Chapter 41: Home Care Safety Nursing School Test Banks

MULTIPLE CHOICE

1. Patients who require home care often experience physical alterations that require changes in their home environment. In the case of older adults, what is the best way to make these changes?

a.

Make changes quickly to prevent problems.

b.

Make changes to limit the patients need to move around.

c.

Make changes to complement the patients strengths.

d.

Make changes regardless of the patients previous sense of personal space.

ANS: C

In the case of older adults, the progressive physical changes of aging create the same type of need. Changes made should complement the patients remaining strengths. Making changes too rapidly without the patients consent will cause more problems than benefits. Appreciate the arrangement of the patients space within the home, and do not move things or suggest modifications without permission. You also need to respect the concept of personal space.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 995

OBJ: Identify interventions that modify the home environment for physical safety.

TOP: Modifying Safety Risks KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe and Effective Care Environment

2. The nurse is assessing a patient for mobility problems that could lead to falls. She has the patient perform a Timed Up and Go (TUG) test. The nurse uses this test to gauge:

a.

the patients ability to perform advanced ambulation maneuvers.

b.

whether the patient can walk 30 feet without fatiguing.

c.

whether the patient can tolerate the activity for longer than 30 seconds.

d.

how quickly the patient can perform the test.

ANS: D

Conduct a TUG for basic mobility. Instruct the patient to rise from a standard chair, walk approximately 10 feet (3 meters), turn around, walk back to the chair, and sit in the chair again. Have patient perform the test 3 times, and then calculate the mean score. Time the patient while he or she performs the activity. The normal time required to finish the test is less than 13.5 seconds. Individuals who cannot complete the test probably have mobility problems, especially if the time is greater than 20 seconds. This is not a test for tolerance of activity.

DIF: Cognitive Level: Application REF: Text reference: p. 997

OBJ: Perform a geriatric fall risk assessment.

TOP: Timed Up and Go (TUG) Test KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe and Effective Care Environment

3. When teaching an elderly patient about safety in the bathroom, which of the following recommendations should the nurse make?

a.

Use bath oils to maintain skin integrity and suppleness.

b.

Hang towels on grab bars for easy access.

c.

Make sure the bathroom door can be locked from the inside only for privacy.

d.

Shower using a shower stool and a handheld sprayer.

ANS: D

A shower stool allows the patient to sit while showering. Use of bath oils makes the tub surface slippery and increases the risk for falls. Do not hang towels on grab bars. Some patients accidentally grab the towel instead of the bar when needing support. Be sure that bathroom doors can be unlocked from both sides of the door. Functional locks prevent the person from becoming trapped in the bathroom.

DIF: Cognitive Level: Analysis REF: Text reference: p. 998

OBJ: Perform a home safety risk assessment. TOP: Home Safety

KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment

4. Which of the following is a safety measure that the patient should implement in the home environment?

a.

Using fluorescent lighting

b.

Wearing extra clothing for padding

c.

Obtaining a large fire extinguisher

d.

Installing additional towel bars for support in the shower

ANS: B

Have the patient use padding or types of clothing that will cushion bony prominences, especially high-risk bony prominences (e.g., hips). Specially designed hip protectors are available; they help to absorb the impact of a falling body. Provide a direct light source in areas where the patient reads, cooks, uses tools, or conducts hobby work. Avoid fluorescent lighting because it creates excessive glare. Have the patient select a fire extinguisher that is easy to handle and manipulate. Have a grab bar installed into wall studs at the tub, toilet, and/or shower. Towel bars are not designed to support the weight of the patient.

DIF: Cognitive Level: Application REF: Text reference: p. 1001

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Padded Clothing

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

5. Of what should the nurse remind the patient when discussing safety measures for the home environment?

a.

Set the hot water heater to only 160 F.

b.

Turn on the cold water faucet first.

c.

Use small throw rugs on slippery wood floors.

d.

Put high-wattage bulbs into all lamps.

