Question 1

The nurse is providing discharge instruction to an 80-year-old patient and her daughter.The patient lives in a two-story home.When asked if the patient has difficulty climbing stairs,the patient says "No," but the nurse notices a look of surprise on the daughter's face.What should the nurse do in this circumstance?

Accepted Answer

Patients and family members often disagree on the health care needs of a patient after discharge.Identifying these discrepancies early leads to more accurate development of the discharge plan.It is often necessary to talk with the patient and family separately to learn about their true concerns or doubts.

Question 2

Once a patient's discharge has been completed,which activity may be delegated to assistive personnel?

Accepted Answer

The assessment,care planning,and instruction included in discharging patients cannot be delegated to nursing assistive personnel.The nurse may direct the NAP to gather and secure the patient's personal items and any supplies that accompany the patient.

Question 3

During admission of a patient,the nurse notes that the patient speaks another language and may have difficulty understanding English.What should the nurse do to facilitate communication?

Accepted Answer

If the patient does not speak English or has a severe hearing impairment,the clerk must have access to an interpreter to assist during the admission procedure.Translation services are preferable to using family members to ensure correct translation of medical terminology.Hand gestures and simple phrases may not be adequate for everything that will be discussed at the time of admission.

Question 4

The patient is scheduled to go home after having coronary angioplasty.What would be the most effective way to provide discharge teaching to this patient?

Accepted Answer

For discharge teaching,use a combination of verbal and written information.This most effectively provides patients with standardized care information,which has been shown to improve patient knowledge and satisfaction.

Question 5

The patient is admitted to the unit for a cardiac catheterization.Which of the following can be delegated to nursing assistive personnel (NAP)? (Select all that apply. )

Accepted Answer

The nursing assessment conducted during admission to a health care facility cannot be delegated to NAP.You cannot delegate admission vital signs as they provide a baseline for all further comparisons.The nurse directs NAP to (1)prepare the patient's room with necessary equipment before admission; (2)gather and secure the patient's personal care items; (3)escort and orient the patient and family to the nursing unit;and (4)collect ordered specimens.

Question 6

The phase of the discharge process where medical attention dominates discharge planning efforts is known as the _____ phase.

Accepted Answer

The discharge process occurs in three phases: acute,transitional,and continuing care.In the acute phase,medical attention dominates discharge planning efforts.During the transitional phase,the need for acute care is still present,but its urgency declines and patients begin to address and plan for their future health care needs.In the continuing care phase,patients participate in planning and implementing continuing care activities needed after discharge.There is no multidisciplinary stage;the discharge planning process is comprehensive and multidisciplinary.

Question 7

The patient is being transferred from the intensive care unit to the acute care unit.The nurse must ensure that the following activities are completed: (Select all that apply. )

Accepted Answer

When providing a "hand-off" of a patient to another unit,it is essential that information about the patient's care,treatment,services,and current condition and any recent or anticipated changes are communicated accurately to meet patient safety goals.The nurse first provides a telephone report to the receiving nurse.This allows the receiving nurse to prepare for the patient (e.g. ,preparing the room,securing necessary equipment).As clinically appropriate,a nurse or technician accompanies the patient during transport,providing the receiving nurse with the patient's medical record;introducing the patient to the receiving nurse;and providing an updated report,including any changes in clinical status or plan of care.

Question 8

The patient has been admitted to the emergency department after being beaten and raped.She is agitated and is frightened that her attacker may find her in the hospital and try to kill her.What should the nurse tell her?

Accepted Answer

A patient who has been a victim of crime can be admitted anonymously under an agency's "blackout" or "do not publish" procedure.HIPAA places limits on the institution's ability to use or disclose the patient's PHI.The Patient Self-Determination Act prohibits the hospital from requiring her to submit to an examination.

Question 9

Which of the following are considered "advance directives"? (Select all that apply. )

Accepted Answer

Advance directives may include a living will,power of attorney for health care,or a notarized handwritten document.

Question 10

At what age is separation anxiety a common problem?

Accepted Answer

Separation anxiety is most common from middle infancy throughout the toddler years,especially from ages 16 to 30 months.Preschoolers are better able to tolerate brief periods of separation,but their protest behaviors are more subtle than those of younger children (e.g. ,refusal to eat,difficulty sleeping,withdrawing from others).School-aged children are able to cope with separation but have an increased need for parental security and guidance.

Question 11

The patient is being transferred from the emergency department to another institution for treatment.Which of the following cannot be delegated to nursing assistive personnel (NAP)?

