NR-442 Community Health Nursing - Set 4 - Part 2

Correct Answer: It sets the Medicare pay rate and measures outcomes

OASIS is the standardized data set that determines the Medicare payment rate and measures outcomes of adult home care clients for outcome-based quality improvement. Accuracy is therefore both a clinical and a compliance duty. Option a is incorrect because the plan of care remains a separate document listing disciplines, visit frequency, treatments, and goals. OASIS feeds payment and quality reporting, and it does not direct day-to-day care. Option b is incorrect because orders come from the provider and live in the plan of care. The data set captures client status, function, and supports rather than serving as an order record. Option c is incorrect because the comprehensive assessment is broader than the item set and includes findings no form captures. OASIS is embedded within that assessment, not a replacement for the nurse's clinical judgment.

Correct Answer: Distance combined with lack of transportation

Distance from services and lack of personal or public transportation head the list of rural barriers the course names, along with weather, inability to pay, and shortages of rural hospitals and providers. Option a is incorrect because it locates the failure in the client rather than the geography. Nothing suggests confusion about times, and treating this as a scheduling misunderstanding would leave the real obstacle untouched. Option b is incorrect because rural residents do seek preventive care less often, but that pattern grows out of distance, cost, and a work based view of health. Calling it refusal stereotypes the population. Option d is incorrect because rural counties have fewer specialists, not more. Shortage of hospitals and providers is itself a named barrier, and many such counties are designated health professional shortage areas.

Correct Answer: Decline both and share only the minimum necessary

The nurse is a health professional first and does not clear anyone for punishment. Confidentiality is protected by maximizing privacy within security limits and disclosing only what custody staff need to keep the person safe. Option a is incorrect because dual loyalty is resolved in favor of the patient. Custody staff may not override clinical judgment, and announcing a psychiatric diagnosis in a corridor breaches privacy no security purpose requires. Option c is incorrect because it fixes half the problem. Withholding the diagnosis protects privacy, yet signing a fitness statement still enlists nursing in a punishment process the profession refuses to take part in. Option d is incorrect because passing the request upward answers nothing and delays a decision the nurse can make now. Where security limits care, the nurse documents the limitation and advocates through the chain of command.

Correct Answer: Secure the threatened worker and notify management

An active threat is an immediate safety problem, so protecting the threatened worker and activating the employer's response comes before any program work. Workplace violence is a recognized hazard the employer must act on under the General Duty Clause. Option a is incorrect because stress classes treat a psychosocial climate over months. They do nothing about a person who made a threat today, and the coworker would still be standing on the same floor tomorrow. Option b is incorrect because annual training is a reasonable long term fix for the underreporting the nurse uncovered. Waiting for the next training cycle leaves an unresolved threat active in the building right now. Option c is incorrect because counseling supports recovery after the danger has been controlled. Sending a frightened employee to a counselor while the threat stands unaddressed reverses the order safety demands.

Correct Answer: A lit cigarette in the caregiver's hand

Smoking near home oxygen creates an immediate fire and explosion risk that can injure everyone present. The nurse addresses it at once with an absolute no-smoking rule and signage wherever oxygen is in use. Option a is incorrect because a loose rug is a genuine fall hazard that the nurse will address during the safety review. It threatens one person over time rather than the household within seconds. Option b is incorrect because expired vitamins belong on the medication reconciliation list, where the nurse discards outdated bottles and simplifies the regimen. Nothing about this finding demands action ahead of a fire risk. Option d is incorrect because dim lighting raises fall risk and is corrected with brighter bulbs and night lights. Poor illumination is a chronic hazard, and correcting it can wait until the ignition source is gone.

Correct Answer: The symptoms to report and whom to call

Discharge occurs once goals are met and skilled care is no longer needed. The teaching that protects the client afterward is knowing which symptoms signal trouble and exactly whom to contact when they appear. Option b is incorrect because readmission to home health would require a new referral, a skilled need, and homebound status. Telling the family they can simply call and resume visits sets up an expectation the benefit will not meet. Option c is incorrect because the wound care ended when the wound healed, which the family already witnessed. Explaining an agency decision looks backward, while discharge teaching has to prepare the household for the weeks ahead. Option d is incorrect because discharge ends the episode of care rather than converting it to telephone monitoring. Promising calls that are not part of the plan leaves the family waiting instead of contacting their own provider.

Correct Answer: Identify exempt and under immunized students for exclusion

The exemption list exists for this moment. Susceptible students are identified first and excluded for the exposure period the health department specifies, because they are the population at risk of infection and of extending transmission. Option a is incorrect because general communication is a supporting task rather than the outbreak priority. Families do need accurate information, yet a newsletter removes no susceptible child from the building during the exposure period. Option b is incorrect because mass rash inspection is an inefficient way to find cases and misses children who are infectious before the rash appears. Case finding proceeds under health department direction, not by lining up every classroom. Option c is incorrect because waiting for families to request vaccine leaves the decision with the least urgent party. Post exposure vaccination has a narrow window, and the nurse works from the susceptibility list instead.

