NR-442 Community Health Nursing - Set 4 - Part 3

Correct Answer: Complete the comprehensive assessment personally as the RN

OASIS is part of the comprehensive assessment and may be completed only by an RN or a qualified therapist. Assessment is nursing process work, which is never delegated, and client stability does not change that. Option a is incorrect because stability governs which tasks may be delegated, not whether an assessment may be. The comprehensive assessment sits outside the practical nurse's scope regardless of how predictable the client appears. Option c is incorrect because an aide may take and report measurements such as weight or a temperature reading. Interpreting findings and scoring functional items call for licensed judgment the aide does not have. Option d is incorrect because a cosignature cannot convert an unauthorized assessment into a valid one. Signing for data the RN did not gather misrepresents the record that drives payment and quality reporting.

Correct Answer: Drugs, equipment, and supplies for the terminal illness are covered

The hospice benefit covers medications, equipment, and supplies related to the terminal diagnosis, so the morphine, oxygen, and hospital bed come through hospice. The family should not be purchasing these items themselves. Option a is incorrect because it splits coverage where hospice does not. Drugs for the terminal illness, including opioids for pain and breathlessness, come through the hospice agency along with the equipment. Option b is incorrect because visits are only one piece of a comprehensive benefit that also supplies aide services, social work, chaplain support, durable medical equipment, and the drugs the terminal illness requires. Option c is incorrect because telling a family to rent and buy would push them toward paying twice for care hospice already provides. Financial strain of that kind is what the benefit prevents.

Correct Answer: Arrange access for workers on every shift

Hazard communication requires a safety data sheet for each hazardous chemical to be readily accessible to workers on every shift without asking permission. A locked binder defeats that access, so the nurse corrects it during the survey. Option a is incorrect because noting the finding for a report later leaves the barrier standing through every shift until then. A walk through exists to identify problems and to get them fixed, not merely catalogued. Option b is incorrect because a secondhand summary is not the document the standard requires. Workers are entitled to the sheet itself, with the first aid and exposure control sections intact when an emergency starts. Option d is incorrect because relocating the sheets to a clinic that closes at night recreates the same problem in a new place. Access has to reach the plating floor whenever chemicals are being handled.

Correct Answer: Medicare covers intermittent skilled care, not continuous nursing

The Medicare home health benefit pays for intermittent skilled nursing, not continuous hourly care. A client needing a nurse around the clock is referred to private duty nursing funded by insurance, Medicaid, or private pay. Option b is incorrect because homebound status is only one of three eligibility criteria and it does not expand what the benefit buys. Meeting it never converts intermittent coverage into continuous coverage. Option c is incorrect because hourly shift nursing is private duty care, a separate service paid by private insurance, Medicaid, or the family. A recent discharge does not change which program pays. Option d is incorrect because custodial care such as bathing, feeding, and housekeeping is excluded from the Medicare benefit unless a skilled service is also in place. Caregiver absence creates no coverage.

Correct Answer: A certified prognosis of six months or less

The hospice physician and the attending physician certify a terminal illness with a life expectancy of six months or less if the illness runs its normal course, and the client elects the benefit. Option a is incorrect because no prior hospitalization is required for the hospice benefit. Eligibility rests on entitlement to Medicare Part A, physician certification of the prognosis, and election of hospice from an approved agency. Option b is incorrect because homebound status is the gateway to Medicare home health, not hospice. A hospice client may leave home freely; the benefit follows the prognosis rather than the ability to travel. Option c is incorrect because a resuscitation order is a separate advance care planning decision. Hospice enrollment does not depend on it, though the team will discuss goals of care and document the client's wishes.

Correct Answer: Call the hospice agency rather than emergency services

Families are taught to call hospice at the time of death, not emergency services, because responders may be obliged to attempt resuscitation. There is no emergency; the family may take the time they need. Option a is incorrect because emergency responders arrive prepared to resuscitate unless a valid recognized out of hospital order is produced. Calling them risks the very intervention this client and family planned to avoid. Option c is incorrect because an allow natural death order directs the team not to resuscitate. Starting compressions would violate a documented wish and turn a peaceful death into a traumatic scene for the daughter. Option d is incorrect because the nurse must first verify the death according to state law and agency policy. Funeral home notification follows the family's plan and comes after that step, never before it.

Correct Answer: Giving stock epinephrine under a standing order

Trained unlicensed staff may give stock epinephrine under a standing order in most states, and the nurse writes the protocol and trains them. Nursing assessment and judgment about a student's condition stay with the nurse. Option a is incorrect because deciding to send a student home follows an assessment of the illness and its severity. That judgment is nursing practice, and an assistant may report findings but cannot make the determination. Option b is incorrect because the individualized healthcare plan is a nursing care plan built from the nurse's own assessment and written with the family. Planning cannot be handed to unlicensed staff under any state's delegation rules. Option c is incorrect because a new complaint of chest pain requires interpretation of findings, not a routine task. Assessment is the step of the nursing process that is never delegated, whatever the staffing pressure.

Correct Answer: Withhold the medication and request a labeled container

Medication must arrive in the original pharmacy labeled container so the label can be matched against the order. Loose tablets cannot be verified for drug, dose, or expiration, so the nurse withholds the dose and contacts the pharmacy or prescriber. Option a is incorrect because a valid order does not verify the tablet in front of the nurse. The container requirement exists so that drug, strength, and directions can be confirmed independently before anything is given. Option c is incorrect because a parent's verbal identification of a pill is not an acceptable substitute for a pharmacy label. Verbal permission and verbal identification both fall short of the written documentation school policy requires. Option d is incorrect because delay solves nothing while the container problem remains unresolved. Keeping unlabeled tablets in the office also creates a storage and accountability problem, so the medication goes back to the parent until it is properly labeled.

Correct Answer: The student body plus faculty and staff

School nursing is population focused. The nurse's client is the whole student body, and employee wellness is a named component of the Whole School, Whole Community, Whole Child framework, so faculty and staff are served too. Option b is incorrect because office visits identify only the students who present themselves. Case finding, screening, and health education reach children who never come in, and the program is judged on the whole population. Option c is incorrect because chronic condition management is one service among the ten components of the Whole School, Whole Community, Whole Child model. Health education, nutrition services, a healthy environment, and family engagement serve every enrolled child. Option d is incorrect because physical education is a single component of that framework rather than the boundary of the population. Narrowing the nurse's population that way would leave most of the school unserved.

Correct Answer: Wash the puncture site with soap and water

Washing the site immediately with soap and water is the first step after a percutaneous exposure. Reporting, source testing, baseline serology, prophylaxis, and documentation all follow, but nothing precedes decontaminating the wound. Option a is incorrect because the sharps injury log is a recordkeeping requirement completed after care. Paperwork first is the classic wrong choice on exposure items, since it delays both decontamination and time sensitive prophylaxis. Option b is incorrect because baseline testing of the exposed worker comes later in the protocol, after the exposure is washed and evaluated. Drawing blood first leaves contaminated material sitting in an open puncture. Option d is incorrect because identifying and testing the source is step four, not step one. It shapes prophylaxis decisions and matters greatly, yet it does nothing for the open wound the housekeeper needs treated now.