disease free. B) Health is having fulfillment in all domains of life. C) Health is having psychological and physiological harmony. D) Health is being connected in body, mind, and spirit. Ans: D Feedback: The World Health Organization (WHO) defines health in the preamble to its constitution as a state of complete physical, mental, and social well-being and not merely the absence of disease and infirmity. The other answers are incorrect because they are not congruent with the WHO definition of health. 2. A nurse is speaking to a group of prospective nursing students about what it is like to be a nurse. What is one characteristic the nurse would cite as necessary to possess to be an effective nurse? A) Sensitivity to cultural differences B) Team-focused approach to problem-solving C) Strict adherence to routine D) Ability to face criticism Ans: A Feedback: To promote an effective nurse-patient relationship and positive outcomes of care, nursing care must be culturally competent, appropriate, and sensitive to cultural differences. Team-focused nursing and strict adherence to routine are not characteristics needed to be an effective nurse. The ability to handle criticism is important, but to a lesser degree than cultural competence. 3. With increases in longevity, people have had to become more knowledgeable about their health and the professional health care that they receive. One outcome of this phenomenon is the development of organized self-care education programs. Which of the following do these programs prioritize? A) Adequate prenatal care B) Government advocacy and lobbying C) Judicious use of online communities D) Management of illness Ans: D Feedback: Organized self-care education programs emphasize health promotion, disease prevention, management of illness, self-care, and judicious use of the professional health care system. Prenatal care, lobbying, and Internet activities are secondary. 4. The home health nurse is assisting a patient and his family in planning the patients return to work after surgery and the development of postsurgical complications. The nurse is preparing a plan of care that addresses the patients multifaceted needs. To which level of Maslows hierarchy of basic needs does the patients need for self-fulfillment relate? A) Physiologic B) Transcendence C) Love and belonging D) Self-actualization Ans: D Feedback: Maslows highest level of human needs is self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. The other answers are incorrect because self-fulfillment does not relate directly to them. 5. The view that health and illness are not static states but that they exist on a continuum is central to professional health care systems. When planning care, this view aids the nurse in appreciating which of the following? A) Care should focus primarily on the treatment of disease. B) A persons state of health is ever-changing. C) A person can transition from health to illness rapidly. D) Care should focus on the patients compliance with interventions. Ans: B Feedback: By viewing health and illness on a continuum, it is possible to consider a person as being neither completely healthy nor completely ill. Instead, a persons state of health is ever-changing and has the potential to range from high-level wellness to extremely poor health and imminent death. The other answers are incorrect because patient care should not focus just on the treatment of disease. Rapid declines in health and compliance with treatment are not key to this view of health. 6. A group of nursing students are participating in a community health clinic. When providing care in this context, what should the students teach participants about disease prevention? A) It is best achieved through attending self-help groups. B) It is best achieved by reducing psychological stress. C) It is best achieved by being an active participant in the community. D) It is best achieved by exhibiting behaviors that promote health. Ans: D Feedback: Today, increasing emphasis is placed on health, health promotion, wellness, and self-care. Health is seen as resulting from a lifestyle oriented toward wellness. Nurses in community health clinics do not teach that disease prevention is best achieved through attending self-help groups, by reducing stress, or by being an active participant in the community, though each of these activities is consistent with a healthy lifestyle. 7. A nurse on a medical-surgical unit has asked to represent the unit on the hospitals quality committee. When describing quality improvement programs to nursing colleagues and members of other health disciplines, what characteristic should the nurse cite? A) These programs establish consequences for health care professionals actions. B) These programs focus on the processes used to provide care. C) These programs identify specific incidents related to quality. D) These programs seek to justify health care costs and systems. Ans: B Feedback: Numerous models seek to improve the quality of health care delivery. A commonality among them is a focus on the processes that are used to provide care. Consequences, a focus on incidents, and justification for health care costs are not universal characteristics of quality improvement efforts. 