Correct Answer: Curative treatment for the cancer is what stops

The election statement chooses hospice instead of Medicare covered curative treatment for the terminal illness and conditions related to it. Treatment of conditions unrelated to the terminal diagnosis is not what the client set aside. Option a is incorrect because electing hospice sets aside curative treatment of the terminal illness and its related conditions, nothing more. The client keeps Medicare Part A and coverage for care unrelated to the pancreatic cancer. Option c is incorrect because hypertension and glaucoma are neither the terminal diagnosis nor related to it, so Medicare continues to pay for their care under the client's other benefits after the election is signed. Option d is incorrect because it invents a time limit. Hospice is a Medicare Part A benefit rather than a replacement for it, and recertification continues as long as the prognosis remains six months or less.

Correct Answer: Eliminating the hazard from the process

Elimination sits at the top of the hierarchy of controls because removing the hazard protects every worker on every shift. It does not depend on training, memory, fit, or individual cooperation to work. Option b is incorrect because respirators are personal protective equipment, the last line of defense. Protection fails whenever the device is the wrong size, poorly sealed, unavailable, or set aside during a rushed task. Option c is incorrect because job rotation is an administrative control. It spreads the same exposure across more people and shortens each person's dose, yet the hazard itself remains fully present in the workplace. Option d is incorrect because signage only informs, and information ranks near the bottom of the hierarchy. A posted warning changes nothing about the hazard and works only when a worker reads it and complies.

Correct Answer: Psychosocial hazard from shift work and understaffing

Psychosocial hazards come from organizational and interpersonal conditions such as shift and night work, understaffing, and high demand with low control. The reported sleep disturbance, irritability, and rising absence are exactly the effects those conditions produce. Option a is incorrect because a physical hazard requires an energy transfer such as noise, vibration, heat, or radiation. Working at night is a schedule, not an energy source acting on the body. Option b is incorrect because biological hazards are living organisms and their products, and none of the reported complaints is an infection. Patient contact does create that risk on a nursing unit, but it is not what these nurses described. Option d is incorrect because ergonomic problems show up as musculoskeletal complaints from posture, lifting, or repetition. Insomnia and irritability do not arise from a mismatch between the task and the body.

Correct Answer: The emergency care plan for anaphylaxis

The emergency care plan is the one page action plan for a foreseeable emergency. It names the allergen, the signs, the epinephrine device, and when to call for help, and it goes to everyone who supervises the child. Option a is incorrect because an education program addresses specially designed instruction for a student who needs it. A food allergy alone rarely requires that, and no teacher reaches for an instructional document during a reaction. Option c is incorrect because a wellness policy sets district level direction on nutrition and activity. Policy shapes the environment over years, while this family is asking who does what in the first two minutes. Option d is incorrect because immunization reporting documents school entry compliance for a population. It answers a public health question about coverage and contains nothing that would guide a staff member facing an allergic emergency.

Correct Answer: Bereavement services remain available for a year

Medicare requires the hospice to make bereavement services available to the family for up to one year after the death. The widow is well within that window and needs no new enrollment. Option a is incorrect because hospice care does not stop at the death. Follow up contact, calls, visits, mailings, memorial services, counseling, and support groups are part of what the family was promised. Option b is incorrect because eligibility for grief support is not tied to an administrative file. The bereavement plan of care is its own service, supervised by someone educated in grief and loss. Option d is incorrect because the family is already enrolled through the client's hospice election. Sending this widow to find an outside program adds a barrier at the moment she finally reached out.

Correct Answer: Stop the restraint and turn the student sideways

Restraint can injure a seizing student and does not shorten the event. The nurse stops it, turns the student onto the side with the mouth angled downward, clears hazards, cushions the head, and times the seizure. Option b is incorrect because nothing goes into the mouth during a seizure. Objects placed between the teeth cause dental and airway injury, and the tongue cannot be swallowed, which is the myth behind the practice. Option c is incorrect because food and drink are withheld until the student is fully alert. Swallowing is unreliable during the postictal period, so offering juice now risks aspiration without treating anything. Option d is incorrect because rescue medication follows the criteria written in the action plan, and duration is one of them. Timing the event tells the nurse whether that threshold has been reached, so positioning and the clock come first.

