Home Care Nursing Practice

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. To receive Medicare coverage for home health care services, the U. S. Government mandated physician certification is a requirement.

a) true
b) false

2. The majority of patients seen in home care are

a) men with COPD.
b) children with developmental delays.
c) older adults, primarily women.
d) older adults, primarily men.

3. As part of the 1997 Balanced Budget Act and the development of PPS (prospective payment services) for Medicare-certified home care services, one of the concerns to home health care nurses is that

a) the potential for fraud and abuse should be minimized.
b) capitation can have the effect of radically changing the motivation of the home care agency.
c) there is a potential incentive for providing services efficiently.
d) none of the above

4. All of the following statements regarding the Rice Model of Dynamic Self-Determination are true except:

a) The home health nurse’s role is that of facilitator of patient self-determination.
b) Optimal health is guaranteed by home care interventions.
c) The patient and caregiver share responsibility for managing health care needs.
d) The caregiver is viewed as an extension of the patient.

5. Which of the following abilities is/are important for a home health RN?

a) advanced assessment skills
b) effective communication skills
c) a and b
d) need for close supervision
e) all of the above

6. Nurses working in home health tend to have more autonomy than many nurses working in the acute care setting.

a) true
b) false

7. In developing the plan of care, the nursing assessment phase includes

a) the medication assessment.
b) the assessment interview.
c) the nursing health history.
d) all of the above

8. The Plan of Care and the Patient Care Plan are the same.

a) true
b) false

9. Medicare guidelines for coverage of home health services include

a) that the patient is not expected to improve.
b) that a patient be bedridden in order to be considered homebound.
c) that Federal regulations for reimbursement do not change.
d) that there is objective clinical evidence to support the patient’s needs.

10. In the home heath care environment, it is not necessary to document telephone conversations with either the patient or the physician.

a) true
b) false

11. Careful documentation serves as a basis for reimbursement of home care services.

a) true
b) false

12. Which poses the larger threat as a source of infection to the homebound patient?

a) the family dog
b) the home health worker who moves from home to home
c) the patient’s spouse
d) an old, discontinued I. V. Site

13. Which of the following is true regarding the mechanism of infection?

a) An infectious agent must exist.
b) There must be a reservoir in which the infectious agent can live and multiply.
c) There must be a mode of transmission and a susceptible host.
d) Only a and c
e) All of the above are necessary.

14. You are a home health nurse. Your assignment for the day includes 4 patients: a diabetic with no other health problems, in need of insulin injection teaching; a post-gunshot wound victim with a purulent wound infection; a ventilator-dependent patient in

a) See the gunshot patient first, followed by the diabetic, the trach patient and the post-transplant last since there may be many questions to answer.
b) See the diabetic first for morning glucose monitoring and insulin, followed by the post-transplant patient, the trach patient, and finally the infected gunshot wound.
c) See the trach patient first, followed by the gunshot patient to complete the most difficult patients first, followed by the diabetic, and the post-transplant patient last.
d) Any of the above is appropriate.

15. The home health care nurse’s “Nursing Bag”

a) should be used for transporting dirty items and contaminated sharps for later disposal.
b) should contain only a supply of newspapers.
c) should always be regarded as a clean area.
d) should be kept open to air as much as possible.

16. The home care nurse is responsible for educating the patient regarding neutralization of infectious waste and safe disposal procedures in compliance with local laws.

a) true
b) false

17. The primary focus of patient care in the home is

a) getting the patient back on his feet as soon as is reasonably possible.
b) easing the burden of the patient’s family by assuming the caregiver role.
c) providing the necessary documentation for Medicare or Insurance reimbursement.
d) teaching and learning (patient education).