8. Nurses in acute care settings must work with other health care team members to maintain quality care while facing pressures to care for patients who are hospitalized for shorter periods of time than in the past. To ensure positive health outcomes when patients return to their homes, what action should the nurse prioritize? A) Promotion of health literacy during hospitalization B) Close communication with insurers C) Thorough and evidence-based discharge planning D) Participation in continuing education initiatives Ans: C Feedback: Following discharges that occur after increasingly short hospital stays, nurses in the community care for patients who need high-technology acute care services as well as long-term care in the home. This is dependent on effective discharge planning to a greater degree than continuing education, communication with insurers, or promotion of health literacy. 9. You are admitting a patient to your medical unit after the patient has been transferred from the emergency department. What is your priority nursing action at this time? A) Identifying the immediate needs of the patient B) Checking the admitting physicians orders C) Obtaining a baseline set of vital signs D) Allowing the family to be with the patient Ans: A Feedback: Among the nurses important functions in health care delivery, identifying the patients immediate needs and working in concert with the patient to address them is most important. The other nursing functions are important, but they are not the most important functions. 10. A nurse on a postsurgical unit is providing care based on a clinical pathway. When performing assessments and interventions with the aid of a pathway, the nurse should prioritize what goal? A) Helping the patient to achieve specific outcomes B) Balancing risks and benefits of interventions C) Documenting the patients response to therapy D) Staying accountable to the interdisciplinary team Ans: A Feedback: Pathways are an EBP tool that is used primarily to move patients toward predetermined outcomes. Documentation, accountability, and balancing risks and benefits are appropriate, but helping the patient achieve outcomes is paramount. 11. Staff nurses in an ICU setting have noticed that their patients required lower and fewer doses of analgesia when noise levels on the unit were consciously reduced. They informed an advanced practice RN of this and asked the APRN to quantify the effects of noise on the pain levels of hospitalized patients. How does this demonstrate a role of the APRN? A) Involving patients in their care while hospitalized B) Contributing to the scientific basis of nursing practice C) Critiquing the quality of patient care D) Explaining medical studies to patients and RNs Ans: B Feedback: Research is within the purview of the APRN. The activity described does not exemplify explaining studies to RNs, critiquing care, or involving patients in their care. 12. Nurses now have the option to practice in a variety of settings and one of the fastest growing venues of practice for the nurse in todays health care environment is home health care. What is the main basis for the growth in this health care setting? A) Chronic nursing shortage B) Western focus on treatment of disease C) Nurses preferences for day shifts instead of evening or night shifts D) Discharge of patients who are more critically ill Ans: D Feedback: With shorter hospital stays and increased use of outpatient health care services, more nursing care is provided in the home and community setting. The other answers are incorrect because they are not the basis for the growth in nursing care delivered in the home setting. 13. Nurses have different educational backgrounds and function under many titles in their practice setting. If a nurse practicing in an oncology clinic had the goal of improving patient outcomes and nursing care by influencing the patient, the nurse, and the health care system, what would most accurately describe this nurses title? A) Nursing care expert B) Clinical nurse specialist C) Nurse manager D) Staff nurse Ans: B Feedback: Clinical nurse specialists are prepared as specialists who practice within a circumscribed area of care (e.g., cardiovascular, oncology). They define their roles as having five major components: clinical practice, education, management, consultation, and research. The other answers are incorrect because they are not the most accurate titles for this nurse. 14. Nursing continues to recognize and participate in collaboration with other health care disciplines to meet the complex needs of the patient. Which of the following is the best example of a collaborative practice model? A) The nurse and the physician jointly making clinical decisions. B) The nurse accompanying the physician on rounds. C) The nurse making a referral on behalf of the patient. D) The nurse attending an appointment with the patient. Ans: A Feedback: The collaborative model, or a variation of it, promotes shared participation, responsibility, and accountability in a health care environment that is striving to meet the complex health care needs of the public. The other answers are incorrect because they are not examples of a collaborative practice model. 15. A hospice nurse is caring for a patient who is dying of lymphoma. According to Maslows hierarchy of needs, what dimension of care should the nurse consider primary in importance when caring for a dying patient? A) Spiritual B) Social C) Physiologic D) Emotional Ans: C Feedback: Maslow ranked human needs as follows: physiologic needs; safety and security; sense of belonging and affection; esteem and self-respect; and self-actualization, which includes self-fulfillment, desire to know and understand, and aesthetic needs. Such a hierarchy of needs is a useful framework that can be applied to the various nursing models for assessment of a patients strengths, limitations, and need for nursing interventions. The other answers are incorrect because they are not of primary importance when caring for a dying patient, though each should certainly be addressed. 