ANS: B

Instruct the patient to always turn cold water on first to prevent direct exposure to hot water. Have the setting on the hot water heater adjusted to 120 F or lower. Secure all carpeting, mats, and tile; place nonskid backing under small rugs and door mats. Have the patient check light bulb wattage in all fixtures; this ensures that proper wattage is being used.

DIF: Cognitive Level: Application REF: Text reference: p. 1002

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Preventing Scalding

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

6. The patient has been brought to the emergency department by a family member, who states that she just doesnt know what to do. The patient often forgets where he is and refuses to bathe or change clothes. He will put things on the stove and forget that he has something cooking. She is obviously concerned for her loved ones safety. The nurse is likely to interpret these symptoms as signs of:

a.

depression.

b.

amnesia.

c.

aphasia.

d.

Alzheimers disease.

ANS: D

Alzheimers disease is a form of dementia that causes problems with memory, thinking, or behavior. There is also a risk for wandering, where patients repeatedly try to carry out tasks or leave the place of residence. Depression is a chronic, insidious emotional disorder characterized by feelings of sadness, melancholy, dejection, and worthlessness that are inappropriate and out of proportion to reality. Amnesia is loss of memory. This is only one symptom of Alzheimers disease. The patient has several symptoms. Aphasia is the loss of language skills. This is only one symptom of Alzheimers disease, and it is not one that the patients family member has identified.

DIF: Cognitive Level: Analysis REF: Text reference: p. 1004

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Alzheimers Disease

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

7. While performing a home visit with an elderly patient, the nurse notices that the patients dress is less tidy than in previous visits, and she finds an open orange juice container in the pantry cabinet instead of the refrigerator and a roll of paper towels in the refrigerator. How should the nurse respond?

a.

Begin rearranging the patients storage, and show her how it needs to be done.

b.

Raise her voice, and tell the patient that this is not acceptable.

c.

Complete a Mini-Mental State Examination (MMSE) or Short Geriatric Depression Scale (GDS).

d.

Realize that elderly patients do things differently.

ANS: C

Behavioral changes associated with cognitive dysfunction are evident in a disorderly home and inappropriate placement of objects (e.g., carton of orange juice placed inside kitchen cabinet instead of in refrigerator). If you suspect a cognitive or mental status change, complete an MMSE (e.g., Folsteins examination) for dementia and/or complete a short GDS for depression. Speak clearly and in a normal tone of voice.

DIF: Cognitive Level: Application REF: Text reference: p. 1005

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Cognitive Assessment

KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment

8. A patient with a cognitive deficit becomes agitated and upset about not being able to remember daily activities. How should the nurse respond to this agitation?

a.

Tell the patient not to worry about it.

b.

Provide an easy-to-follow calendar and reinforce the information.

c.

Explain that becoming upset is not going to help the situation.

d.

Remind the patient that now is the time to rest and relax.

ANS: B

If the patient has difficulty remembering when to perform tasks (e.g., paying bills, taking medicines), help the patient to create a list, or post reminder notes in a conspicuous location (e.g., bulletin board, front of refrigerator), provide a medication container organized by days of the week, and recommend a wristwatch with alarm to signal medication administration times. Memory function in older adults tends to be preserved for relevant, well-learned material. Lists and organizers will help the patient cope with memory loss and safely perform activities. Telling the patient not to worry negates the patients feelings. Reminding the patient that it is his or her time to rest and relax may be seen as a dismissal. False reassurance is not helpful to the patient. Focus on the patients abilities, and modify approaches used to perform daily activities.

DIF: Cognitive Level: Application REF: Text reference: p. 1007

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Cognitive Assessment

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

9. When communicating with a patient with a cognitive deficit, what is the best way for the nurse to respond?

a.

You managed all of your medications very well today.

b.

Your family should really take over the cooking. Its too hard for you to do.

c.

I dont see how you will be able to shop for yourself anymore. Someone will have to do it for you.

d.

This schedule will be too difficult for you to remember. I better write it all down.

ANS: A

Focus on the patients abilities rather than disabilities; this retains the patients autonomy and sense of self-worth.