18. In applying Maslow’s theory of human motivation as an approach to patient learning, the home health nurse

a) would see to it that the patient’s basic physiological needs were met before patient education was attempted.
b) would make sure that the physician had instructed the patient in understanding the particular disease process.
c) would acknowledge a patient’s anxiety over unmet basic needs and leave immediately so as not to increase the patient’s psychological needs.
d) all of the above

19. A successful plan of care for self-care is most effective

a) when the patient is instructed that the doctor is the author.
b) when it is clearly written or printed out for the patient and the family to read.
c) when it is mutually determined by the patient and the nurse.
d) when it is problem-focused.

20. Teaching strategies in the home include primarily discussion, storytelling, and demonstration.

a) true
b) false

21. When dealing with the non-compliant patient, the home care nurse

a) should just ignore the uncooperative behavior so as not to give it credibility.
b) should keep in mind that all behavior is purposeful and has meaning.
c) should immediately speak to the physician about terminating home care services until the patient is more cooperative.
d) should realize that there will always be ungrateful patients and that this kind of behavior cannot be changed.

22. Teaching strategies for the illiterate patient would include

a) simplified therapeutic regimens.
b) cuing and tailoring.
c) use of pictures and stick figures.
d) all of the above

23. Malpractice must include only two of the following elements: duty, breach of duty, injury and causation.

a) true
b) false

24. It is important for a home-health nurse to know whether he/she will be functioning as an agency employee or as an independent contractor.

a) true
b) false

25. Pertaining to nursing documentation in home care, one of the following statements is false:

a) All assessments should be documented subjectively.
b) The date and time of each visit should be documented.
c) Each visit report should be signed.
d) Only approved abbreviations should be used.

26. It is a patient’s right not to inform the home care agency or nurse of a significant change in his/her status.

a) true
b) false

27. The term “case management” by the home care nurse refers to delivering patient care according to individual needs with the focus on the achievement of patient outcomes within an effective and appropriate time frame.

a) true
b) false

28. Medicare’s OASIS data is a critical link for quality improvement (QI), but not for quality assurance (QA) monitoring.

a) true
b) false

29. An evidence-based practice model does not work well in home care nursing because home care nursing is more intuitive.

a) true
b) false

30. Chronic obstructive pulmonary disease is a group of diseases with the underlying pathology of obstruction of the small airways in the lungs.

a) true
b) false

31. When caring for the COPD patient, oxygen flow rates are usually ordered at 3L/minute or less. The reason for this is:

a) This will help save the patient money by stretching each tank of oxygen as far as possible.
b) To prevent the drying out of the nasal mucous membranes.
c) To preserve the hypoxic drive, which is the stimulus for breathing in the COPD patient.
d) To prevent CO2 interference with the pulse oximeter.

32. Patient/family teaching for a patient receiving home oxygen should include:

a) keeping the oxygen at least 10 feet away from any potentially explosive hazard. (e.g., gas burners, heaters, stoves)
b) notifying the local fire department that there is oxygen equipment in the home
c) instructing the patient not to use any petroleum-based product on sore nostrils
d) all of the above

33. Examples of controlled breathing exercises would include:

a) panting
b) pursed-lip breathing
c) rapid deep-knee bends with open mouth
d) using inhalers only while in a hot bath

34. In a patient with COPD, sudden disorientation or belligerence is to be expected and should not be a cause for concern.

a) true
b) false

35. Initially, left ventricular failure results in a backward flow in which

a) blood is not pumped into the arterial system and backs up into the pulmonary vessels and lungs.
b) blood backs up into the systemic circulation.
c) there is an increase in cardiac output.
d) none of the above

36. In the CHF patient, nausea/vomiting or diarrhea may be related to underlying right-sided heart failure.

a) true
b) false

37. Benazepril (Lotensin) is an oral medication used to treat CHF and acts as a

a) beta-blocker.
b) nitrate.
c) loop diuretic.
d) angiotensin-converting enzyme.

38. An important component of diet therapy for the CHF patient is sodium and fluid restriction.

a) true
b) false

39. Prior to being discharged home on mechanical ventilation

a) ventilator-dependent patients must be warned that they will be at greater risk for developing a nosocomial infection.
b) ventilator-dependent patients must be physiologically stable.
c) ventilator-dependent patients must demonstrate the likelihood of being weaned off the ventilator in the near future.
d) none of the above.

