Skilled Nursing Home Health Competency Test Form

1. Which will be the MOST significant in promoting patient satisfaction?

A. Tidying and disinfecting the patient’s immediate environment.

B. Identifying appealing food choices within the patient’s dietary restrictions.

C. Communicating clearly and continuously with patients and families.

D. Discussing the patient rights policy and HIPAA information with patient.

2. Acceptable identifiers for verifying a patient’s identity include:

A. Name and zip code.

B. Name and Birthdate.

C. The patient’s provider and next of kin.

D. Social security card or Medicare card and a major credit card.

3. In which situation does the CDC recommend washing your hands with soap and water rather than ONLY disinfecting with an alcohol-base hand gel?

A. You have just removed your gloves after inserting a urinary catheter. B. Your patient has been diagnosed clostridium difficle. C. You have just taken a patient’s vital signs. D. You have just positioned the IV stand/pump closer to the patient while she sits in the chair.

4. Which evidence-based practice action is most likely to prevent catheter-associated urinary tract infection?

A. Reassess the continued need for an indwelling catheter.

B. Irrigate the indwelling urinary catheter once per day.

C. Empty the drainage bag only when completely filled.

D. Maintain the drainage bag below the level of the bladder, EXCEPT during transport.

5. During your admission assessment, you notice a reddened area on your patient’s sacrum. When you touch and release the skin, the redness remains. How will you describe this finding in your documentation?

A. Blanchable erythema.

B. Non-Blanchable erythema.

C. Stage 2 pressure ulcer.

D. Stage 3 pressure ulcer.

6. You are teaching your patient how to use the sliding scale below prescribed for rapid-acting insulin prior to meals. You give the example that his blood glucose level before breakfast is 165 mg/dL and ask him what he will do in that situation. What is his correct answer?

A. Check the blood glucose again in 2 hours.

B. Repeat the finger stick to ensure the reading is accurate and if so, administer 2 units regular insulin subcutaneously.

C. Administer 3 units rapid-acting insulin subcutaneously.

D. Administer 5 units rapid-acting insulin subcutaneously.

7. To infuse IV fluid at a rate of 125 mL/hr with an IV set that delivers 15 gtts/mL, you will regulate the drip rate to:

A. 11 gtts/minute.

B. 15 gtts/minute.

C. 31 gtts/minute.

D. 60 gtts/minute.

8. Which classification of medications MOST often contributes to an elderly patient’s risk for falling?

A. Benzodiazepines.

B. Stool softeners.

C. Bronchodilators.

D. Antiplatelet agents.

9. Your patient has an order for warfarin (Coumadin) 5mg PO daily. Which of the following contains the ordered dose?

A. One-half 7.5 mg tablet.

B. One 3 mg tablet.

C. Two 2.5 mg tablets.

D. Two and one-half 3 mg tablets.

10. Your patient has an indwelling urinary catheter and drainage bag. You will instruct the patient to:

A. Disconnect the catheter from the bag to empty the bag.

B. Fasten the bag just above the waist level using a belt.

C. Keep the bag below the level of the urinary bladder.

D. Place the bag on his lap when seated in a chair.

11. You will administer enoxaparin (Lovenox) 30 mg deep subcutaneous as ordered. The prefilled syringe contains enoxaparin 100 mg/mL and is labeled as a 30 mg dose. How many mL does the syringe contain if it is correctly filled with a 30 mg dose?

A. 0.2 mL

B. 0.3 mL

C. 0.5 mL

D. 1 mL

12. In the home setting of a patient who is receiving oxygen, you will assure that:

A. The patient or caregiver opens valves rapidly.

B. The tank is in a secure container and in an upright position.

C. Windows remain closed and other sources of ventilation are limited.

D. A precautionary sign is placed on the door only if the patient gives permission.

13. You are making your first visit to a patient who has multiple-drug-resistant staphylococcus aureus (MRSA) wound infection. You will plan to:

