Competency evaluation- home care aide
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Last Name
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Part 1: Observation and Reporting:
1. Mr. Jones pulse rate is usually 64-70. When you take it today it is 52. You should:
Wait 30 minutes and recheck it
Tell the patient to go to the doctor
Call the nurse or supervisor immediately
2. Mr. Smith tells you he feels like he is going to vomit after taking his new medicine the doctor ordered so he is not takin it. You should:
Tell him he must take it if he wants to get well
Tell his wife to make him take it
Tell him to take it with 7-Up
Tell him you will call the supervisor about what he should do.
3. While bathing the patient, the home health aide has an opportunity to:
Talk about your personal life
Think about your personal life
Visit with the family
Observe the skin condition, mobility and movement of the patient
4. When reporting a change in your patient's pulse, temperature or respiration, you need to specify all the following EXCEPT:
Method of measuring body temperature (oral, rectal, axillary)
The exact time the temperature, pulse and respirations were taken
Any other complaints the patient may be expressing (pain, stress, etc)
Why you were late getting to the patient's home
5. When reporting or recording information, it is important to:
Report and record exactly how you feel about the situation
Report and record exactly what you see
Report and record what the family feels is wrong
Report and record what the nurse feels is wrong
Part 2: Infection Control
1. Good hand washing techniques are important because
It prevents the spread of germs
It is required by the health department
It's good for the patient's morale
2. The perineal area is washed:
From front to back
From back to front
It doesn't matter
3. Wearing disposable gloves while giving personal care
Means your patient has an incurable disease
Protects both you and your patient from the spread of germs
Is never necessary unless the patient has AIDS
4. When handling dirty linens and clothing it is best to:
Put the dirty linens and clothing on the floor
Shake the linens and clothing before washing them
Place dirty linens and clothing in clothes hamper or plastic bag until they can be washed
5. When considering the home health aide's role in reducing the spread of germs, the home health aide would do all of the following EXCEPT:
Cover nose and mouth when sneezing or couching
Go to work even when you are ill
Wash hands after handling soiled items such as linens, clothing, garbage, etc.
To protect self, clean and cover cuts and breaks in the skin
Part 3: Basic Elements in the Body Functioning & Abnormalities Reported to RN
1. A five (5) pound weight gain in two days
Is normal and nothing to be worries about
Shows that the patient has be eating too many sweets
Should be reported to the nurse
2. Mrs. Smith's catheter bag contains a very large amount of dark red urine. You should:
Encourage her to drink more fluids
Empty the bag
Call you supervising nurse as soon as possible
3. A red spot over the patient's hip joint
Might develop into a bdesore
Is a normal sigh of old age
Should be treated with a heat lamp
4. When observing the patient's bowel habits, the following should be reported to the nurse immediately:
Symptoms of pain, abdominal swelling, or cramping
Patient not passing gas
Bowel movements occurring every other day
5. Ms. Whit, who lives alone, is usually talkative during her bath. Today she says very little, appears anxious and worried and has difficulty speaking. When would you report Ms. Whit's change of condition to your supervisor?
At the next case conference
At the end of the day
As soon as possible after making the observation
Part 4: Maintenance of Clean, Safe & Healthy Environment
1. Before transferring a patient from the bed to a wheelchair, it is always necessary to:
Put a pillow in the seat
Put a blanket over the seat and back
Lock the wheelchari brakes
Unlock the wheelchair brakes
2. Prior to assisting the patient into the tub or the shower, as a safety factor, you should check for:
A rubber mat for the tub or shower
Lotion for his/her skin
Comfortable water temperature
Both A & C
3. Regardless of the type of bath given to the elderly, the temperature of the water is important because:
You cannot get them clean unless it is hot enough
You have to follow the procedure manual
Elderly skin is more delicate and burns easily
We have to keep the family happy
4. Wrinkles in the patient's bed linens may cause:
No problems
The linens to wear out
Contractures
Bedsores
5. Which one of the following statements is NOT true:
Puddles of water or other liquids should be mopped up immediately to avoid falls.