40. If possible, the caregiver in the home should be taught the fundamentals of changing the tracheostomy tube and encouraged to assist the home care nurse with this procedure.

a) true
b) false

41. In developing the care plan for a ventilator-dependent patient, ultimately the technology and equipment should always take precedence and dominate the plan of care.

a) true
b) false

42. Which of the following is not considered a contributing factor of tissue damage and alteration in skin integrity?

a) prolonged pressure over bony prominences
b) friction and shearing
c) age under 10 years old
d) inadequate diet

43. You are assessing a 90-year-old bedridden woman. When you turn her to her side, you see a 3 cm x 2.5 cm nonblanchable, reddened area located over her sacrum. She has no history of diabetes or circulatory problems and is bedridden due to severe arthritis

a) an arterial ulcer due to old age.
b) a pressure ulcer due to prolonged pressure.
c) a venous ulcer due to bad veins.
d) an allergic reaction to one of her oral medications.

44. All of the following are phases of normal wound healing except:

a) purulent phase
b) restoration phase
c) inflammatory phase
d) remodeling phase

45. Wound healing is enhanced by

a) a dry wound environment.
b) a protective build-up of thick eschar.
c) a moist wound environment.
d) a decrease in angiogenesis.

46. Ideally, chronic wounds should be assessed and measured at least weekly by the same nurse to ensure consistency.

a) true
b) false

47. You are instructing the patient and caregiver in proper body positioning to prevent pressure sores. A position which minimizes potential pressure on bony prominences would be

a) prone with head turned to the side.
b) in a 30-degree oblique position using pillows.
c) a high Fowler’s position with a footboard to prevent sliding.
d) supine with a donut under each heel.

48. Donut-shaped cushions make simple but excellent pressure reduction devices and can be utilized in many different at-risk areas.

a) true
b) false

49. Recommendations for the classification and diagnosis of diabetes include the preferred use of the terms “type 1” and “type 2” instead of “insulin dependent (IDDM)” and “non-insulin dependent (NIDDM)”.

a) true
b) false

50. Type 1 diabetes is the most prevalent form of diabetes and commonly occurs in those over age 64.

a) true
b) false

51. You are visiting a diabetic patient. The patient is very lethargic, with a pulse rate of 140 and shallow respiration of 35 per minute. You also notice a fruity/acetone smell from the patient’s breath. The blood glucose reading is 600 mg/dl. What is th

a) impending hypoglycemic coma
b) impending cerebrovascular accident
c) hyperglycemic ketoacidosis
d) hyperglycemic hyperosmolar nonketotic coma

52. With the diabetic patient, the overall goal of the home care nurse is

a) to assess family members for genetic risk factors.
b) to determine the family’s particular cultural risk factors.
c) to treat the patient’s signs/symptoms as they occur.
d) to help the patient and caregiver to acquire the knowledge and skills needed for accurate monitoring and effective self-management of diabetes and its complications.

53. In the elderly, the classic symptoms of an urinary tract infection may be absent with a change in mental status being the only manifestation.

a) true
b) false

54. Human and animal insulin

a) differ in the rate of onset and duration of action.
b) have the same rate of onset and duration of action.
c) have the same rate of onset but a different duration of action.
d) have a different rate of onset but the same duration of action.

55. Insulin syringes must match the concentration of the insulin being used.

a) true
b) false

56. What is the most frequent complication of insulin therapy?

a) edema at the injection site
b) infection of the injection site
c) hypoglycemia
d) hyperglycemia

57. Illness in a diabetic patient is often accompanied by

a) hypoglycemia
b) hyperglycemia
c) lipohypertrophy
d) lipoatrophy

58. The term bladder dysfunction refers to the failure of the bladder either to store urine or empty properly.

a) true
b) false

59. Bladder storage occurs

a) under control of the peripheral nervous system.
b) under control of the parasympathetic nervous system.
c) under control of the sympathetic nervous system.
d) none of the above

60. Constipation often is a major factor contributing to incontinence.

a) true
b) false

61. Kegel pelvic floor exercises are recommended

a) to treat atonic bladder in men and women.
b) to treat atonic bladder in women only.
c) to treat stress incontinence in men and women.
d) to treat stress incontinence in women only.

