Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Lewis: Medical-Surgical Nursing, 8th Edition
Chapter 6: Community-Based Nursing and Home Care
Test Bank
MULTIPLE CHOICE
1. A family caregiver tells the home health nurse, “I feel like I can never get away to do
anything for myself.” Which action will be best for the nurse to take?
a. Assist the caregiver in finding respite services.
b. Assure the caregiver that the work is appreciated.
c. Teach the caregiver that family members provide excellent patient care.
d. Encourage the caregiver to discuss feelings openly with the nurse as needed.
ANS: A
Respite services allow family caregivers to have free time. The other actions also may be
helpful, but the caregiver’s statement clearly indicates the need for some free time.
DIF: Cognitive Level: Application REF: 88
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
2. A patient who was in an automobile accident is assigned a nurse as a case manager. The
responsibilities of the nurse in this role are to
a. care for the patient during hospitalization for the injuries.
b. assist the patient with home care activities during recovery.
c. coordinate the services that the patient receives in the hospital and at home.
d. determine the types of medical care the patient needs for optimal rehabilitation.
ANS: C
The role of the case manager is to coordinate the patient’s care through multiple settings
and levels of care to allow the maximal patient benefit at the least cost. The case manager
does not provide direct care in either the acute or home setting. The case manager
coordinates and advocates for care but does not determine what types of medical care are
needed, which is done by the health care provider or other provider.
DIF: Cognitive Level: Comprehension REF: 83
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care
Environment
3. A patient who has just moved to a long-term care facility has a nursing diagnosis of
relocation stress syndrome. Which action should the nurse include in the plan of care?
a. Remind the patient that making changes is usually stressful.
b. Discuss the reason for the move to the facility with the patient.
c. Restrict family visits until the patient is accustomed to the facility.
d. Have staff members write notes welcoming the patient to the facility.
ANS: D
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
6-2
Having staff members write notes will make the patient feel more welcome and
comfortable at the long-term care facility. Discussing the reason for the move and
reminding the patient that change is usually stressful will not decrease the patient’s stress
about the move. Family member visits will decrease the patient’s sense of stress about the
relocation.
DIF: Cognitive Level: Application REF: 84 TOP: Nursing Process:
Planning
MSC: NCLEX: Psychosocial Integrity
4. A 78-year-old patient hospitalized for a fractured hip has recovered from the surgery but
needs to work with physical therapy to improve mobility before returning home. The
nurse will anticipate transferring the patient to
a. an acute care setting.
b. a transitional care setting.
c. a residential care facility.
d. an intermediate care facility.
ANS: B
Transitional care settings are appropriate for patients who need continued rehabilitation
before discharge to home or to long-term care settings. The patient is no longer in need of
the more continuous assessment and care given in acute care settings. There is no
indication that the patient will need the permanent and ongoing medical and nursing
services available in intermediate care. The patient is not yet independent enough to
transfer to a residential care facility.
DIF: Cognitive Level: Application REF: 83 TOP: Nursing Process:
Planning
MSC: NCLEX: Safe and Effective Care Environment
5. In describing home care services to a patient requiring extended care, the nurse tells the
patient that
a. technologically complex therapies must be managed in the hospital.
b. the patient’s family will be included in planning and the patient’s care.
c. home care services are limited to visits by registered nurses or home health aides.
d. in order for insurance to cover the home care, the patient must be confined to bed.
ANS: B
Family members who are providing care are included in planning the patient’s care and
treatments. Other disciplines, such as physical and occupational therapy, also provide
appropriate home health services. The patient must be homebound, but not bed bound, to
receive reimbursement for home care services. High-tech services are increasingly
accomplished in the home setting where the patient is more comfortable and the risks for
complications such as infection are less.
DIF: Cognitive Level: Comprehension REF: 84-86
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care
Environment
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
6-3
6. Which of these patients being discharged by the acute care nurse meets the requirements
for Medicare reimbursement for home health services?
a. A 71-year-old who needs weekly blood sampling for monitoring of clotting times
b. A 70-year-old who receives daily intravenous antibiotics for an infected leg wound
c. A 68-year-old diabetic patient who needs teaching about a diabetic diet and
lifestyle
d. A 65-year-old patient with a spinal cord injury and paralysis who needs dressing
changes
ANS: D
The patient with paralysis meets the standard because it would require considerable effort
for the patient to leave the home for the dressing changes. The diabetic patient is able to
obtain transportation to an ambulatory setting for diabetic teaching. The patient with the
leg wound is able to receive daily antibiotics in an outpatient setting. Weekly blood
samples can be obtained in a laboratory and do not require home health services.
DIF: Cognitive Level: Application REF: 86
TOP: Nursing Process: Assessment MSC: NCLEX: Safe and Effective Care
Environment
7. When the home health nurse is caring for a patient who needs to relearn self-care skills
such as dressing and self-feeding, which referral will be best?
a. Dietitian
b. Speech therapist
c. Physical therapist
d. Occupational therapist
ANS: D
Occupational therapists assist patients with self-care skills. Physical therapists assist
patients with strengthening, transferring, and ambulation. Dietitians assist with nutritional
choices. Speech therapists assist with speech and swallowing needs.