16. A nurse is planning a medical patients care with consideration of Maslows hierarchy of needs. Within this framework of understanding, what would be the nurses first priority? A) Allowing the family to see a newly admitted patient B) Ambulating the patient in the hallway C) Administering pain medication D) Teaching the patient to self-administer insulin safely Ans: C Feedback: In Maslows hierarchy of needs, pain relief addresses the patients basic physiologic need. Activity, such as ambulation, is a higher level need above the physiologic need. Allowing the patient to see family addresses a higher level need related to love and belonging. Teaching the patient is also a higher level need related to the desire to know and understand and is not appropriate at this time, as the basic physiologic need of pain control must be addressed before the patient can address these higher level needs. 17. A medical-surgical nurse is aware of the scope of practice as defined in the state where the nurse provides care. This nurses compliance with the nurse practice act demonstrates adherence to which of the following? A) National Council of Nursings guidelines for care B) National League for Nursings Code of Conduct American Nurses Associations Social Policy Statement C) Department of Health and Human Services White Paper on Nursing D) Ans: C Feedback: Nurses have a responsibility to carry out their role as described in the Social Policy Statement to comply with the nurse practice act of the state in which they practice and to comply with the Code of Ethics for Nurses as spelled out by the ANA (2001) and the International Council of Nurses (International Council of Nurses [ICN], 2006). The other answers are incorrect; the Code of Ethics for nursing is not included in the ANAs white paper. The DHHS has not published a white paper on nursing nor has the NLN published a specific code of conduct. 18. Nursing is, by necessity, a flexible profession. It has adapted to meet both the expectations and the changing health needs of our aging population. What is one factor that has impacted the need for certified nurse practitioners (CNPs)? A) The increased need for primary care providers B) The need to improve patient diagnostic services C) The push to drive institutional excellence D) The need to decrease the number of medical errors Ans: A Feedback: CNPs who are educationally prepared with a population focus in adult-gerontology or pediatrics receive additional focused training in primary care or acute care. CNPs help meet the need for primary care providers. Diagnostic services, institutional excellence, and reduction of medical errors are congruent with the CNP role, but these considerations are the not primary impetus for the increased role for CNPs. 19. A nurse is providing care for a patient who is postoperative day one following a bowel resection for the treatment of colorectal cancer. How can the nurse best exemplify the QSEN competency of quality improvement? A) By liaising with the members of the interdisciplinary care team B) By critically appraising the outcomes of care that is provided C) By integrating the patients preferences into the plan of care D) By documenting care in the electronic health record in a timely fashion Ans: B Feedback: Evaluation of outcomes is central to the QSEN competency of quality improvements. Each of the other listed activities is a component of quality nursing care, but none clearly exemplifies quality improvement activities. 20. Professional nursing expands and grows because of factors driven by the changing needs of health care consumers. Which of the following is a factor that nurses should reflect in the planning and provision of health care? A) Decreased access to health care information by individuals B) Gradual increases in the cultural unity of the American population C) Increasing mean and median age of the American population D) Decreasing consumer expectations related to health care outcomes Ans: C Feedback: The decline in birth rate and the increase in lifespan due to improved health care have resulted in fewer school-age children and more senior citizens, many of whom are women. The population has become more culturally diverse as increasing numbers of people from different national backgrounds enter the country. Access to information and consumer expectations continue to increase. 21. A public health nurse has been commissioned to draft a health promotion program that meets the health care needs and expectations of the community. Which of the following focuses is most likely to influence the nurses choice of interventions? A) Management of chronic conditions and disability B) Increasing need for self-care among a younger population C) A shifting focus to disease management D) An increasing focus on acute conditions and rehabilitation Ans: A Feedback: In response to current priorities, health care must focus more on management of chronic conditions and disability than in previous times. The other answers are incorrect because the change in focus of health care is not an increasing need for self-care among our aging population; our focus is shifting away from disease management, not toward it; and we are moving away from the management of acute conditions to managing chronic conditions. 