Chapter 02: Nursing in Varied Patient Care Settings
Linton: Introduction to Medical-Surgical Nursing, 6th Edition
MULTIPLE CHOICE
1. While a home health nurse is making the entry to a service assessment on a home-bound
patient, the spouse of the patient asks whether Medicare will cover the patient’s ventilator
therapy and insulin injections. What is the best response by the nurse?
a.
“Yes, Medicare will cover both the ventilator therapy and the insulin injections.”
b.
“No, Medicare will not cover either of these ongoing therapies.”
c.
“Medicare will cover the ventilator therapy, but it does not cover the insulin
injections.”
d.
“Medicare will cover the ongoing insulin therapy, but it does not cover a highly
technical skill such as ventilator therapy.”
2. The wife of a patient asks the nurse whether her husband would be considered for placement
in a skilled nursing care facility when he is discharged from the general hospital. The patient
is incontinent, has mild dementia but is able to ambulate with a walker, and must have help to
eat and dress himself. What is the nurse’s most appropriate response?
a.
“Yes, your husband would qualify for a skilled care facility because of his inability
to feed and dress himself.”
b.
“No, your husband’s disabilities would not qualify him for a skilled facility.”
c.
“Yes, your husband qualifies for placement in a skilled care facility because of his
dementia.”
d.
“Yes, anyone who is willing to pay can be placed in a skilled nursing facility.”
3. A nurse has noted that a newly admitted resident to an extended care facility stays in her
room, does not take active part in activities, and leaves the meal table after having eaten very
little. The nurse should analyze this relocation response as
a.
regression.
b.
social withdrawal.
c.
depersonalization.
d.
passive aggressive.
4. A nurse clarifies to a new patient in a rehabilitation center what rehabilitation means. What
statement made by the patient indicates a correct understanding?
a.
“I will return to my previous level of functioning.”
b.
“I will be counseled into a new career.”
c.
“I will develop better coping skills to accept his disability.”
d.
“I will attain the greatest degree of independence possible.”
5. A nurse assesses a patient who needs to be reminded to take premeasured oral medications,
wash, go to meals, and undress and come to bed at night, but coming and going as he pleases
is considered safe for him. What facility placement would be most appropriate for this
patient?
a.
Skilled care
b.
Intermediate care
c.
Sheltered housing
d.
Domiciliary care
6. A nurse is making a list of the members of the rehabilitation team so the different types of
services available to patients may be taught to a group of families. Which lists should be
used?
a.
Physical therapist, nurse, family members, and personal physician
b.
Occupational therapist, dietitian, nurse, and patient
c.
Rehabilitation physician, laboratory technician, patient, and family
d.
Vocational rehabilitation specialist, patient, and psychiatrist
7. A nurse explains the level of disability to a patient who was injured in a construction accident
that resulted in the loss of both his right arm and right leg. This loss has affected his quality of
life and ability to return to previous employment. At what level should the client be classified
as being disabled?
a.
I
b.
II
c.
III
d.
IV
8. A nurse explains that in 1990, the Americans with Disabilities Act (ADA) was passed. For
which extended services for the disabled persons did this act provide?
a.
Covering the costs for the rehabilitation of disabled World War I servicemen by
providing job training
b.
Extending protection to the disabled in the military sector, such as wheelchair
ramps on military bases
c.
Extending protection to the disabled in private areas, such as accessibility to public
restaurant bathrooms and telephones
d.
Affording disabled persons full access to all health care services
9. A frail patient in a long-term care facility asks the nurse if a bath is to be given this morning.
What is the best reply by the nurse to encourage independence and give the patient the most
flexibility?
a.
“Based on your room number, you get bathed on Monday, Wednesday, and Friday.
Today is Tuesday.”
b.
“If you want to eat breakfast in the dining room with the others, you may sponge
yourself off in your bathroom.”
c.
“When your daughter comes this evening, ask her if she can give you a bath.”
d.
“I will bring a basin of water for a sponge off for right now. After breakfast, we
will talk about a bath schedule.”
10. A computer programmer who lost both legs is being retained by his employer, who has made
arrangements for a ramp and a special desk to accommodate the patient’s wheelchair. What is
the disability level of the computer programmer?
a.
I
b.
II
c.
III
d.
IV
11. A partially paralyzed forklift operator is to be retrained by vocational rehabilitation services
for less demanding office work. What law provides for this rehabilitation?
a.
Vocational Rehabilitation Act of 1920
b.
Social Security Act of 1935
c.
Rehabilitation Act of 1973
d.
Americans with Disabilities Act of 1990
12. The home health care nurse performs all the following actions. Which is the only action that is
reimbursable under Medicare payment rules?
a.
Observing a spouse cleaning and changing a dressing
b.
Taking a frail couple for a walk to provide exercise
c.
Watching a patient measure out all medications
d.