DIF: Cognitive Level: Application REF: Text reference: p. 1007

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Patient Autonomy

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

10. The nurse is visiting an elderly patient who lives with his wife and daughter. He takes several daily medications, including antihypertensives, antiarrhythmics, diuretics, and pain medication. The patients wife states that he takes all of the pills in the morning and some at night. The nurse should examine the pills and suggest which of the following?

a.

Take the antiarrhythmics and antihypertensives together in the morning to prevent hypotension during sleep.

b.

Take the diuretics at bedtime.

c.

Increase the different types of pain medication to prevent addiction to one.

d.

Administer at bedtime medications that are likely to cause confusion.

ANS: D

Administer at bedtime medications that are likely to cause confusion to reduce the risk for confusion during waking hours, which contributes to disorientation and the risk for falling. However, do not recommend this if the patient has nocturia. Space antihypertensives and antiarrhythmics at different times to minimize side effects. Have diuretics taken early in the day and not at night, so that the diuretic effect occurs during the day, while the patient is awake. Reduce the number of pain medications used when possible. Drugs create sedative effects, increasing the risk for falls.

DIF: Cognitive Level: Application REF: Text reference: p. 1007

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Medication Changes

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

11. Which assistive device would most benefit a patient with a neuromuscular weakness?

a.

Large-print labels

b.

A syringe with a magnifier

c.

Screw-top medication containers

d.

Color-coded tops for medications

ANS: C

For patients with a weakened grasp or pain in the hands and fingers, have the local pharmacist place medications in a screw-top container. Larger labels and syringe magnifiers are used for patients with visual alterations. Color-coding systems are designed for patients taking multiple medications.

DIF: Cognitive Level: Application REF: Text reference: p. 1011

OBJ: Recommend strategies to ensure safe drug administration within the home.

TOP: Medication Safety KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

12. The patient is on neutral protamine Hagedorn (NPH) insulin and regular insulin at home. How should the nurse teach the patient and the patients caregiver to store the insulin?

a.

In the refrigerator and removed only for administration

b.

In a warm place such as in a cabinet above the stove

c.

In the dairy bin of the refrigerator with the cheese and eggs

d.

At room temperature for up to 30 days

ANS: D

Insulin may be stored in the refrigerator, but this is not necessary. Patients can store insulin at room temperature for up to 30 days without losing potency as per the manufacturers guidelines. Insulin should be kept in a cool place and away from very warm temperatures. If insulin is stored in the refrigerator, be sure that the drug is in a bin or container away from food.

DIF: Cognitive Level: Application REF: Text reference: p. 1011

OBJ: Recommend strategies to ensure safe drug administration within the home.

TOP: Insulin Storage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

13. When teaching about medication use in the home, what instructions should the nurse provide to the patient?

a.

Always keep insulin in the refrigerator.

b.

Put used needles in double paper bags.

c.

Put all of the medication to be taken in one bottle.

d.

Discard unused or expired medication in a bag containing coffee grounds.

ANS: D

Discard unused portions of drugs or outdated drugs in a bag containing coffee grounds or kitty litter. This ensures that no one in the household uses a drug not prescribed for their use or that will be ineffective pharmacologically. Insulin may be stored in the refrigerator, but this is not necessary. Discard sharps in puncture-resistant sharps containers or in a 2-liter soda bottle with a cap. Do not place different medicines in the same container.

DIF: Cognitive Level: Application REF: Text reference: p. 1012

OBJ: Recommend strategies to ensure safe drug administration within the home.

TOP: Disposal of Outdated Medication KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe and Effective Care Environment

MULTIPLE RESPONSE

1. Common causes of falls in older patients include which of the following? (Select all that apply.)

a.

Gait disturbances

b.

Muscle weakness

c.

Visual impairments

d.

Environmental hazards

ANS: A, B, C, D

Environmental hazards, gait disturbances, muscle weakness, and visual impairments are some of the causes of falls in older patients. Polypharmacy adds to the risk.

DIF: Cognitive Level: Comprehension REF: Text reference: p. 994

OBJ: Describe factors within a home environment that create risks for patient injury.

TOP: Causes of Falls KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2. In determining the causes of falls or other injuries within the home, the nurse should assess for which of the following? (Select all that apply.)

a.

Symptoms at time of fall and history of previous falls

b.

Location of fall and activity at the time of the fall

c.

Time of fall

d.

Trauma post fall

ANS: A, B, C, D

Key symptoms are helpful in identifying causes of falls. Onset, location, and activity associated with falls provide additional details on causative factors and how to prevent future falls. Determine whether the patient has had a history of falls or other injuries within the home. Be specific in your assessment. Use the mnemonic SPLATT: Symptoms at time of fall, Previous fall, Location of fall, Activity at time of fall, Time of fall, and Trauma post fall.

DIF: Cognitive Level: Analysis REF: Text reference: p. 996

OBJ: Identify interventions that modify the home environment for physical safety.

TOP: SPLATT Mnemonic KEY: Nursing Process Step: Assessment

MSC: NCLEX: Safe and Effective Care Environment

3. The nurse is assessing the home of an elderly patient for safety issues. Which of the following would reassure the nurse? (Select all that apply.)

a.

Cleaning the stove top

b.

Putting a shower chair in the bathroom

c.

Installing adequate lighting in all living areas

d.

Placing emergency numbers close to the telephone

ANS: A, B, C, D

The kitchen is one of the most hazard-oriented rooms in a home and poses serious hazards for fire. Grease is highly flammable. Stove tops and ovens should be kept clean and grease free. A shower stool allows patients to sit while showering. Adequate lighting helps persons to see any barriers or uneven walking surfaces. Emergency numbers near the phone are important for all home care patients.

DIF: Cognitive Level: Analysis REF: Text reference: p. 998

OBJ: Perform a home safety risk assessment. TOP: Home Safety

KEY: Nursing Process Step: Assessment MSC: NCLEX: Safe and Effective Care Environment

4. When a caregiver is communicating with a patient, which of the following may facilitate communication? (Select all that apply.)

a.

Face the patient who has a hearing impairment.

b.

Avoid eye contact.

c.

Use simple words.

d.

Be aware of nonverbal gestures.

ANS: A, C, D

Instruct the caregiver on how to use simple and direct communication: Sit or stand in front of the patient in full view. This promotes reception of verbal and nonverbal messages. Face the patient who has a hearing impairment while speaking so that the patient can see the speakers lips. Use a calm and relaxed approach. Use eye contact and touch to help reinforce messages. Speak slowly, in simple words and short sentences, to enhance understanding of messages. Use nonverbal gestures that complement verbal messages.

DIF: Cognitive Level: Application REF: Text reference: p. 1007

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Communication

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

COMPLETION

1. ___________ is a generalized impairment of intellectual functioning, with the most common form being Alzheimers disease.

ANS:

Dementia

Dementia is a generalized impairment of intellectual functioning, with the most common form being Alzheimers disease.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 1004

OBJ: Identify patients at risk for safety problems and possible accidents in the home.

TOP: Dementia KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity

2. Activities of daily living (ADLs) include the patients ability to bathe, dress, go to the toilet, transfer, maintain continence, and feed himself; _______ include the ability to use a telephone, prepare meals, travel, do housework, take medication, and shop.

ANS:

independent activities of daily living (IADLs)

ADLs include the patients ability to bathe, dress, go to the toilet, transfer, maintain continence, and feed himself; IADLs include the ability to use a telephone, prepare meals, travel, do housework, take medication, and shop.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 1004

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: ADLs/IADLs

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

3. Dementia is characterized by a gradual, progressive, irreversible _______ dysfunction.

ANS:

cerebral

Dementia is characterized by a gradual, progressive, irreversible cerebral dysfunction.

DIF: Cognitive Level: Knowledge REF: Text reference: p. 1004

OBJ: Identify interventions used to reduce safety risks for patients with sensory, cognitive, and mental status alterations. TOP: Dementia

KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity

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