22. A community health nurse has witnessed significant shifts in patterns of disease over the course of a four-decade career. Which of the following focuses most clearly demonstrates the changing pattern of disease in the United States? A) Type 1 diabetes management B) Treatment of community-acquired pneumonia C) Rehabilitation from traumatic brain injuries D) Management of acute Staphylococcus aureus infections Ans: A Feedback: Management of chronic diseases such as diabetes is a priority focus of the current health care environment. This supersedes the treatment of acute infections and rehabilitation needs. 23. The ANA has identified several phenomena toward which the focus of nursing care should be directed, and a nurse is planning care that reflects these priorities. Which of the nurses actions best demonstrates these priorities? A) Encouraging the patients dependence on caregivers B) Fostering the patients ability to make choices C) Teaching the patient about nurses roles in the health care system D) Assessing the patients adherence to treatment Ans: B Feedback: The ANA identifies several focuses for nursing care and research, including the ability to make choices. The other answers are incorrect because they are not phenomena identified by the ANA. 24. The role of the certified nurse practitioner (CNP) has become a dominant role for nurses in all levels of health care. Which of the following activities are considered integral to the CNP role? Select all that apply. A) Educating patients and family members B) Coordinating care with other disciplines C) Using direct provision of interventions D) Educating registered nurses and practical nurses E) Coordinating payment plans for patients Ans: A, B, C Feedback: This role is a dominant one for nurses in primary, secondary, and tertiary health care settings and in home care and community nursing. Nurses help patients meet their needs by using direct intervention, by teaching patients and family members to perform care, and by coordinating and collaborating with other disciplines to provide needed services. The other answers are incorrect because NPs do not commonly perform education of nurses and they do not focus on matters related to payment. 25. The ANA has identified central characteristics of nursing practice that are applicable across the wide variety of contexts in which nurses practice. A nurse can best demonstrate these principles by performing which of the following actions? A) Teaching the public about the role of nursing B) Taking action to control the costs of health care C) Ensuring that all of his or her actions exemplify caring D) Making sure to carry adequate liability insurance Ans: C Feedback: The ANA emphasizes the fact that caring is central to the practice of the registered nurse. The ANA does not identify teaching the public about nursing, controlling costs, or maintaining insurance as a central tenet of nursing practice. 26. A nurse has accepted a position as a clinical nurse leader (CNL), a new role that has been launched within the past decade. In this role, the nurse should prioritize which of the following activities? A) Acting as a spokesperson for the nursing profession B) Generating and disseminating new nursing knowledge C) Diagnosing and treating health problems that have a predictable course D) Helping patients to navigate the health care system Ans: D Feedback: The CNL is a nurse generalist with a masters degree in nursing and a special background in clinical leadership, educated to help patients navigate through the complex health care system. The other answers are incorrect because they are not what nursing has identified as the CNL role. 27. Our world is connected by a sophisticated communication system that makes much health information instantly accessible, no matter where the patient is being treated. This instant access to health information has impacted health care delivery strategies, including the delivery of nursing care. What is one way the delivery of health care has been impacted by this phenomenon? A) Brisk changes as well as swift obsolescence B) Rapid change that is nearly permanent C) Limitations on the settings where care can be provided D) Increased need for social acceptance Ans: A Feedback: The sophisticated communication systems that connect most parts of the world, with the capability of rapid storage, retrieval, and dissemination of information, have stimulated brisk change as well as swift obsolescence in health care delivery strategies. The other answers are incorrect because, although we have rapid change in the delivery of nursing care, it does not last a long time; it is evolving as health care itself evolves. Giving nursing care has not become easier, it becomes more complex with every change; and it does not need to be more socially acceptable; it needs to be more culturally sensitive. 28. With the changing population of health care consumers, it has become necessary for nurses to work more closely with other nurses, as when acute care nurses collaborate with public health and home health nurses. What nursing function has increased in importance because of this phenomenon? A) Prescribing medication B) Performing discharge planning C) Promoting family involvement D) Forming collegial relationships Ans: B Feedback: The importance of effective discharge planning and quality improvement cannot be overstated. The other answers are incorrect because giving medication and family involvement in the patients care have not grown in importance. Making and maintaining collegial relationships has become a necessity in working in the health care delivery system. Effective discharge planning aids in getting patients out of the inpatient setting sooner, cutting costs, and making rehabilitation in the community and home setting possible. 