A nurse is documenting the care provided to a client who receives home health services.

Which of the following records should the nurse use to certify that the client meets Medicare eligibility criteria and to outline the services to be provided?

Home health certification and plan of treatment.

Outcome and assessment information set.

Home care flow sheet.

Home care progress note.

Answer and Explanation

The Correct Answer is A

Home health certification and plan of treatment. This is the record that the nurse uses to certify that the client meets Medicare eligibility criteria and to outline the services to be provided. A home health certification and plan of treatment is a document that contains the physician’s or allowed practitioner’s orders for home health services, the patient’s diagnosis, the patient’s functional limitations, the type and amount of services needed, and the expected duration of care.

Choice B is wrong because Outcome and Assessment Information Set (OASIS) is a standardized assessment tool that HHAs use to collect data on adult patients receiving skilled services.

OASIS is not used to certify eligibility or plan treatment.

Choice C is wrong because Home care flow sheet is a form that HHAs use to document the daily care provided by nurses and home health aides.

A home care flow sheet does not certify eligibility or plan treatment.

Choice D is wrong because Home care progress note is a form that HHAs use to document the patient’s progress toward the goals of care, any changes in the plan of care, and any communication with other health care providers.

A home care progress note does not certify eligibility or plan treatment.

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Correct Answer is ["A","D"]

Explanation

The nurse should include factual information about what happened and notify the risk management department.These actions are part of the steps of reporting medication errorsand the good practice guide on recording, coding, reporting and assessment of medication errors.

Choice B is wrong because the nurse should not state opinions about who was responsible for the error.

This could be seen as biased, unprofessional or accusatory.

The nurse should focus on the facts and the causes of the error, not on blaming individuals.

Choice C is wrong because the nurse should not file the report in the client’s medical record.

This could violate the client’s privacy and confidentiality.

The report should be filed in a separate system that is accessible only to authorized personnel.

Choice E is wrong because the nurse should not discuss possible solutions to prevent future errors.

This could be premature, unrealistic or inappropriate.

The nurse should leave this task to the investigation team or the risk management department, who will analyse the incident and make recommendations based on evidence and best practice.

A. It highlights the client’s concerns and strengths. B. It reduces redundancy and duplication of data. C. It facilitates communication among health care team members. D. It incorporates nursing diagnoses and care plans. E. It provides a chronological record of events.

Correct Answer is ["A","B","C"]

Explanation

Focus charting is a method of organizing health information in an individual’s record that centers on the patient’s concerns and strengths.It uses a three-column format to document the data, action and response (DAR) of each focus.

The advantages of using focus charting are:.

• It highlights the client’s concerns and strengths, which makes the care more patient-centered and holistic.

• It reduces redundancy and duplication of data, as it avoids repeating information that is already recorded in other forms or flow sheets.

• It facilitates communication among health care team members, as it promotes interdisciplinary documentation and helps organize the information in a concise and precise way.

Choice D is wrong because focus charting does not incorporate nursing diagnoses and care plans, although it is based on the nursing process.Nursing diagnoses and care plans are documented separately or as part of the action category.

Choice E is wrong because focus charting does not provide a chronological record of events, but rather organizes the data by the focus.A chronological record of events can be found in other forms of documentation, such as narrative or SOAP notes.

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A nurse is documenting the care provided to a client who receives home health services. Which of the following records should the nurse use to certify that the client meets Medicare eligibility criteria and to outline the services to be provided?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is documenting an incident report for a medication error that occurred on her unit. Which of the following actions should the nurse take? (Select all that apply.).

Correct Answer is ["A","D"]

Explanation

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Correct Answer is ["A","B","C"]

Explanation

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A nurse is documenting the care provided to a client who receives home health services.

Which of the following records should the nurse use to certify that the client meets Medicare eligibility criteria and to outline the services to be provided?