62. Encrustation refers to

a) accumulation of debris around the catheter tip that blocks the drainage holes.
b) a lack of physical cleanliness in the perineal area surrounding the catheter.
c) a complication of silicone indwelling catheters.
d) the result of an acidic urinary pH.

63. Medicare benefits for home care rehabilitation services do allow for home visits to instruct and educate a caregiver.

a) true
b) false

64. Several ambulatory infusion pumps have the capability to be assessed by the home infusion provider over a telephone line.

a) true
b) false

65. Blood transfusions can only be given in a hospital or clinic setting or via piggyback in the home care setting.

a) true
b) false

66. When it occurs, mechanical phlebitis will usually occur within one hour after insertion of a PICC line.

a) true
b) false

67. You assess the patient’s peripheral IV site and find it to be swollen and tender. You cannot verify backflow of blood. This is probably due to

a) site infection.
b) infiltration.
c) catheter breakage.
d) phlebitis.

68. You visit a patient with a CVC who has been receiving overnight hydration. You find the patient with a weak and thready pulse, in respiratory distress and lethargic. The IV tubing is still connected to the CVC, but the bag and tubing are both dry. What

a) Immediately raise the head of the bed and hang a new bag of fluid.
b) Immediately check the patient’s blood glucose.
c) Immediately discontinue the IV, turn the patient on his/her left side, administer O2 if available and call 911.
d) None of the above.

69. In the IV administration of a chemotherapeutic agent, the patient should receive the first dose in the hospital or in the physician’s office.

a) true
b) false

70. An abnormal condition of the cerebral blood vessels characterized by occlusion or hemorrhage, resulting in ischemia and damage to the affected brain tissue is called

a) a stroke.
b) a cerebrovascular accident (CVA)
c) cerebrovascular disease
d) all of the above

71. A reversible ischemic neurological deficit (RIND) is a type of stroke syndrome which

a) lasts an average of one minute and no longer than 24 hours.
b) lasts longer than 24 hours with no symptoms or neurological deficits after 48 hours.
c) is considered a stroke in evolution or a progressive stroke.
d) is a completed stroke.

72. In contrast to the slow progressive disease resulting in a thrombotic stroke, embolic strokes cause instant symptoms.

a) true
b) false

73. The 4th cranial nerve’s main function is

a) vision.
b) smell.
c) raising the eyelid.
d) allowing the eye to move down and inward.

74. The most common neurological disease affecting young adults is

a) multiple sclerosis.
b) myasthenia gravis.
c) multiple dystrophy.
d) Guillaine-Barre syndrome.

75. Lhermitte’s phenomenon

a) is a musculoskeletal dysfunction resulting in a loss of balance.
b) is a psychological disorder affecting cognition and behavior.
c) is an oral-motor dysfunction affecting language/communication.
d) is a sudden, transient, electric-like shock that spreads down the body when the head is flexed forward.

76. There are 3 stages of progression in Alzheimer’s dementia and the rate of progression from stage to stage varies with the individual.

a) true
b) false

77. Medications for sleep are not appropriate for patients with Alzheimer’s dementia.

a) true
b) false

78. At present, transmission of HIV is believed to occur in only one way: through exposure to infected blood.

a) true
b) false

79. Cytomegalovirus (CMV) resulting in retinopathy is the most frequently occurring eye infection in persons with AIDS.

a) true
b) false

80. Statements addressing perinatal home care have been published by

a) The Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN)
b) The American Nursing Association (ANA).
c) The March of Dimes.
d) all of the above.

