members and refusing assignments do not ensure safety.

Question 23

23.
What must a nurse do before altering the arrangement of furniture in the home to facilitate care?
A)
Nothing; the nurse may move the furniture if needed.
B)
Document the need to move the furniture.
C)
Tell the client that the furniture has to be moved.
D)
Ask the client’s permission to move the furniture.

Answer 23

D

Feedback:
The nurse may believe the furniture in the client’s home needs to be rearranged to allow the use of equipment and to remove safety hazards, but the client should give permission before any changes are made. It is not necessary to document the need to move furniture.

Question 24

24.
What technique should the nurse use to implement infection control in the home?
A)
Avoid touching any object in the home, including door knobs.
B)
Practice hand hygiene when beginning and ending the home visit.
C)
Wear gloves at all times when in the home or traveling in the car.
D)
Take prescribed antibiotics on a regular basis on working days.

Answer 24

B

Feedback:

Of all the methods used to prevent infection, hand hygiene is the most important and is necessary before and after treating the client (i.e., when beginning and ending the home visit).

Question 25

``` 25. A client is diagnosed with mild dementia while in the hospital. In preparing for discharge, what should the nurse should discuss with the family? A) Possible need for home care B) Legal responsibility for the future C) Need for transfer to a long-term care facility D) Lack of free resources of care ```

Answer 25

A Feedback: The needs of the client should be considered when making discharge plans. Common risk factors associated with the need for home care include limited social, mental, or physical functioning. Legal issues, long-term care, and free resources are not indicated in this situation.

Question 26

``` 26. Which of the following are examples of nursing actions performed in the entry phase of the home visit? Select all that apply. A) Developing rapport B) Making assessments C) Evaluating safety issues D) Gathering supplies E) Collecting client information ```

Answer 26

A, B Feedback: In the entry phase, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes (along with the client and family), plans and implements prescribed care, and provides education. In the pre-entry phase, the nurse evaluates safety issues, gathers supplies, and collects client information.

Question 27

27. Which of the following interventions would be performed by the occupational therapist as a member of the home health care team? Select all that apply. A) Evaluate the client’s functional level. B) Provide muscle-strengthening exercises. C) Educate client and family about promoting self-care in ADLs. D) Provide assistance with securing needed equipment. E) Implement the plan of care designed by the nurse.

Answer 27

A, C Feedback: The occupational therapist evaluates the client’s functional level, educates the client and family on promoting self-care in activities of daily living, assesses the home for safety, and provides adaptive equipment (as necessary). Muscle-strengthening exercises are provided by the physical therapist. Assistance with securing needed equipment is provided by the social worker. The home health aide implements the plan of care designed by the nurse, and the nurse researches the cost-effectiveness of the plan.

Question 28

``` 28. Which of the following roles of the nurse is most important in providing continuity of care to clients? Select all that apply. A) Educator B) Collaborator C) Mentor D) Advocate E) Role model ```

Answer 28

A, B, D Feedback: To provide continuity of care, nurses must consider education and referrals in the care of any person admitted to any type of health care setting, and must also involve the client and family in a mutual planning process. The nurse must also collaborate with other members of the health care team in meeting the physical, psychological, sociocultural, and spiritual needs of the client and family, in all settings and at all levels of health or illness. Although it is important to be a mentor, role model, and researcher, these roles are not directly related to providing continuity of care.

Question 29

``` 29. The nurse is planning the discharge of a client who had surgery for a left hip replacement. The client is being discharged from the hospital to the home and requires a walker and high-rise toilet seat. Which type of home health care service does the client require? A) Custodial services B) Home medical services C) High-technology pharmacology services D) Hospice services ```

Answer 29

B Feedback: Home medical services provide durable medical equipment, such as walkers, canes, crutches, wheelchairs, high-rise toilet seats, commodes, beds, and oxygen. Custodial services include homemaking and housekeeping services, as well as companionship and live-in services. Hospice services provide pain management, physician services, spiritual support, respite care, and bereavement counseling. High-technology pharmacology services provide intravenous therapy, home uterine monitoring, ventilator management, and chemotherapy.