DIF: Cognitive Level: Comprehension REF: 87 TOP: Nursing Process:
Planning
MSC: NCLEX: Safe and Effective Care Environment
8. When making an initial home visit, the most appropriate approach by the nurse is to
a. ask the patient and family what their expectations are.
b. tell the patient and family all of the planned interventions.
c. instruct the family members that they will need to participate in care.
d. discuss the importance of following through with health care provider orders.
ANS: A
The nurse is a visitor in the home setting, and the most effective initial approach is to
determine the expectations of the patient and family for the home health experience. The
other approaches indicate that the nurse or health care team is in charge of care, which is
not the case in this setting.
DIF: Cognitive Level: Application REF: 86
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
6-4
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
9. Which of these patients should the nurse refer for Medicare-reimbursed home health
services?
a. A 71-year-old with dementia who needs 24-hour care to prevent injury
b. An 82-year-old whose family has asked for respite care for a few days a month
c. A 67-year-old who requires assistance with shopping, housework, and cooking
d. A 79-year-old who needs to have medications placed in a marked pillbox weekly
ANS: D
Medicare will reimburse for intermediate skilled nursing care, such as setting up
medications once weekly. Services such as shopping, housework, and cooking are not
skilled nursing services and are not reimbursed by Medicare or most insurers. Medicare
reimburses for intermittent care; care that is needed 24 hours daily does not meet the
Medicare requirements. Respite care is not skilled nursing and does not meet the
requirement for home health services.
DIF: Cognitive Level: Application REF: 86
TOP: Nursing Process: Implementation MSC: NCLEX: Safe and Effective Care
Environment
10. The family of an 85-year-old with chronic health problems and increasing weakness is
considering placing the patient in a long-term care (LTC) facility. Which action by the
nurse will be most helpful in assisting the patient to make the transition?
a. Have the family select an LTC facility that is relatively new.
b. Obtain the patient’s input about the choice of LTC facility.
c. Ask that the patient be placed in a private room at the facility.
d. Explain the reasons for the need to live in LTC to the patient.
ANS: B
The stress of relocation is likely to be less when the patient has input into the choice of
facility. The age of the long-term care facility does not indicate a better fit for the patient
or better quality of care. Although some patients may prefer a private room, others may
adjust better when given a well-suited roommate. The patient should understand the
reasons for the move but will make the best adjustment when involved with the choice to
move and choice of facility.
DIF: Cognitive Level: Application REF: 84
TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity
11. Which of the following nursing activities is appropriate for the home care RN who is
caring for a newly diagnosed diabetic patient to delegate to a home health aide?
a. Assist the patient to choose an appropriate diet.
b. Check the patient’s feet for signs of breakdown.
c. Help the patient with a daily bath and oral care.
d. Teach the patient how to monitor blood glucose.
ANS: C
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
6-5
Assisting with patient hygiene is included in home health-aide education and scope of
practice. Assessment of the patient and instructing the patient in new skills, such as diet
and blood glucose monitoring, are complex skills that are included in RN education and
scope of practice.
DIF: Cognitive Level: Application REF: 87
OBJ: Special Questions: Delegation TOP: Nursing Process: Implementation
MSC: NCLEX: Safe and Effective Care Environment
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
Lewis: Medical-Surgical Nursing, 8th Edition
Chapter 7: Complementary and Alternative Therapies
Test Bank
MULTIPLE CHOICE
1. After the charge nurse has completed orienting a new staff nurse, which action by the
staff nurse indicates that further education about complementary and alternative therapy
may be needed?
a. The new nurse massages the legs of a patient who has a left foot stasis ulcer.
b. The new nurse does a capillary blood glucose check for a patient taking aloe.
c. The new nurse suggests the use of acupressure to a patient with tension headaches.
d. The new nurse shows family members how to provide a hand massage to a patient.
ANS: A
Massage should not be done for a patient with open wounds. The other actions by the
new nurse are appropriate.
DIF: Cognitive Level: Application REF: 95 TOP: Nursing Process:
Evaluation
MSC: NCLEX: Safe and Effective Care Environment
2. A patient with fibromyalgia has back pain and stiffness. The nurse suggests that a therapy
that might be appropriate for this patient is
a. acupuncture.
b. aromatherapy.
c. St. John’s wort.
d. magnetic therapy.
ANS: A
Acupuncture may be useful in the treatment of back pain. The other therapies are not
used to treat pain.
DIF: Cognitive Level: Application REF: 92
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
3. Which of these complementary and alternative therapies should the nurse suggest to a
patient who has elevated triglyceride levels?
a. Fish oil
b. Milk thistle
c. Saw palmetto
d. Ginkgo biloba
ANS: A
There is evidence that fish oil is helpful in treating hypertriglyceridemia. The other
therapies will not be helpful for this patient.