Always be sure electrical cords are not lying in open walk areas
If someone in a house uses a cane or a walker, it is a good idea to cushion the floor by using lots of throw rugs
Cleaning supplies and other dangerous substances should be kept in a safe, secure cabinet or area
Part 5: Recognizing Emergencies & Knowledge of Emergency Procedures
1. Mr. Jones lives alone and never goes our of the house. When you arrive at his home, the door is locked, and although it is the middle of the day, you can see the lights turned on in the living room. When you knock, you can hear a low moan coming from somewhere in the house. You should:
Come back later
Get to the nearest phone and call you home health agency
Break a window and climb in
Keep knocking until he opens the door
2. Fire safety instruction is important because:
The supervisor says it is
The patient will think you are great
It prepares you to know the proper emergency action in case of a fire
It will look good on your visit record
3. Upon arriving at your patient's home, she tells you that she spilled boiling water on her hand while trying to cook. You should"
Cover the area with Vaseline
Apply cold water or ice to the area if there is no break in the skin and notify the supervisor
Scold the patient for being in the kitchen
4. Your patient who is awake and alert, begins to complain of heaviness in the chest and nausea. You should:
Run to the neighbors for help
Begin CPR
Call your supervisor immediately and follow instructions given by the supervisor
Give him some heart medicine you know he used to take for chest pain
5. If your patient falls while you are in the home, you should NOT do which of the following:
If exessive bleeding occurs, apply a pressure dressing with a clean cloth or sterile gauze
Move the patient to the bed to make him/her more comfortable
Watch for symptoms of shock- paleness, skin cold and clammy, weak, nausea, etc.
Call your supervisor immediately
Part 6: Physical, Emotional & Development Needs- Respect for Privacy & Property
1. Mr. Dodd is eating lunch when you arrive at his home. Your assignment is to take his vital signs and assist him in and our of the bathtub. Which of the following answers is correct?
Tell him to finish his lunch later because you have three more patients to see today
Allow him to finish his lunch, then do the bath and take his vital signs last
Allow him to finish his lunch, rest for at least ten (10) minutes, take the vital signs and then do the bath
2. When performing any procedure in which a part is exposed, keep the patient covered with a blanket as much as possible:
This is important because the patient has the right to dignity and privacy
It is not necessary to do this because it is easier to give care withou having blankets get in the way
It is better to just turn the heat to keep the patient warm
3. A patient, Miss Green, tells you she is very upset with you and demands you to tell her the supervisor's name so she can call and report you. The correct action is:
Tell her you are doing the best you can
Leave her home and go to the next patient
Refuse to see her again
Give her the supervisor's name and phone number
4. Your patient asks you what his diagnosis is and if he is going to die. You should:
Ignore the question
Tell him that you do not know the answer, but that you will have your nursing supervisor come talk to him
Tell him to call his doctor
5. When caring for a patient who is from another culture than yours, remember that:
The patient lives in Texas now and could change their ways to conform to Texas culture
The patient's response to grief and pain should be the same as yours
Family habits and religious practices will affect the way the patient responds to the care you provide
Part 7: Adequate Nutrition & Fluid Intake
1. Elderly patients may not eat a well-balanced diet due to:
Improperly fitting dentures
Loss of the ability to taste food well
Weakness and fatigue
All of the above
2. Fiber or roughage in the diet:
Has no effect on the digestive tract
Helps food move through the digestive tract
Helps people to chew food better
Adds lots of cholesterol to the diet
3. Very good sources of protein are:
Beans, peanut butter and eggs
Green salads and cooked greens
Potatoes and noodles
Apples and oranges
4. Which one of the following statements is correct
Always feed a patient- never let him feed himself
All food served to the patient should be lukewarm
Before serving the meal, it is important to be sure the patient is clean and comfortable
5. When the plan of care requires you to increase fluids, the following food would NOT be encouraged
Milkshakes
Gelatin
Potato chips
Broth
Part 8: DNR/ Advance Directives
1. Your patient is watching '911" on TV when you arrive. He tells you that "Nobody better put all those machines on me". He has already mentioned this on several other occasions. You should:
Tell him to stop talking like that
Bring a DNR form with you to your next HCA visit
Call the doctor to inform him of the patient's wishes
Notify the primary care nurse
2. You arrive at your patient's house and find him on the kitchen floor, not breathing or responding to your voice. Your remember that your primary case nurse had told you that he was a DNR even though it is not written on your assignment sheet. You should:
Honor his wishes--do nothing
Call the office and have them discharge him from the service because he is dead
Call 911, activate the emergency medial system and begin CPR
Go on to your next patient
3. If you know your patient is a DNR but it is not written on your assignment sheet:
Notify the primary care nurse to write "DNR" on the assignment sheet because you know that the HCA is legally obligated to begin CPR if it is not on your assignment sheet
Just write "DNR" on your copy of the assignment sheet so you won't forget.