A. Wear sterile gloves during all patient contacts.

B. Wear an N95 respirator mask while in the home.

C. Leave necessary medical equipment and supplies in the home.

D. Instruct the patient to wear a surgical mask when in within 3 feet of other persons.

14. Your patient, who has a history of falling, is receiving physical therapy visits that include strength, balance, and endurance exercises. The patient tells you, “Those exercises are silly and I can’t be bothered.” You will base your reply on research findings that suggest that the effectiveness of exercise in preventing falls is:

A. Highly significant among older adults.

B. Effective only if the patient is free of chronic diseases.

C. Far less effective among elderly persons that among young adults.

D. Much less helpful than environmental adjustments such as bright lighting.

15. You are administering an IV antibiotic to your patient. He complains of itching and you observe a flat red rash over his chest and upper back. Your first action will be to:

A. Slow the IV infusion.

B. Call the patient’s provider.

C. Discontinue the IV infusion.

D. Implement the anaphylaxis protocol.

16. When should you complete the majority of your documentation of a home health visit?

A. During the visit.

B. Immediately after the visit.

C. Upon returning to the office after the visit.

D. Immediately prior to entering the home setting.

17. The most accurate way to determine whether the patient prepares her medications correctly is to:

A. Observe the patient preparing her medications.

B. Monitor closely for toxic and subtherapeutic effects of her medications.

C. Check to see if the expected amount of medication is remaining in each prescription container.

D. Ask the patient’s family member or caregiver if the patient has any problems preparing medications.

18. How do you create the most effective initial care plan?

A. Develop the plan at the time of recertification.

B. Use referral information to create a detailed plan before the visit.

C. Base the initial plan upon physician approval of the Plan of Care (POC).

D. Incorporate assessment information collected during the first visit.

19. In which of these settings can home health services legitimately be delivered?

A. A daycare center.

B. The home health agency’s office.

C. The office of the patient’s primary physician.

D. An assisted living facility in which the patient resides.

20. Which patient’s situation fits the criteria for homebound?

A. A woman who had a high risk pregnancy and is 2 weeks postpartum.

B. A person who uses a wheelchair and uses a transportation service to attend activities at a community center 3 times per week.

C. A 50-year-old who has severe rheumatoid arthritis, uses assistive devices when driving.

D. A 90-year-old whose son lifts her into the car to take her to lab and MD appointments.

21. Data collection for recertification takes place:

A. On the last day of a quality episode.

B. Within 14 days of the end of the billing episode.

C. Within the last 5 days of each 60-day period after Start of Care (SOC).

D. When home health care is resumed after an acute care stay of 24 hours or longer.

22. You are planning to teach a patient and family member how to administer TPN. For the purposes of teaching you will schedule:

A. One skilled care visit.

B. Daily visits for one week.

C. At least 2 visits to allow for teaching and return demonstration.

D. One visit for teaching and a follow up visit by a home health aide.

23. It is important to document contacts to the patient’s primary provider:

A. Even if you fail to reach the provider.

B. Within 48 hours of any attempt to make contact.

C. Only when you receive changes to the Plan of Care (POC).

D. Only when reporting a significant change in the patient’s condition.

24. Which phrase used in documentation best reflects that patient teaching occurred?

A. Asked the patient to explain his disease process.

B. Discussed dietary considerations for warfarin therapy.

C. Shared information about foods to avoid on the low sodium diet.

D. Instructed the patient in the use of the Accu-Check glucometer.

25. Your patient has returned home from the hospital today. The Center for Medicare and Medicaid Services (CMS) requires that you complete the Resumption of Case (ROC) comprehensive assessment:

A. Before 7:00 PM today.

B. Within 24 hours.

C. Within 48 hours.

D. Within 5 days, today being day zero.

26. During your assessment, the patient complains of severe osteoarthritis pain in her hips and knees. Your most appropriate response is to:

A. Focus your assessment on items related to mobility.

B. Tell her to take her pain medication and get it for her if necessary.

C. Find out what she does to relive pain and encourage her to take those actions now.

D. Reassure her that you will complete your assessment soon and that will allow her to assume a more comfortable position.