29. A nurse has integrated the principles of evidence-based practice into care. EBP has the potential to help the nurse achieve what goal? A) Increasing career satisfaction B) Obtaining federal grant money Ensuring high quality patient care C) D) Enhancing the publics esteem for nursing Ans: C Feedback: Quality improvement is the ultimate goal of EBP. Career satisfaction, public esteem, and grant money are not priorities. 30. A case manager has been hired at a rural hospital that has a combined medical-surgical unit. When defining this new role, which of the following outcomes should be prioritized by the hospitals leadership? A) Decreased need for physician services B) Improved patient and family education C) Increased adherence to the principles of EBP D) Increased coordination of health services Ans: D Feedback: Case management is a system of coordinating health care services to ensure cost-effectiveness, accountability, and quality care. The case manager coordinates the care of a caseload of patients through facilitating communication between nurses, other health care personnel who provide care, and insurance companies. Reducing the need for physician services is not a central goal. Education and EBP are consistent with case management, but they are not central to this particular role. 31. A hospitals current quality improvement program has integrated the principles of the Institute for Healthcare Improvement (IHI) 5 Million Lives Campaign. How can the hospital best achieve the campaign goals of reducing preventable harm and death? A) By adhering to EBP guidelines B) By reducing nurse-to-patient ratios and increasing accountability C) By having researchers from outside the facility evaluate care D) By involving patients and families in their care planning Ans: A Feedback: The 5 Million Lives Campaign posits that if evidence-based guidelines it advocated were voluntarily implemented by U.S. hospitals, 5 million lives would be saved from either harm or death over a twoyear period. Nurse-to-patient ratios, family participation, and independent evaluation are not stated components of the campaign. 32. Over the past several decades, nursing roles have changed and expanded in many ways. Which of the following factors has provided the strongest impetus for this change? A) The need to decrease the cost of health care B) The need to improve the quality of nursing education C) The need to increase the number of nursing jobs available D) The need to increase the public perception of nursing Ans: A Feedback: The role of the nurse has expanded to improve the distribution of health care services and to decrease the cost of health care. The other answers are incorrect because the expansion of roles in nursing did not occur to improve education, increase the number of nursing jobs, or increase public perception. 33. Advanced practice nursing roles have grown in number and in visibility in recent years. What characteristic sets these nurses apart from the registered nurse? A) Collaboration with other health care providers B) Education that goes beyond that of the RN C) Advanced documentation skills D) Ability to provide care in the surgical context Ans: B Feedback: There is wide variety in APRN roles. However, a commonality is that they require education beyond that of the professional RN. All nurses collaborate with other health care providers to provide nursing care to their patients. Advanced documentation skills are not what sets advanced practice nurses apart from the staff nurse. RNs have the ability to provide care in the operating room. 34. CNPs are educated as specialists in areas such as family care, pediatrics, or geriatrics. In most states, what right do CNPs have that RNs do not possess? A) Perform health interventions independently B) Make referrals to members of other health disciplines C) Prescribe medications D) Perform surgery independently Ans: C Feedback: In most states, nurse practitioners have prescriptive authority. Surgery is beyond the CNP scope of practice and all professional nurses may perform interventions and make certain referrals. 35. A team of community health nurses are planning to draft a proposal for a program that will increase the communitys alignment with the principles contained in the Healthy People 2020report. Which of the following activities would best demonstrate the priorities identified in this report? A) Addressing determinants of health such as clean environments and safety in the community B) Lobbying for increased funding to the county hospital where many residents receive primary care C) Collaborating with health professionals in neighboring communities to pool resources and increase efficiencies D) Creating clinical placements where nursing students and members of other health disciplines can gain experience in a community setting Ans: A Feedback: Healthy People 2020 addresses social determinants of health such as safety and the state of the environment. This report does not specifically address matters such as hospital funding, nursing education, or resource allocation. 36. A nurse is aware that an increasing emphasis is being placed on health, health promotion, wellness, and self-care. Which of the following activities would best demonstrate the principles of health promotion? A) A discharge planning initiative between acute care and community care nurses B) Collaboration between several schools of nursing in an urban area C) Creation of a smoking prevention program undertaken in a middle school D) Establishment of a website where patients can check emergency department wait-times Ans: C Feedback: Smoking prevention is a clear example of health promotion. Each of the other listed activities has the potential to be beneficial, but none is considered health promotion. 