Question 30

30. The nurse is identifying needs of the client and family during the initial home visit. Which question would be inappropriate for the nurse to ask? A) Tell me what responsibilities each member of the family has. B) “Can we get rid of some of this clutter in your home? C) What do you believe is causing your illness? D) What foods are important in your family life?

Answer 30

B Feedback: When identifying needs of the client and family the nurse needs to consider the culture of the family unit. Information regarding the responsibilities of each family member, cultural foods important to the family, and the family members’ perceptions of what is causing the illness can assist the nurse in providing culturally sensitive care. The nurse also needs to assess the physical environment of the home. However, referring to the home as cluttered is a judgmental statement that will cause the family to become defensive and will prevent the development of a trusting relationship.

Question 31

31. The Joint Commission is one agency that accredits health care institutions. The nurse understands that the Joint Commission has mandated the use of which national safety practice to protect clients admitted to a health care facility? A) Nurses use the Rights checklist prior to administering medications. B) Upon admission all clients sign advanced directives. C) The use of a wristband for identification of the patient. D) The use of standard precautions in the operating room.

Answer 31

C Feedback: The Joint Commission accredits health care organizations and has required that to maintain client safety the wristband with the identification number/bar-code, client’s name, physician’s name, and other important identifying information be worn by the client. It does not require clients to sign advanced directives, and does not regulate nursing practice regarding medications and standard precautions.

Question 32

32. Nursing continues to recognize and participate in providing appropriate, uninterrupted care and facilitate clients’ transitions between different settings and levels of care. What would be an example of this continuity of care? A) The nurse collaborating with other members of the health care team B) The nurse accompanying the physician on rounds C) The nurse taking detailed notes on how each client wants to continue care D) The nurse attending an appointment with the client in some place other than where the nurse works

Answer 32

A Feedback: Continuity of care is a process by which health care providers give appropriate, uninterrupted care and facilitate a client’s transition between different settings and levels of care. To do this, the nurse must, along with other responsibilities, collaborate with other members of the health care team in meeting all the needs of each client. The other answers are incorrect because they are not examples of the idea of the continuity of care.

Question 33

``` 33. The models of nursing care delivery have been many and varied throughout the history of nursing. Which of the following best describes the idea of the continuity of care? A) Money focused B) Client focused C) Primary nursing D) Functional nursing ```

Answer 33

B Feedback: Community-based nursing practice, admission and discharge from a health care setting, transfer from one setting to another, and readiness for home health care all have to do with the continuity of care and are client-focused. In other words, they focus on a client’s needs and the nurse’s role in providing that continuity. The other answers are incorrect.

Question 34

``` 34. The wristband is an important safety component during the client’s stay because it is one of two identifiers required by which group’s national safety standards (2008) to accurately identify a client during such activities as giving medication, fluids, and blood? A) The Joint Commission B) NANDA C) HIPAA D) The Kardex ```

Answer 34

A Feedback: The wristband is an important safety component during the client’s stay because it is one of two identifiers required by The Joint Commission’s national safety standards (2008) to accurately identify a patient during such activities as giving medication, fluids, and blood.

Question 35

35. The home health nurse receives a referral from the hospital for a client who needs a home visit. After reading the referral, what would be the first action the nurse should take? A) Identify community services initially for the client B) Obtain client information from the discharge planner C) Call the client to obtain permission to visit D) Schedule a home health aide to visit the client

Answer 35

B Feedback: After receiving a referral, the first step is to call the physician or discharge planner to collect as much information as possible about the client. After the nurse reviews the information, he or she can call the client to obtain permission and schedule the visit. The nurse may identify community services or the need for a home health aide after she assesses the client and the home environment during the first visit with the client.