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
7-2
DIF: Cognitive Level: Application REF: 94
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
4. Which information obtained by the nurse when admitting a patient with osteoarthritis
may indicate a need for patient teaching?
a. The patient obtains information about herbal therapies online.
b. The patient takes glucosamine daily to prevent knee and hip pain.
c. The patient attends a weekly yoga class to improve flexibility and balance.
d. The patient states that prayer helps to improve the knee pain and function.
ANS: A
Online information sources are not always reliable and the patient may need some
teaching about safe use of herbal remedies. The other information given by the patient
indicates appropriate use of complementary and alternative therapies.
DIF: Cognitive Level: Application REF: 96
TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance
5. A patient with chronic headaches seeks treatment from a nurse trained in Healing Touch
(HT). During the HT session, the nurse will
a. realign the patient’s energy flow.
b. manipulate muscles and soft tissues.
c. apply pressure to body points where energy is obstructed.
d. passively move stressed joints through the range of motion.
ANS: A
Healing touch involves the use of the practitioner’s hands to realign the patient’s energy
flow. The other responses describe other complementary and alternative therapies
(CATs) such as massage, chiropractic therapy, and acupressure.
DIF: Cognitive Level: Comprehension REF: 96
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
6. A patient who has nausea associated with chemotherapy asks the nurse whether there are
any complementary and alternative therapies that might be effective. The nurse should
discuss the use of
a. green tea.
b. acupuncture.
c. black cohosh.
d. chiropractic therapy.
ANS: B
Acupuncture is helpful in chemotherapy-induced nausea. The other therapies are not used
for nausea.
DIF: Cognitive Level: Comprehension REF: 92
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
7-3
7. A patient who develops frequent upper respiratory infections (URIs) asks the nurse
whether any herbal therapies might help. The nurse suggests that the patient try
a. ginger.
b. echinacea.
c. ginkgo biloba.
d. St. John’s wort.
ANS: B
Echinacea may have some benefit in reducing the incidence and duration of the common
cold. Ginkgo biloba, ginger, and St. John’s wort are useful for other conditions, but they
would not be helpful for this patient.
DIF: Cognitive Level: Comprehension REF: 94
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
8. Which information will the nurse include when discussing the use of herbal remedies
with a patient who uses a variety of herbs for health maintenance?
a. Herbs should be purchased only from manufacturers with a history of quality
control.
b. Most herbs are toxic and carcinogenic and should be used only when proven
effective.
c. Herbs are no better than conventional drugs in maintaining health and may be less
safe.
d. Frequent medical evaluation is required during the use of herbs to avoid adverse
effects.
ANS: A
The quality of herb preparations can vary, so it is important that patients purchase herbal
remedies from reputable manufacturers. When appropriately used, herbs are generally
safe and have fewer side effects than conventional medications.
DIF: Cognitive Level: Application REF: 92-93
TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance
9. Which information obtained by the nurse during the preoperative assessment of a patient
is most important to assess further?
a. The patient uses several herbal remedies routinely.
b. The patient recently visited a chiropractor for back pain.
c. The patient has used acupressure to relieve postoperative nausea in the past.
d. The patient expresses a wish to use acupuncture for postoperative pain control.
ANS: A
Many herbs prolong bleeding time, so further assessment of the types of herbs that are
used and how recently they were used is needed before the patient has surgery. The other
information given by the patient also requires further assessment but will not affect the
timing of the patient’s surgery.
DIF: Cognitive Level: Application REF: 93 | 94
TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity
Test Bank
Mosby items and derived items © 2011, 2007 by Mosby, Inc., an affiliate of Elsevier, Inc.
7-4
10. A patient who has a chronic foot wound tells the nurse about using herbal therapies to
boost immune function rather than taking antibiotics. Which action should the nurse take
first?
a. Instruct the patient about the rationale for antibiotic use to treat infection.
b. Remind the patient that the infection has not cleared with herbal treatment.
c. Determine how the patient would feel about using antibiotics in addition to herbal
products.
d. Tell the patient that studies of herbal products indicate that they are not effective in
treating infection.
ANS: C
Further assessment of the patient’s feelings about using Western and natural therapies is
needed before further action is taken. The patient may need instruction about antibiotics
if further assessment indicates that the patient is receptive to antibiotic use. Pointing out
that herbal therapy has not been successful is disrespectful to the patient’s belief system.
Although herbal therapy alone may not eradicate the infection, some herbal therapies do
improve immune function.
DIF: Cognitive Level: Application REF: 96
OBJ: Special Questions: Prioritization TOP: Nursing Process: Implementation
MSC: NCLEX: Physiological Integrity
MULTIPLE RESPONSE
1. A patient who uses multiple herbal products is scheduled to undergo knee replacement
surgery. The nurse informs the patient that herbs that should be discontinued at least 2 to
3 weeks before surgery include (select all that apply)
a. garlic.
b. ginger.
c. feverfew.
d. echinacea.
e. ginkgo biloba.
ANS: A, B, C, E
Feverfew, ginger, garlic, and ginkgo biloba all prolong bleeding time and should be
discontinued before surgery. Echinacea is usually safe to continue.
DIF: Cognitive Level: Application REF: 94
OBJ: Special Questions: Alternate Item Format
TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity
