Community Public Health Nursing Practice 4th Edition By Maurer – Test Bank

Chapter 11: Home Visit: Opening the Doors for Family Health
Test Bank
MULTIPLE CHOICE
1. A senior student nurse asked the instructor, “Why do we have to make home visits? I taught the client self care in the hospital.” What might be the instructor’s reply?

A. “Home visits allow you to focus on the entire family and see threats to health and safety.”
B. “Making home visits will increase your marketability after you graduate.”
C. “Our State Board of Nursing requires home visits as part of community/public health education.”
D. “The national accreditation policies require that students make home visits before they graduate.”

ANS: A
Home visits allow the nurse to see threats to the family health and safety in the home or immediate environment. Home visits also encourage a family focus, although they do not guarantee it. It is common for new nurses who have little experience in home visiting to feel uncertainty and ambivalence about the experience.
Cognitive Level: Application

REF: Text page 303

2. It was suggested that public health department funding for making home visits be cut because so much time and money were spent in travel and such expenses seemed inappropriate in a time of fiscal restraint. What might be the nurse’s response to this suggestion?

A. Research has shown home visits save far more than their cost in decreasing child abuse, drug-resistant infections, and even emergency department visits.
B. The public health department staff are the most knowledgeable concerning funding needed and how best to spend the funds.
C. The voters agreed on the tax levy funding the department. It would not be politically wise to act against voters’ obvious desires.
D. With all the fear about bioterrorism, it is an inappropriate time to cut funds to the public health department!

ANS: A
Research has demonstrated that home visits result in fewer instances of child abuse and neglect and fewer emergency department visits, accidents, and poisonings during the child’s first 2 years of life and that the effects were still apparent 15 years later.
Cognitive Level: Knowledge

REF: Text page 303

3. A student nurse was anxious about making home visits and suggested the same tasks could be accomplished if the family met the student and instructor at the outreach clinic in the client’s neighborhood. “No,” replied the instructor, “What is home nursing?”

A. “The client will be the hostess who has to be polite and nice at all times since the nurse is the visitor.”
B. “The nurse goes to the client rather than the client going to the nurse.”
C. “You don’t have to keep such detailed nurse’s notes when visiting in the home.”
D. “You can use the client’s equipment and supplies rather than the hospital’s.”

ANS: B
A major distinction of a home visit is that the health professional goes to the client rather than the client coming to the health professional. Assessment can then be much more complete and comprehensive. Anxiety over home visits is not uncommon because of the reduced control, the increased focus on family, the need to adapt care to the home setting, and the need for primary prevention in addition to secondary and tertiary prevention. All these factors result in a very complex role for a nurse.
Cognitive Level: Knowledge

REF: Text page 304

4. A clinical specialist in gerontology accepted a position with the local health department as a community/public health nurse. What sort of assignment can the nurse expect?

A. To geriatric clients and the local senior citizen centers
B. To the highest risk neighborhood in the city, because that is where the need is most acute
C. To the neighborhood where the nurse lives, to reduce travel time
D. Wherever the nurse wants so that the nurse will accept the position in this time of nurse shortages

ANS: A
A nurse can be assigned a specific neighborhood or a specific aggregate. As a clinical specialist in geriatrics, the nurse would more probably be assigned to work where there is a need for such expertise. The nurse could also be assigned a specific neighborhood, but not on the basis of the rationale given in the answer choices.
Cognitive Level: Application

REF: Text page 305

5. A new mother asked the community/public health nurse what a nurse visiting her at home would do differently from what the nurses in the hospital had already done. What might be the nurse’s response?

A. “All nurses try to help people stay well, but I can also help you assess your home for any dangers to the baby.”
B. “Hospital nurses and I all try to be helpful, but I can also tell you how to obtain excellent child care.”
C. “In the hospital, you had a nurse focus on your baby and another nurse focus on your care. I’ll be focusing on both you and your baby.”
D. “The other nurses in the hospital focus on helping you and the baby get off to a great start. I’m going to repeat everything to be sure you really know it.”

ANS: A
While all nurses try to keep clients safe and well, the community/public health nurse is most qualified to assess the home environment and wider community for dangers as well as resources.
Cognitive Level: Application

REF: Text page 303

6. What might be a problem for the nurse making home visits? Select all that apply.

A. Assessing the client may be more complex when family and environmental factors are considered in the assessment.
B. The nurse may be unable to care for as many clients because of the time lost in transportation.
C. Clients may expect more individualized care when in their own home.
D. Teaching may be more time-consuming when both the client and the family are involved.
E. The nurse may sometimes be concerned for personal safety.
F. There may be difficult to control distractions, such as noisy children.

ANS: B, E, F
Travel time is costly, and it is less efficient for the nurse than working with groups or seeing many clients in an ambulatory site. Distractions, such as television and noisy children, may be more difficult to control. Lastly, nurse safety can be an issue.
Cognitive Level: Knowledge

REF: Box 1; Text page 304

7. After leaving the home of a new mother and her newborn baby, the student nurse asked the instructor, “What will the new mom do when we aren’t there to help?” How did the instructor probably reply?

A. “I am going to ask you to come back tomorrow to help the new mom further.”
B. “Mothers have been having and caring for babies since the world began without nurses. Why would the new mother have any problems?”
C. “We have to assume that the new mom will be able to manage without us.”
D. “We’ll have another nurse stop by tomorrow to help the new mom.”

ANS: C
Receiving care in the community assumes that the family is able to remain at home and manage without the constant presence of health care providers.
Cognitive Level: Application

REF: Text page 304

8. A home health nurse was making an initial visit to an elderly man. As the nurse began the assessment, the wife gave all the information requested. What does the nurse need to do next?

A. Because the nurse has all the needed information, appropriate interventions must be agreed upon with the family.
B. Having the information, the nurse should now decide upon appropriate nursing diagnoses.
C. The next step is to assess the environment of the wider community.
D. The nurse needs to confirm with the client as the nurse has heard only the wife’s perspective.

ANS: D
Having heard from only the wife, the nurse must attempt to validate the information with the husband and/or recognize that all information was from only one perspective.
Cognitive Level: Application

REF: Text page 305

9. Many new community/public health nurses find home visiting very uncomfortable, even in nice neighborhoods. What would be the primary reason for such a feeling?

A. Home visits are a new skill to be mastered, and learning is uncomfortable.
B. Home visits reflect a situation under the client’s control and in the client’s environment.
C. Home visits require lots of supervision, backup, and extra resources.
D. Home visits take much more time and effort than giving care in the hospital.

ANS: B
All of these factors can lead a nurse, especially a newer one, to feel uncomfortable. However, the major difference is that the setting and the control are clearly the client’s, not the nurse’s.
Cognitive Level: Knowledge

REF: Text pages 306, 307

10. As the nurse entered the house of an elderly couple and was invited to sit, three cats rubbed against the nurse’s legs. What would be the most appropriate comment to make at this time?

A. “Are these cats hungry? Or do they want something else?”
B. “Cats can really cause health problems. Would you like me to call the animal shelter for you?”
C. “Would you like to introduce me to your cats?”
D. “Would you please lock up your cats until we’re done?”

ANS: C
The appropriate response to animals in the house is to first assess for safety. If safety is not an issue, then ask for an introduction. Pets are often considered members of the family.
Cognitive Level: Application

REF: Text page 305