Chapter 9: Discharge Planning

Why is it important for the home health nurse to inform the health care agency of the nurses' daily itinerary?

-Supports suggested safety precautions for the nurse when making a home care visit

A client is admitted to the acute care facility for the treatment of pneumonia. What exemplifies the nurse-managed care approach?

-The case manager identifies dates when oxygen should be discontinued, bronchodilators changed to self-administered inhalers, and antibiotics changed from intravenous to oral treatment.

A client is receiving home health services after having a stroke and being hospitalized. After a thorough assessment of the home environment and the client, what would indicate to the nurse that there is an alteration in the client's home management?

-The client's caregiver is absent whenever the nurse visits and the client is alone.

The nurse is preparing to begin the discharge planning process with a client whose pulmonary embolism has recently resolved. Which factor should the nurse prioritize during this process?

-The client's identified needs and goals

A patient is being transferred from the ICU to a regular hospital room. What must the ICU nurse be prepared to do as part of this transfer? *a.* Provide a verbal report to the nurse on the new unit. *b.* Provide a detailed written report to the unit secretary. *c.* Delegate the responsibility for providing information. *d.* Make a copy of the patient's medical record.

-A

A discharge nurse is evaluating patients and their families to determine the need for a formal discharge plan and/or referrals to another agency. Which patients would most likely be a candidate for these services? Select all that apply. *a.* An older patient who is diagnosed with dementia in the hospital *b.* A 45-year-old male who is diagnosed with Parkinson's disease *c.* A 35-year-old female who is receiving chemotherapy for breast cancer *d.* A 16-year-old who is being discharged with a cast on his leg *e.* A new mother who delivered a healthy infant via a cesarean birth *f.* A 59-year-old male who is diagnosed with end-stage bladder cancer

-A,B,F

A nurse decides to become a home health care nurse. Which personal qualities are key to being successful as a community-based nurse? Select all that apply. *a.* Making accurate assessments *b.* Researching new treatments for chronic diseases *c.* Communicating effectively *d.* Delegating tasks appropriately *e.* Performing clinical skills effectively *f.* Making independent decisions

-A,C,E,F

The nurse is admitting a client to the acute care facility. What actions by the nurse will assist in establishing an effective nurse-client relationship? Select all that apply.

-Anticipating the client's anxiety and response to strangers -Determining the client's problems and expectations after discharge -Assisting family members with the transition to hospitalization

Which statements or questions would be appropriate in establishing a discharge plan for a patient who has had major abdominal surgery? *a.* "I'll bet you will be so glad to be home in your own bed." *b.* "What are your expectations for recovery from your surgery?" *c.* "Be sure and take your pain medications and change your dressing." *d.* "You will just be fine! Please stop worrying."

-B

A nurse who is a discharge planner in a large metropolitan hospital is preparing a discharge plan for a patient after a kidney transplant. Which actions would this nurse typically perform to ensure continuity of care as the patient moves from acute care to home care? Select all that apply. *a.* Performing an admission health assessment *b.* Evaluating the nursing plan for effectiveness of care *c.* Participating in the transfer of the patient to the postoperative care unit *d.* Making referrals to appropriate agencies *e.* Maintaining records of patient satisfaction with services *f.* Assessing the strengths and limitations of the patient and family

-B,D,F

A nurse is preparing an infant and his family for a hernia repair to be performed in an ambulatory care facility. What is the primary role of the nurse during the admission process? *a.* Assist with screening tests. *b.* Provide patient teaching. *c.* Assess what has been done and what still needs to be done. *d.* Assist with hernia repair.

-C

A home health care nurse is scheduled to visit a 38-year-old female client who has been discharged from the hospital with a new colostomy. Which duties would the nurse perform for this patient in the entry phase of the home visit? Select all that apply. *a.* Collect information about the patient's diagnosis, surgery, and treatments. *b.* Call the patient to make initial contact and schedule a visit. *c.* Develop rapport with the patient and her family. *d.* Assess the patient to identify her needs. *e.* Assess the physical environment of the home. *f.* Evaluate safety issues including the neighborhood in which she lives.

-C,D,E

A hospital nurse is admitting a patient who sustained a head injury in a motor vehicle accident. Which activities could the nurse delegate to licensed assistive personnel? *a.* Collecting information for a health history *b.* Performing a physical assessment *c.* Contacting the physician for medical orders *d.* Preparing the bed and collecting needed supplies

-D

A nurse ensures that a hospital room prepared by an aide is ready for a new ambulatory patient. Which condition would the nurse ask the aide to correct? *a.* The bed linens are folded back. *b.* A hospital gown is on the bed. *c.* Equipment for taking vital signs is in the room. *d.* The bed is in the highest position.