37. A group of nursing students are learning about recent changes in the pattern of disease in the United States. Which of the following statements best describes these current changes? A) Infectious diseases continue to decrease in incidence and prevalence. B) Chronic illnesses are becoming increasingly resistant to treatment. C) Most acute, infectious diseases have been eradicated. D) Most, but not all, communicable diseases are declining. Ans: D Feedback: Although some infectious diseases have been controlled or eradicated, others are on the rise. Antibiotic resistance is a more serious problem in acute, not chronic, illnesses. 38. The Joint Commission and the Centers for Medicare and Medicaid Services (CMS) are evaluating a large, university medical center according to core measures. Evaluators should perform this evaluation in what way? A) By auditing the medical centers electronic health records B) By performing focus groups and interviews with care providers from numerous disciplines C) By performing statistical analysis of patient satisfaction surveys D) By comparing the centers patient outcomes to best practice indicators Ans: D Feedback: Core measures are used to gauge how well a hospital gives care to its patients who are admitted to seek treatment for a specific disease or who need a specific treatment as compared to evidence-based guidelines and standards of care. Benchmark standards of quality are used to compare the care or treatment patients receive with the best practice standards. Patient satisfaction is considered, but this is not the only criterion. 39. Leadership of a medical unit have been instructed to integrate the principles of the Quality and Safety Education for Nurses (QSEN) competency of quality improvement. What action should the units leaders take? A) Provide access to online journals and Web-based clinical resources for nursing staff. B) Use flow charts to document the processes of care that are used on the unit. C) Enforce continuing education requirements for all care providers. D) Reduce the use of chemical and physical restraints on the unit. Ans: B Feedback: One of the quality improvement skills is to use tools, such as flow charts and cause-effect diagrams, to make processes of care explicit. Each of the other listed actions has the potential to benefit patients and care givers, but none is an explicit knowledge, skill, or attitude associated with this QSEN competency. 40. The IOM Report Health Professions Education: A Bridge to Quality issued a number of challenges to the educational programs that teach nurses and members of other health professions. According to this report, what activity should educational institutions prioritize? A) More clearly delineate each professions scope of practice during education B) Move toward developing a single health curriculum that can be adapted for any health profession C) Include interdisciplinary core competencies into curricula D) Elicit input from patients and families into health care curricula Ans: C Feedback: Health Professions Education: A Bridge to Quality challenged health professions education programs to integrate interdisciplinary core competencies into their respective curricula to include patient-centered care, interdisciplinary teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics. This report did not specify clearer definitions of scope of practice, patient input, or a single curriculum. Chapter 02: Community-Based Nursing Practice 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 Ans: B Feedback: Secondary prevention centers on health maintenance aim at early detection and prevention. Disease prevention is not a form of health care but is a focus on primary prevention. 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 Ans: D 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, though each of the other listed groups may sometimes receive home care. 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. Ans: C 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 nurses. This can be difficult when a patients lifestyle involves activities that a nurse considers harmful or unacceptable, such as smoking, use of alcohol, drug abuse, or overeating. The nurse should not request another assignment because of a difference in beliefs, nor do nurses ask for the patient to come to you at the agency to receive treatment. It is also inappropriate to convert the patients home to a hospital-like environment. 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. Ans: A 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 ones hands before and after giving direct patient care, even in a home that does not have running water. Removing the wound dressings from the home and disinfecting all work areas in the home are not the best implementations of infection control in the home. Used syringes are never disinfected and a sterile field is not always necessary. 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 Ans: C Feedback: Discharge planning begins with the patients admission to the hospital and must consider the possible need for follow-up home care. Discharge planning should begin prior to the other listed times. 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 Ans: A 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. The nurses credentials are not normally discussed. Giving the patient the dates and times of their scheduled home visits is appropriate, but may not always be possible. 