RN – Annual Skills Fair Test 2023
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RN 2023 - Annual Skills Fair Test

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Comfort Home Care’s Mission is: to provide compassionate and comprehensive mental health care within the comfort and familiarity of our patients' homes. We are dedicated to empowering individuals with psychiatric challenges to achieve their highest level of well-being, independence, and quality of life. Through a personalized and holistic approach, we strive to deliver evidence-based interventions, support, and education to foster healing, recovery, and lasting stability.

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Comfort Home Care’s Vision is to be the premier psychiatric home health agency in Massachusetts. We envision a world where mental health support seamlessly integrates into the daily lives of individuals, erasing stigmas and barriers. By leveraging technology, innovation, and a deep understanding of human psychology, we aim to set new standards in home-based mental health services. Our ultimate aspiration is to create a future where every person has access to exceptional, individualized psychiatric care that respects their dignity, strengthens their connections, and ignites hope for a brighter tomorrow.

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CHC’s patient oriented goals to comply with Joint Commission’s National Patient Safety Goals are to identify patients correctly, use medicatons safely, prevent infection & falls, and identify any patient safety risks.

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It is insurance fraud to submit a signed note that is blank/empty.

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You can directly recruit clients to CHC regardless of actual skilled need.

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The CHC Compliance officer is Jenna Barta.

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You can be fined or sentenced to jail for not reporting abuse/neglect.

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You have to report suspected abuse to your immediate Supervisor prior to filing a report with DPH.

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All patients are instructed of their rights of confidentiality during the Admission process.

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Signed consent for release of information is obtained from the patient at the time of Admission.

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You can still get the current strain of flu if you are vaccinated against it.

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If you got the flu shot last year, you don’t need to get it again this year.

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You do not need to wash your hands after contact with inanimate objects (ie cell phone) or medical equipment.

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When hands are visibly soiled, you cannot use hand sanitizer, you must use soap & water.

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Under the OSHA Act, employers are NOT responsible for providing a safe and healthful workplace.

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According to the National Safety Council, the minimum safe following distance between you and the vehicle in front of you is one second.

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When you are unsure of lifting/moving an object it is best to just go ahead and perform the action.

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Using a wide base of support and your leg muscles while lifting is better than using an unsafe back position.

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CHC does not promote fighting or threatening violence in the workplace.

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Actions, words, jokes or comments based on an individual’s sex, race, ethnicity, age, or religion are acceptable at CHC.

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CHC has a zero-tolerance policy for sexual abuse committed by an employee

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Open toed shoes are acceptable to wear while seeing patients.

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Telling a patient about your divorce is maintaining professional boundaries.

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When professional boundaries are becoming endangered, the clinician should ask for assistance from their supervisor and remove self from the case.

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You can perform a comprehensive medical & psych assessment without using an interpreter if the client does not speak your language.

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If you use family to interpret, you don’t need to document “family use with patient’s permission” in the chart

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A written incident report does not need to be completed if a patient falls.

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After a reported incident with a patient, the clinician should review the current medication regimen and notify the Physician.

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In order to assess the quality of care we provide to our patients, CHC utilizes SHP to send standardized Home Health Consumer Assessment of Health Care Providers and Systems (HHCAHPS) surveys to each patient per Centers for Medicare and Medicaid Services (CMS) guidelines.

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The Massachusetts Substance Abuse Hotline is both free and confidential.

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The Massachusetts Health promotion clearing house provides FREE health promotion materials for Massachusetts residents, health care providers, and social service providers.

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CHC assesses all patients for fall risks.

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If coughing in a patient’s home, you should always cough into your hand.

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A “yellow” surgical mask is sufficient to wear when treating a client with tuberculosis.

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For safety reasons, all CHC employees are not permitted to give clients a ride in their car for any reason.

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In the event that a Clinician feels unsafe in a patient’s home, then they should leave the area immediately and report this to their Supervisor as soon as possible.

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Personal Safety is the freedom from physical harm or threat of physical harm and freedom from hostility, aggression, harassment by anyone in the community or at work. One of the most important rules of personal safety is staying alert and being aware of your surroundings.