27. Your patient is able to take a bath in the bath tub. During the bath, his daughter checks on him periodically and washes his back. Rate your patient on M1830.

A. 0

B. 2

C. 3

D. 5

28. Your patient is physically able to plan and prepare light meals and snacks, but prefers to have his wife do these activities. Rate your patient on M1880.

A. 0

B. 1

C. 2

D. Not Applicable.

29. At the Start of Care (SOC), you documented one Stage 3 Pressure Ulcer. At Follow-Up, you assess that this pressure ulcer is granulating. At which stage will you document this pressure ulcer on M1308?

A. Stage 1.

B. Stage 2.

C. Stage 3.

D. Unstageable.

30. Patient teaching for a diabetic patient who has loss of protective sensation (LOPS) includes how to:

A. Massage the feet vigorously to restore sensation.

B. Inspect the feet daily for blisters, red areas, or injuries.

C. Walk safely in stocking feet by wearing socks that have non-skid bottoms.

D. Soak the feet in water as hot as can be tolerated to improve circulation.

31. Which patient is at greater risk for skin breakdown?

A. A 34-year-old immediately post-operative after open reduction of a fractured femur.

B. A 50-year-old diabetic who has early renal failure and is ambulating to the chair.

C. A 60-year-old who is post-CABG surgery and is resting on an air mattress.

D. An obese 80-year-old who is incontinent of urine and unable to ambulate.

32. You have applied a fresh Wound V.A.C. dressing and turned on the pump to activate negative pressure. You hear a whistling sound which indicates that:

A. The dressing is leaking.

B. V.A.C. unit settings are too high.

C. The correct negative pressure is achieved.

D. Clamps on the dressing tubing and canister tubing are not fully open.

33. To promote wound healing, you will recommend that your patient’s diet provides generous amounts of:

A. Calories; sodium.

B. Zinc; low-fat foods.

C. Protein; vitamins A and C.

D. Fat; complex carbohydrates.

34. You will advise the patient who is receiving TPN to:

A. Expect the catheter insertion site to feel warm and tender.

B. Weigh herself daily; report weight gain of more than 2.2 lbs (1kg).

C. Administer TPN Solution at a cool temperature, directly from the refrigerator.

D. Be aware that chills and fever are frequent side effects; relieve with acetaminophen.

35. When teaching the diabetic patient who has foot ulcers you will emphasize:

A. Blood glucose control.

B. Use of tight-fitting support hose.

C. Daily prophylactic use of antibiotic ointments.

D. Coverage of ulcerated areas with dry dressings.

36. You will teach the patient who has a PICC line in place to:

A. Immobilize the arm in which the site is located.

B. Keep clamps in the open position if his catheter has clamps.

C. Pull on the catheter gently to assure that it is properly secured.

D. Observe the site daily and report any swelling, redness, leakage, or pain.

37. You observe that your patient who has congestive heart failure (CHF) has 2+ edema in his ankles. It is MOST important to ask him questions about his medications, diet, and:

A. Pulse.

B. Positioning.

C. Bowel habits.

D. Blood glucose.

38. The MOST important reason to confirm placement of a feeding tube before beginning a tube feed is to:

A. Prevent aspiration in the feeding.

B. Promote proper absorption of nutrients.

C. Determine the volume of the next feeding based on residual.

D. Assure that medications have been completely flushed through the tube.

39. To effectively promote wound healing for a pressure ulcer, it is essential to identify the:

A. Medication profile of the patient.

B. Ambulatory status of the patient.

C. Causative factors for this patient.

D. Peripheral sensation in the patient’s extremities.

40. You are preparing to change the patient’s PICC line dressing. Before beginning the procedure, you will advise the patient to:

A. Wash his hands.

B. Take rapid, shallow breaths.

C. Turn his head away from the site.

D. Assist in removing the old dressing.

PHARMACOLOGY SKILLED NURSING TEST

CONVERSIONS

MATCH COLUMN A WITH COLUMNN B

LIST THE 5 RIGHTS LIST THE 5 RIGHTS OF MEDICATION ADMINISTRATION