81. A comprehensive and skilled postpartum home care program for a mother and infant requires the RN providing the skilled postpartum home care

a) to have a minimum of one year maternal infant care experience and appropriate competencies.
b) to have a minimum of three years’ maternal infant care experience and appropriate competencies.
c) to have a minimum of five years’ maternal infant care experience and appropriate competencies.
d) none of the above

82. A benign, brief “blues” type of postpartum depression occurring 2-10 days after birth is common.

a) true
b) false

83. Uterine healing and cervical closure occurs ________, precluding placement of an intrauterine contraceptive device (IUD) before this time.

a) over a 8-week period
b) over a 8-month period
c) over a 4-week period
d) over a 4-month period

84. Which of the following is not a major category for assessment of the newborn infant?

a) physical
b) psychosocial
c) nutritional
d) behavioral

85. Which of the following is an abnormal finding in a newborn?

a) Female newborn has white mucous vaginal discharge.
b) Newborn infant is breathing through the nose.
c) The newborn infant’s respiratory rate is 67/minute with nasal flaring.
d) The newborn infant cries 1-4 hours a day.

86. Because home care nurses may encounter patients with mental illness, all home care nurses may be required to attend to the complex needs of patients experiencing mental health problems and problems of their families.

a) true
b) false

87. The two most common mental disorders treated in the home are

a) schizophrenia and substance abuse.
b) depression and catatonia.
c) acute depression and chronic depression.
d) depression and schizophrenia.

88. Which of the following would be a cause for immediate concern and intervention to protect a patient from suicide?

a) admits to having a clear plan in place with the necessary means available
b) admits to having thoughts of suicide but no plan
c) admits to having a plan which is vague and with no convenient way to carry it out
d) none of the above

89. Your patient is taking medications to control symptoms of schizophrenia. You would monitor the patient for early signs of tardive dyskinesia, including

a) chewing movements
b) repetitive protrusion of the tongue
c) grimaces
d) all of the above

90. Which of the following is not an age-related physiological change?

a) decreased contractibility and cardiac output
b) increase in pulmonary blood flow and diffusion
c) atrophy of hair follicles and epidermal sweat glands
d) decreased glomerular filtration rate

91. Which of the following is an age-related change in the nervous system?

a) loss of abstract thinking ability
b) heightened perception of vibration
c) slowing in reaction to multiple stimuli
d) heightened gustatory sensation

92. The best way to assess the medication use of elderly patients is

a) to ask them ahead of time to write down all of their pill names.
b) to have them show you everything that they take.
c) to search their bathroom cabinet and bedroom drawers.
d) to request weekly drug screening draws.

93. The philosophy of hospice care is to focus on the patient and not on the disease.

a) true
b) false

94. A patient is in the terminal stages of cancer, but the family does not want the patient to know the severity of the illness. Would this patient be a candidate for a home hospice program?

a) yes
b) no

95. Because hospice patients are deemed terminal, there is never a need for physical therapy (PT), occupational therapy (OT), or speech therapy (ST) services.

a) true
b) false

96. Which of the following types of pain does not respond well to opioid medications?

a) visceral pain
b) somatic pain
c) psychological pain
d) neuropathic pain

97. Home care nurses should be able to

a) recognize the smell of Radon gas.
b) determine when electrical and magnetic fields are at dangerously high levels.
c) recognize those clients at greatest risk for exposure to toxins.
d) all of the above

98. It is believed by some that by increasing their use of telecommunication, home care nurses can reduce travel time and overall administrative costs of care.

a) true
b) false

99. Movement toward capitation strategies for home care services will likely impact the number of actual visits the patient receives and increase telehealth services.

a) true
b) false

100. Currently, the two main grounds for liability when a nurse gives advice over the phone are:

a) (1) the unauthorized practice of medicine and (2) exceeding the scope of nursing practice
b) (1) not spending enough time on the call and (2) being rude and abrupt
c) (1) accidental disconnection and (2) equipment malfunction
d) (1) inadequate personnel and (2) busy signals