Teaching a patient to self-administer insulin
13. A patient with multiple sclerosis must be fed, bathed, and dressed. How should the nurse
assess this patient?
a.
Disabled
b.
Disadvantaged
c.
Handicapped
d.
Impaired
14. Which law initially provided for rehabilitation of disabled Americans?
a.
Vocational Rehabilitation Act of 1920
b.
Social Security Act of 1935
c.
Rehabilitation Act of 1973
d.
Americans with Disabilities Act of 1990
15. A client was admitted to a long-term residential care facility. On what should the admitting
nurse tell the family the concepts of long-term care are based?
a.
Amount of activities the resident can do for herself
b.
Maintenance care with an emphasis on incontinence
c.
Successful adaptation to the regulations of the home
d.
Maintenance of as much function as possible
16. A 58-year-old patient with diabetes is recuperating from a broken hip and is concerned about
how to pay for rehabilitation. The nurse should inform this patient that funds for rehabilitation
are available from which resource?
a.
Vocational Rehabilitation Act of 1920
b.
Rehabilitation Act of 1973
c.
Disabled American Veterans Act of 1990
d.
Title V, Health of Crippled Americans 1935
17. What is an example of a description of community health nursing?
a.
Visiting patients in their homes after hospital discharge to assess their personal
health status
b.
Asking a nursing assistant (NA) to identify the health services most needed in the
patient’s personal life
c.
Meeting with residents of low-income housing to identify their health care needs
d.
Developing a hospital-based home health care service
18. Home health nurses have some different nursing activities than those of community health
nurses. Which statement best describes the home health nurse’s activities?
a.
Conducting health education classes in a senior citizens’ common residence
building
b.
Conducting blood pressure screening on a regular basis at a local mall
c.
Visiting and assessing the home care and further teaching needs of a patient who
has been recently discharged from the hospital
d.
Acting as a nurse consultant to a chronic psychiatric section in a state institution
19. Based on guidelines from the Americans with Disability Act (ADA), which question is an
appropriate choice for the director of nurses to ask a nurse with an artificial leg who is
applying for a staff position in an extended care facility?
a.
“How long have you had your prosthesis?”
b.
“How many flights of stairs are you able to climb without assistance?”
c.
“Are you able to lift a load of 45 lb?”
d.
“Has your disability caused you to miss work?”
MULTIPLE RESPONSE
20. What care skills are safe and appropriate for the licensed practical nurse (LPN) to teach family
members in the home health care setting? (Select all that apply.)
a.
Insulin injection
b.
Sterile dressing changes
c.
Venipunctures
d.
Periodic Foley catheter insertions
e.
Instillation of eye drops
f.
Changing dressings on small wounds
21. The nursing care plan in a long-term care facility calls for the documentation of regressive
behavior of a newly admitted 82-year-old resident who has had congestive heart failure and
osteoarthritis. Of these behaviors observed by the nurse, which should be documented as
regression? (Select all that apply.)
a.
Talks nonstop to staff and other residents
b.
Wets and soils self several times a day
c.
Wakes in the middle of the night and is unable to return to sleep
d.
Wears the same clothes day after day
e.
Cries frequently for no apparent reason
22. From what do most quality-of-care problems in home health care result? (Select all that
apply.)
a.
Patient’s noncompliance
b.
Family’s reluctance to participate in the care
c.
Inadequate documentation
d.
Limited funding
e.
Defective communication among care team members
23. An 80-year-old man is newly admitted to a long-term care facility and suddenly becomes
incontinent of urine at night. What nursing interventions should be used to help restore
self-toileting? (Select all that apply.)
a.
Waking the resident every 2 hours and escorting him to the bathroom
b.
Leaving a night-light on
c.
Discouraging the use of long-legged pajama bottoms
d.
Placing a urinal at the bedside
e.
Keeping the room uncluttered
COMPLETION
24. The nurse clarifies that an impairment that creates a measurable diminished capacity to work
is a(n) _______.
OTHER
25. A home health nurse, while in the home to change a decubitus dressing, notices that the
wound has a musky odor and is weepier than the previous visit, 2 days earlier. Place the
following nursing interventions in order of priority from most to least. (Separate the letters
with a comma and space: A, B, C, D.)
A. Contact the case manager.
B. Assess the patient’s entire skin and vital signs and be prepared to describe the wound
findings.
C. Cleanse the decubitus area well and redress the wound.
D. Chart the appearance of the decubitus completely.
D. Assess the patient’s mobility.
26. What should the home health nurse do when teaching a family member the skill of injecting
insulin effectively? Prioritize these nursing interventions for this situation. (Separate the
letters with a comma and space: A, B, C, D.)
A. Offer instruction at an appropriate pace.
B. Write down the steps of the procedure.
C. Assess the level of knowledge of the family member.
D. Inquire about the preferred learning style.
E. Evaluate the family member’s performance.