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The sequence for removing Personal Protective Equiptment (PPE) is: Gown & Gloves (roll away from body method), Goggles/Face Shield, Mask/Respirator, immediately wash hands.

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You notice that all surfaces in the home are dirty and you lack a barrier to place down, in this case, you could hang your bag on a door knob or work directly from the bag across your body.

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PACE is a Medicare program and Medicaid state option that gives community based care & services, such as adult day care, to people 35 years and older.

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Early diagnosis and treatment of sepsis with IV fluids and antibiotics significantly increases one’s chances of survival.

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Systemic signs of sepsis can include: Fever or chills, bradycardia, & shortness of breath.

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It is not my responsibility to ensure my patients see their community provider.

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For new orders from the ER, Walk-In, Dentist, etc, you should send them to the MD who actually signs the 485 and must write a clinical summary explaining the new additional meds.

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After assessing a patient’s lung sounds, the clinician wipes their stethoscope down with an alcohol wipe and places it in the “clean” side of their bag.

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Clinicians can carry their own glucometers to use on any patient if needed.

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Clinicians can purchase automatic BP cuffs to use on all their patients.

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Advanced directives are assessed to be in place at SOC, implemented when the patient’s physician determines, in writing, that the patient is unable to make their own health care decisions, and documented in the attributes tab.

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You need to complete another white ABN form if you make increase changes to the VFO of your dual eligible Medicaid patient.

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The patients rights are not reviewed with the patient by the admitting clinician & as needed.

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You need to call the MD & document in a quick note when a client falls “outside” of their VFO range. (Ie pt to be seen 5-7 times a week and you only saw them 4 times.)

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When performing a task for a patient, you do not need to document why they cannot do it themselves safely.

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It is okay to only change one thing on your new 485 upon recert and consider that enough of a change.

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In place of case conference forms, you are required to document monthly in the CC/issues problems & plan box, in conjuction with the date of your case conference.

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Immunizations such as flu, pneumo, and shingles are documented in the immunization tab of the chart, not in call logs/quick notes.

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It is okay to use “end of certification” for a goal end date.

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When a goal is met mid certification- you must make a new goal to replace it.

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When oxygen cylinders/canisters are not secured, they should be stored standing upright.

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An order for oxygen use in home requires clinician to note: dose, flow rate, continuous or PRN in EMR & med list in home, as well as thorough assessment every visit.

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It is acceptable to recap a needle only if there is no sharps container within arm’s reach.

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If the patient has the dexterity to do so, they should be the one to remove the insulin pen needle after use and dispose into the sharps container.

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When assessing the intensity of pain, the nurse should offer the client a pain scale to objectify the information.

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The client covered under Medicare, and select few insurances, must be homebound but doesn’t need it documented in each visit.

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Homebound status documentation requires 3 key points in each note; 1. “yes” to homebound, 2. “what the taxing effort is” and 3. “what they require an assist of” (ie cane, walker & 1 person assist, etc)

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Gloves should be worn when performing blood glucose and INR testing.

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If the patient’s finger appears to be clean, there is no need to clean it.

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Before using the Coagu-check, you must be sure the code number on the test strip vial corresponds to the code number displayed.

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Medications and Diagnoses do not need to be reconciled with all providers upon SOC and ROC.

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This is the correct way to write a medication order when the Doctor tells you the patient takes two tabs of Depakote 500mg each AM- “Depakote 1000mg PO every AM”

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It is policy to enter the last dose of ANY/ALL long term injectibles into a quick note.

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The first dose of Risperdal Consta, Invega Sustenna, and Abilify Maintena can be given in the home if the client has never take a PO dose before.

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If I am not changing the dressing, I don’t need to document anything about the wound.

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ALL wounds are reported to the Education Team upon discovery & measured weekly in centimeters, using the head to toe for length, and hip to hip for width-technique, LxWxD, and documented in your notes.

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If you wear gloves while cleaning up bodily fluids, you should still wash your hands afterwards.

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Bloodborne pathogens are disease causing microorganisms that are present in human blood and body fluids that may contain blood.