Accepted Answer

The assessment and decision making conducted during transfers cannot be delegated to nursing assistive personnel.NAP can assist the patient with dressing,can gather and secure the patient's personal belongings and any necessary equipment,and can escort the patient to the nursing unit or transport area.

Question 12

The nurse is admitting the patient to the medical unit.The patient indicates that he has had several surgeries in the past and has been a diabetic for the past 15 years.He also stated that he is allergic to Morphine.What does this information prompt the nurse to do next?

Accepted Answer

Provide the patient with an allergy armband listing allergies to foods,drugs,latex,or other substances;document allergies according to hospital policy.Postpone routine admission procedures only if the patient is having acute physical problems.Smoking is prohibited throughout the hospital,and family or friends can remain if the patient wishes to have them assist with changing into a hospital gown or pajamas.

Question 13

An unconscious patient is admitted through the emergency department.How and when is identification of the patient made?

Accepted Answer

If a patient is unconscious,identification often is not made until family members arrive.Delaying treatment can cause deterioration of the patient's condition.Blackout procedures are intended mainly to protect crime victims.

Question 14

While preparing for the patient's discharge,the nurse uses a discharge planning checklist and notes that the patient is concerned about going home because she has to depend on her family for care.The nurse realizes that successful recovery at home is often based on:

Accepted Answer

Discharge from an agency is stressful for a patient and family.Before a patient is discharged,the patient and family need to know how to manage care in the home and what to expect with regard to any continuing physical problems.Family caregiving is a highly stressful experience.Family members who are not properly prepared for caregiving are frequently overwhelmed by patient needs,which can lead to unnecessary hospital readmissions.

Question 15

The patient arrives in the emergency department complaining of severe abdominal pain and vomiting,and is severely dehydrated.The physician orders IV fluids for the dehydration and an IV antiemetic for the patient.However,the patient states that she is fearful of needles and adamantly refuses to have an IV started.The nurse explains the importance of and rationale for the ordered treatment,but the patient continues to refuse.What should the nurse do?

Accepted Answer

The Patient Self-Determination Act,effective December 1,1991,requires all Medicare- and Medicaid-recipient hospitals to provide patients with information about their right to accept or reject medical treatment.The patient has the right to refuse treatment.Refusal should be documented and the health care provider consulted about alternate treatment.

Question 16

The patient is admitted to the ICU after having been in a motor vehicle accident.He was intubated in the emergency department and needs to receive two units of packed red blood cells.He is conscious but is indicating that he is in pain by guarding his abdomen.To admit this patient,the nurse first will focus on:

Accepted Answer

When a critically ill patient reaches a hospital's nursing division,the patient immediately undergoes extensive examination and treatment procedures.Little time is available for the nurse to orient the patient and family to the division,or to learn of their fears or concerns.

Question 17

The patient has decided that he would like to create an advance directive.The nurse is asked if she would be a witness.What is the best response for the nurse to make to this request?

Accepted Answer

A social worker often fulfills this requirement.Witnesses for an advance directive document should not be medical personnel,and direct refusal does not meet the nurse's obligation to meet the patient's needs.Referral to a department that can ensure this service is required.

Question 18

The patient is being admitted to the intensive care department with multiple fractures and internal bleeding.Which of the following are considered roles of the nurse in this situation? (Select all that apply. )

Accepted Answer

The nurse identifies patients' ongoing health care needs;anticipates physical,psychological,and social deficits that have implications for resuming normal activities;involves family and significant others in a plan of care;provides health education;and assists in making health care resources available to the patient.Separating the processes of admission and discharge is a critical error;the two are simultaneous and continuous.

Question 19

When does the plan for patient discharge from a health care facility begin?

Accepted Answer

Planning for discharge begins at admission and continues throughout the patient's stay in the agency.Separating the processes of admission and discharge is a critical error;the two are simultaneous and continuous.

Question 20

Under the Health Insurance Portability and Accountability Act (HIPAA),a patient must: (Select all that apply. )

Accepted Answer

HIPAA is a federal law designed to protect the privacy of patient health information,referred to as PHI,or protected health information.Three key concepts of HIPAA are (1)institutions are required to inform patients of the privacy rights they have and how the institution will handle their PHI; (2)the institution and health care providers are to use or disclose the patient's PHI only for the purpose of treatment or payment or for health care operations;and (3)health care providers disclose only the minimum amount of PHI necessary on a need-to-know basis to accomplish the purpose of the use.

Quiz 2: Admitting, Transfer, and Discharge