-D

A nurse is counseling an older female patient hospitalized for dehydration secondary to a urinary tract infection. The patient tells the nurse: "I don't like being in the hospital. There are too many bad bugs in here. I'll probably go home sicker than I came in." She also insists that she is going to get dressed and go home. She has the capacity to make these decisions. What is the legal responsibility of the nurse in this situation? *a.* To inform the patient that only the primary health care provider can authorize discharge from a hospital *b.* To collect the patient's belongings and prepare the paperwork for the patient's discharge *c.* To request a psych consult for the patient and inform her primary care provider of the results *d.* To explain that the choice carries a risk for increased complications and make sure that the patient has signed a release form

-D

The nurse is assigned to care for a middle-aged client who is very agitated and wants to go home. The client states that he does not have time to waste in the hospital, and no one is doing anything anyway. Which action by the nurse is most appropriate if the client insists on leaving the hospital against medical advice (AMA)?

-Have the client sign the AMA form.

The nurse is planning discharge of the client who had surgery for a left hip replacement. The client is being discharged from the hospital to the home and requires home medical services. Which item would be provided by home medical services?

-High-rise toilet seat

The client is being discharged to the home setting following a stroke. The client requires assistance in relearning how to cook safely. To which of the following home health care team members would the nurse refer the client?

-Occupational therapist

Which type of home healthcare agency is a local health department?

-Official or public agency

The home care nurse is providing care and education to a woman who is pregnant with her first child. The client states, "I have no money or food. I don't know what I should do. I want to provide for my unborn child." The nurse refers the woman to the WIC program and a local food bank. This is an example of what aspect of community-based nursing?

-Planning

When initiating home health care services, during which phase is it appropriate for the home health nurse to implement the initial client assessment?

-Pre-entry phase >Initial assessment is conducted by the nurse during the pre-entry and entry phases of the home visit. The referral phase involves the physician or discharge planner of a hospital contacting the home health care agency with the indications for the referral. The initiation phase consists of clarifying the source of referral and the purpose of the visit, as well as the initial contact with the family. Determining the need for further visits occurs during the termination phase.

The nurse is providing care to a homeless client who presents to the emergency department with a foot wound. Which is the priority nursing intervention prior to discharge?

-Refer the client to social services for assistance.

A client visits the health care facility, where the nurse provides primary health care. Which service would the nurse most likely provide?

-Screening >Screening falls within the category of primary health care. Acute care and treatment are a part of secondary healthcare. Rehabilitation falls under tertiary health care.

An 82-year-old woman is being discharged from the hospital following a bowel resection. The woman lives alone and her family is out of town. Which factor will have the greatest effect on her home care management?

-Support Systems

Complex Discharge

-The discharge plan is more complex. This level of discharge plan involves interdisciplinary collaboration and coordination. The discharge planner takes responsibility for coordinating the activities necessary to transfer the client from one setting to another. Because the client had a caregiver prior to discharge and is now experiencing a change in functioning, the client and the client's daughter will need additional resources. A simple discharge is a discharge to one facility such as a home or apartment. A discharge plan has the necessary instructions the client is supposed to adhere to after discharge. These may include medications, weight bearing or lifting, and follow up appointment and care. Nursing home discharge is when a client is discharged to a nursing home. The discharge has a discharge plan that is sent to the nursing home.

Which of the following members of the care team is most often responsible for providing the order that will begin a patient's course of home healthcare?

-The physician

A nurse is covering all aspects of admission procedures for a client who is receiving home health services. The nurse explains what procedures will be covered during his visits. Which aspect of the admission process does this represent?

-clearly defining the purpose and expectations of the admission

A 16-year-old girl has been injured in an accident and is receiving home care due to fractures and multiple trauma-related injuries. She states, "I don't know why I survived and not my best friend." It is most important to:

-communicate her feelings to family and friends.

After teaching a class of nursing students about home health care, the nursing instructor determines that the education was successful when the class identifies what as a goal of home health care?

-functioning within limitations

Community-based health care is best defined as:

-health care developed in partnership with communities.

The nurse is caring for a client who will benefit from home health care services. In preparing for discharge, the nurse is aware that home health care can only be initiated if the:

-physician writes an order for home care.

Prior to the client's discharge from an acute care facility, the nursing case manager has the nursing staff, client, client's family, physical therapist, and home health nurse meet. The purpose of this is to:

-prepare the client for home care.

In preparation for discharge, the nurse is reviewing information related to new dietary guidelines with the client. This is an example of which step in discharge planning?

-providing client education

When a client is admitted to the hospital, admissions personnel are required to determine if the client has a document indicating advanced directives. If so, a copy is made for the client's medical record. The advanced directive document indicates:

-that the client has made his wishes for terminal care known.

The nurse completes the admission assessment. As part of the admission database, what will the nurse determine and record regarding functional abilities? Select all that apply.

-whether the client wears eyeglasses -the client's ability to ambulate -the client's comprehension