It is no big deal
Be sure you tell any other HCAs that see the patient
4. What do you do if a patient has a DNR order, but the daughter from out of town whispers to you as you leave one day, "Just don't pay attention to what dad says he wants, I want everything done to keep him alive:.
Start CPR but only if the daughter is there
Respect the patient's wishes
Tell the daughter she will need to call the doctor
Report to primary nurse
5. DNR means:
Activate the emergency medial system by calling 911 and start CPR immediately
Patient does not want tube feedings and surgery should be become really ill
The patient does not want to be resuscitated should his heart and breathing stop
Report to primary nurse
Part 9: Patient Rights/or Responsibilities
1. You are at a patient's house and your patient says, "I heard you are also taking care of Mr. Jones down the street. How is he doing?" You reply:
"Oh he complains about hurting all the time since his hip surgery and he can barely get around even with his walker but he is doing ok."
You lie and tell your patient that Mr. Jones is not really your patient
You ignore the patient
You explain to your patient that you are bound by confidentiality law to protect the patients' right to privacy including hers and you cannot say
2. You arrive at a patient's house and she refuses your visit. After several attempts to convince her she gets irritable and still refuses your visit. You should:
Leave and notify your primary care nurse. Complete a missed visit from (notification to physician).
Continue to try to convince her
Do the visit anyway-- she is old and really doesn't know what is good for her
Complete a daily visit note so you can get paid for the visit
3. You are assisting another HCA, Brenda, with a bedbound patient. As you are turning the patient so she can wash his backside, Brenda starts talking about a patient that she has to do next. You should:
Tell her to shut up
Quickly interrupt her and tell her that perhaps now is not a good time to talk about ut
Just ignore her--the patient is probably not listening anyway
4. When doing a HCA visit you should do all the following except
Make sure the shades or curtains are open to let light in so you can see better during their bath
Use a towel of sheet to keep the patient covered
Let the patient do as much as they can
Observe the patient and report anything unusual
5. The patient's son has a big dog who jumps at the fence and barks ferociously at you when you visit the patient. Lately the dog has been in the house and meets you at the front door in the same manner. What do you do?
Go around to the back door
Take a treat for the dog next time you visit
Tell the patient's son to put his dog up when you visit or you won't come to visit his mother anymore
Contact the primary nurse and report the problem
Part 10: Patient Abuse/ Neglect/ Restraints
1. You have been assigned to Mrs. Johnson who is a recent stroke victim. Since the stroke she has left sided weakness and has not been able to talk. She seems to understand what you are telling her and does everything you ask her to do. The daughter has hired someone to help with her care during the day when the daughter is working. After taking care of her for a couple of weeks you notice that every time the care giver comes in the room the patient gets very anxious and upset and appears very frightened. You should:
Call the daughter and let her know what is going on
Notify the primary care nurse and document that you called on your note
Call the doctor for a sedative
Confront the caregiver and ask her why the patient is so scared of her
2. You have a bed/chair bound patient that is confused and disoriented and needs help with almost all of his ADLs. This is the third time this week that you have found him home alone without available food or drink and even if he could use the phone it is in the other room. You should:
Wait until the wife returns and chew her out for leaving him alone
Go onto your next patient when you get through with him
Wait until the wife gets home and say nothing--after all taking care of him is hard work and she needed a break
Notify the primary care nurse and document you called on your note
3. Restraints can be used anytime that the caregiver of family member wants to use them especially if they want the patient to stay put while they do other things such as household chores
True
False
4. A patient keeps on getting up from their wheelchair and the patient's wife says, "Just tie him in the chair with this sheet. He's going to fall down otherwise." What do you do?
Tie the patient in the chair because the wife is the legal guardian
Report the wife to the RN so that the wife can be turned into Adult Protective Services
Call the doctor for an order so that you can get a proper restraint like a Posey vest
All the abobe
None of the above
5. Your patient has bruises on her back one week and she states that she fell. The next week, she has bruises across the back of her thighs and says she fell. You:
Write about the places you observed and your patient's explanations on your note
Call the primary nurse and ask for a safety assessment
Report to the primary nurse and write down your observations and the patient's explanations
Write down on your note, "appears to have been beaten by husband" because you know from case conference that her husband has beater her previously.
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