Correct Answer: Assess aide services at least every fourteen days

When the client is also receiving skilled nursing or therapy, the RN must assess the aide's services at least every fourteen days, and the aide does not need to be present for that assessment. Option a is incorrect because direct observation at every visit is neither required nor feasible for a caseload. The rule sets a minimum interval for assessing the services, not a standing presence at the bedside. Option b is incorrect because the longer interval applies to clients receiving aide services alone, with a semiannual onsite visit while the aide is working. This client is also getting skilled nursing, so the shorter interval governs. Option c is incorrect because supervision is ongoing rather than a single event at the end of service. Waiting until discharge would leave weeks of unsupervised personal care and no chance to correct problems early.

Correct Answer: Leave the area and telephone the agency

When the area feels unsafe the nurse does not enter. Leaving and calling the agency allows the visit to be rescheduled or made with an escort, and it protects the nurse without abandoning the client. Option b is incorrect because sitting in a parked car keeps the nurse at the scene and visible to it. Waiting also assumes the situation will improve, which is not something the nurse can predict. Option c is incorrect because walking into an active disturbance trades the nurse's safety for one visit. A visit can be rescheduled or covered with an escort, but an injury to the nurse cannot be undone. Option d is incorrect because de-escalating a street confrontation is not the nurse's role and engaging an intoxicated person raises the risk. Field safety guidance directs the nurse away from the situation, not into it.

Correct Answer: Give fifteen grams of fast acting carbohydrate

A conscious student who can swallow receives fifteen grams of fast acting carbohydrate, with a recheck in fifteen minutes and a repeat dose if the level is still low. Nothing by mouth applies only when consciousness is lost. Option a is incorrect because a hypoglycemic student is never sent anywhere unaccompanied. Symptoms can progress to confusion or loss of consciousness on the way, and treatment is brought to the student instead. Option b is incorrect because glucagon is reserved for the student who is unconscious, seizing, or unable to swallow safely. This student is awake and cooperative, so oral carbohydrate is both faster and less invasive. Option d is incorrect because protein and fat slow absorption exactly when a rapid rise is needed. A longer acting snack has a place after the level has come up, and an hour is far too long to wait.

Correct Answer: Explain the risk and offer alternative placement options

The nurse negotiates rather than dictates in someone's home. Explaining the specific fall risk and offering choices, such as moving the rug or securing it with non-slip backing, keeps the client engaged and the hallway safer. Option a is incorrect because the nurse is a guest and the client owns the decision about her own belongings. Removing the rug without consent damages the relationship and the rug will simply return after the visit. Option b is incorrect because the client declined one specific change, not teaching as a whole. Charting a blanket refusal mislabels her, closes the subject prematurely, and gives the team an inaccurate picture of the home. Option c is incorrect because a single throw rug does not make a residence unsafe for care. Escalating to the provider skips the negotiation that usually resolves hazards and may end services the client still needs.

Correct Answer: Sit him upright with a fan near his face

Positioning upright with cool air moving across the face relieves the sensation of breathlessness and can be done at once. A low dose opioid is first line pharmacologically, and an anxiolytic helps when anxiety amplifies it. Option a is incorrect because oxygen relieves dyspnea reliably only when the client is hypoxemic. This man's saturation is normal, so a mask adds noise, heat, and a barrier between him and his family. Option c is incorrect because lying flat worsens the work of breathing by pushing abdominal contents against the diaphragm. Darkening the room does nothing for air hunger and may deepen his fear. Option d is incorrect because hospice families are taught to call the agency, not to seek emergency transport. Sending him out subjects a dying man to a trip that hospice measures at home can spare him.

Correct Answer: General inpatient care for symptom control

General inpatient care provides inpatient pain control and symptom management that cannot be managed in the home. This client's vomiting and pain have defeated home measures, so the level of care matches the symptom crisis. Option a is incorrect because routine home care is the standard level for a client who is not in crisis. Adding aide visits supplies personal care, which does nothing for uncontrolled vomiting and bone pain. Option b is incorrect because respite exists to let an exhausted caregiver rest and is capped at five consecutive days. Nothing in this scenario points to caregiver fatigue; the problem is uncontrolled symptoms. Option d is incorrect because continuous home care manages a crisis while the client stays at home. Here the home has already failed to control the symptoms, which is precisely when the team moves him inpatient.

Correct Answer: The nurse is a guest with influence, not authority

In the home the client controls the environment, the schedule, and who is present. The nurse has influence rather than authority and must negotiate care, which shapes every intervention in this setting. Option b is incorrect because control of the setting belongs to the household, not the agency. A hospital unit is arranged for care delivery, while a home is arranged for living and stays that way. Option c is incorrect because visit schedules bend around the family, the pets, and the client's own day. Fixed shift routines describe inpatient staffing, and importing one into a residence would fail immediately. Option d is incorrect because an untrained relative delivers the care between visits. Caregiver teaching is not an extra task added to the visit, and for most home health cases the teaching is the visit.