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Healthcare workers who received the Hepatitis B vaccine and develop immunity are at no risk for infection.

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Bloodborne pathogens can be transmitted through food or water.

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If you are exposed to bodily fluid, the first thing you should do is wash the area thoroughly.

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It is not important to report any exposure immediately after occurrence.

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You should never attempt to wash or disinfect used disposable gloves, even if you think no exposure has occurred.

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You can catch a bloodborne disease if an infected material splashes into your eyes.

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The Hepatitis B virus can survive on environmental surfaces for at least one week.

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Universal precautions require you to treat all bodily fluids as if they were not infected by bloodborne pathogens.

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By November of 2017, all home-health agencies are required by CMS (Centers for Medicare & Medicaid Services) to implement emergency preparedness; one of those requirements includes a communications plan to maintain contact with staff and patients.

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It is safe practice to have an emergency/disaster kit in your own home which would contain items such as bottled water, non-perishable food rations, first aid supplies, whistle and flashlights.

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The Incident Commander will activate CHC emergency procedures If needed.

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We have a disaster practice plan that includes prioritization of our patients based on severity of their needs/conditions for the purpose of visits during an emergency or disaster.

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I am not responsible for my patients in a disaster and if they were to evacuate, I don’t need to know where they would go.

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Overloaded electrical outlets, lit candles, patients playing with matches, and unattended lit cigarettes are all potential fire hazards.

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Every patient needs to be evaluated upon each OASIS for emergency preparedness and requires 4 more questions to be answered, to assess priority, evacuation, transportation and any special needs

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I do not need to report off to my supervisor or on call after I worked a shift.

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Making a phone call to a family member during a mass crisis by way of a natural, biological, chemical, or civil disturbance is more reliable than texting.

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Resources such as: www.redcross.org, www.ready.gov, www.mass211.org, www.smart911.com  & www.fema.gov are disaster assistance organizations available to me and my family as well as my patients.

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It is ok to perform a SOC, ROC, Recert, or D/C assessment while the patient is sitting down. 
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Star Ratings are calculated based on the patients’ outcomes.
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An Ostomy is considered a Surgical Wound
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It is acceptable to routinely select “Refused” for the GG item questions.

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An intercepted fall is considered a fall.
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When you arrive to a patient’s home, the patient states that he is taking all his medications independently, but the 2 newly prescribed meds are written down for him by a family member. His score for Management of all oral meds would be: 0- Independent

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M1800 is looking at patients ABILITY to perform Grooming (washing face, shaving, fingernail care, teeth).

You are admitting a pt who has schizophrenia with impaired judgement/confusion at times. He has greasy hair, stubble on face, and dirty fingernails.  He states that he grooms self “sometimes” and admits that he hasn’t in the past few days.   Based on your assessment, the currently ability to tend safely to personal hygiene needs is at least a: 2- Someone must assist pt to groom self.

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When assessing a patients ADL/IADL’s, it is important to consider not what the patient is doing, but what they would need to do to be safe.  For example, an elderly patient lives alone, and has an unsteady gait.  She showers independently every day without a shower chair.   She should be coded at least a: 2- Able to Shower with intermittent assistance of another person.
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You receive a referral from a psychiatric facility to admit a pt. who has Dx of significant depressive disorder.  When you arrive to the pt. home, you note that the pt is taking medications for medical disorders as well.  It is ok to only focus on the psych dx, as we were not referred for a medical disorder.
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A patient is admitted with a surgical wound that is approximated by staples.  When answering M1342, the status of the most problematic surgical wound, you should select: 2- early/partial granulation.      
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The Confusion Assessment Method (CAM) is not a standardized, evidence-based tool that enables clinicians to identify and recognize delirium.

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The Brief Interview of Mental Status (BIMS) should be conducted with all patients.

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In the CAM, Inattention, Disorganized Thinking, and Altered level of consciousness are assessed

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When Medications are reconciled, it is important to not only identify what high risk meds that the pt is taking, but also whether the indication for the med is noted in the record

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When answering the BIMS question, the patient states, “I’m tired and don’t want to do this anymore”. How should you code?

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Your score is