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 for wound care. After obtaining the referral, what would be the first action the nurse should take? A) Have community services make contact with the patient. B) Obtain a physicians order for the visit. C) Call the patient to obtain permission to visit. D) Arrange for a home health aide to initially visit the patient. Ans: C 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 physicians 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 assessing the patient and the home environment during the first visit with the patient. This would not be delegated to a home health aide. 8. 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. Ans: B Feedback: Whenever a nurse makes a home visit, the agency should know the nurses 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. It is also not intended for the patients ease in canceling appointments. 9. 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 Ans: D Feedback: Medicare, Medicaid, and third-party payers require documentation of the patients 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, tax information, or the quality of care needed. 10. 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 Ans: D Feedback: The initial assessment includes evaluating the patient, the home environment, the patients self-care abilities or the familys ability to provide care, and the patients need for additional resources. Normally an assessment is not made of assistance on the part of neighbors or the costs of the visit. Medicare and Medicaid qualifications would normally be determined beforehand. 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 coordinator C) Clinical nurse specialist D) Clinic supervisor Ans: A Feedback: Nurse practitioners, educated in primary care, often practice in ambulatory care settings that focus on gerontology, pediatrics, family or adult health, or womens health. Case coordinators and clinical supervisors do not necessarily require an advanced degree, and a clinical nurse specialist is not educated in primary care. Primary care is the specific focus of CNPs. 12. 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 Ans: A 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 nurses placement in a manufacturing setting. 13. 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 Ans: D Feedback: School-aged children and adolescents with health problems are at major risk for underachieving or failing in school. These students do not necessarily have a high risk of mental health disorders or a desire to overachieve. Health problems do not normally cause a progressive decline in intelligence. 14. 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 Ans: A 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 as often seek care late in the course of their disease process and deteriorate quicker than other populations. 15. 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 Ans: A, D, E 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. 16. 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 Ans: B Feedback: As health care delivery shifts into the community, more nurses are working in a variety of communitybased 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 a more rural base, and the use of primary care clinics has not influenced an increase in practice settings or the use of rehabilitation hospitals. 17. 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 Ans: C Feedback: Community-based nursing practice focuses centrally on promoting and maintaining the health of individuals and families, preventing and minimizing the progression of disease, and improving quality of life. Health literacy is not a goal in itself, but rather a means to promoting health. Distributing ownership and identifying links between lifestyle and health are not the essence of community-based care. 18. 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 Ans: B 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 factors about which a community-based nurse must be knowledgeable. 19. 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 Ans: C Feedback: Most communities have directories of health and social service agencies that the nurse can consult. The other answers are incorrect because hospital directories and intranets usually only include people affiliated with the hospital. The nurses personal network of contacts may or may not be of use. 20. 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 Ans: C, D, E 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 usually would not include links to online professional journals and it would not identify specific social service workers, only agencies. 21. 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. Ans: D Feedback: During initial and subsequent home visits, the nurse helps the patient and family identify community services and encourages them to contact the appropriate agencies. This is preferable to delegating another person to make contact. When appropriate, nurses may make the initial contact. A home-health nurse would not normally encourage the patient to become more involved in the community as a means of promoting health. Online forms of support can be useful, but they are not the sole form of support that most patients need. 22. 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 Ans: B 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 and hospice care is not generally provided in hospital settings. Occupational health care is situated in workplaces. 23. 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 Ans: A 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. The physical location of emergency services is not important, though methods for contacting emergency services are a priority. Infection control is part of the nurses own professional responsibility. Self-defense strategies are not always addressed and are not legally mandated. 24. 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. Ans: B Feedback: If a dangerous situation is encountered during a visit, the nurse should return to the agency and contact his or her supervisor or law enforcement officials, or both. 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. 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 Ans: C Feedback: When making visits in high-crime areas, visit with another person rather than alone. A person who is waiting in the car is of little benefit. An early morning or late afternoon appointment would not necessarily guarantee safety. Similarly, assigned parking would not guarantee the nurses safety while performing the visit. 26. 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 Ans: D 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. Preventive care is an umbrella term for all three levels of care. 27. 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. Ans: D 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 other suggestions address property rather than personal safety. 28. 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 Ans: A, B, D 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 pharmacy technician does not participate in discharge planning and there is no indication that Meals-on-Wheels are necessary. 29. 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. Ans: B Feedback: Improvisation is a necessity in many home health situations. It would be logistically difficult to have the supplies delivered and leaving the wound open to air may be contraindicated. A return visit the next day does not resolve the immediate problem. 30. 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 Ans: A Feedback: The discharge planning process involves identifying the patients needs and developing a thorough plan to meet them. The other options might be appropriate for some patients, but they are not all appropriate for every patient. 31. 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 Ans: B 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. Income disparities, profit potential, and increased use of complementary therapies do not account for this change. 32. 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 Ans: C Feedback: Cultural competence is necessary in any and every care setting. The other answers are incorrect because an advanced education, specialty certification, and the ability to practice independently are not consistencies between every nursing care delivery setting. 33. 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 Ans: D 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 normally 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 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 Ans: A 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. 35. 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. Ans: C Feedback: If the nurse carries a patients medical record into a house, it must be put in a secure place to prevent it from being picked up by others or from being misplaced. This does not mean, however, that it must never be brought to the home. It is not normally necessary to limit discussions to times when the patient is alone. The patient has the right to decide with whom he will discuss his condition and care. 36. 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. Ans: B Feedback: The patients needs and the nursing care provided must be documented to ensure that the agency qualifies for payment for the visit. Medicare, Medicaid, and other third-party payors (i.e., organizations that provide reimbursement for services covered under a health care insurance plan) require documentation of the patients homebound status and the need for skilled professional nursing care. Documentation does not guarantee an absence of liability. Documentation is not normally provided to the patient to gauge his or her progress. Documentation is not primarily used to facilitate delegation to unlicensed caregivers. 37. 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. Ans: B Feedback: Patients are eligible for hospice care services if they are determined to be within the final 6 months of life. Eligibility is not determined on the basis of the familys inability to provide care and it is not determined by whether the patient can or cannot receive care in a hospital setting. 38. 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? Ans: C Feedback: Determining the willingness and ability of friends and family to provide care can help determine appropriate levels of professional home care. The time of initial diagnosis and the patients coping style are secondary. The nurse, not the patient, is responsible for creating the plan of care. 39. 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 Ans: D Feedback: The Omaha System of care documentation has been required for over a decade to assure that outcomebased care is provided for all care reimbursed by Medicare. This system uses six major domains: sociodemographic, environment, support system, health status, functional status, and behavioral status and addresses selected health service utilization. It does not explicitly assess spirituality, psychiatric status, or compliance with care. 40. A community health nur