NURS: Ch 9 NCLEX
Which of the following hospital patients would likely need a formal discharge plan and referral to another agency? (Select all that apply) a) A patient who received a kidney transplant b) A patient who had a cholecystectomy (gallbladder removal) c) A patient whose sepsis required 3 weeks of care in the intensive care unit. d) A patient who is being discharged with a stage II pressure ulcer e) A patient who has been recently diagnosed with diabetes
a) A patient who received a kidney transplant c) A patient whose sepsis required 3 weeks of care in the intensive care unit. d) A patient who is being discharged with a stage II pressure ulcer e) A patient who has been recently diagnosed with diabetes Patients who have experienced major surgery or extensive hospital treatment or who have a recent diagnosis of a chronic condition require written discharge planning and likely a referral. Similarly, a patient whose wound will require care in the community will require these measures. Patients who have had a less major surgery, such as cholecystectomy, are less likely to have these requirements.
What role will the nurse have when admitting a patient to a hospital for outpatient surgery that will result in discharge the same day? a) Complete regular admission procedures b) Prepare for long-term care needs c) Provide detailed information on the procedure d) Schedule the patient for screening tests
a) Complete regular admission procedures Patients entering the hospital setting for outpatient surgery have regular admission procedures conducted by the nurse. Scheduling of screening tests and initial teaching is completed in the days prior to the surgery. Same-day surgery and discharge may require community-based follow-up, but it generally does not require long-term care. Detailed information on the procedure will be provided by the physician performing the procedure.
What role will the nurse play in transferring a patient to a long-term care facility? a) Provide a verbal report to the nurse at the long-term care facility on the patient, the hospital care, and the patient's current condition. b) Inform that patient that transferring should be a stress-free situation. c) Arrange for the patient's belongings to remain at the hospital until discharge from the long-term care facility. d) Assure that the patient's original chart accompanies the patient.
a) Provide a verbal report to the nurse at the long-term care facility on the patient, the hospital care, and the patient's current condition. The nurse at the hospital will provide a verbal report to the nurse at the long-term facility. The patient's belongings will accompany the patient to the long-term facility, and the nurse should assure that the belongings are sent with the patient. The original chart will not accompany the patient, but copies of the chart or sections of the chart may be sent based upon agency protocols. The nurse should also recognize and inform the patient that while a transfer may be a welcome event, it also can be stressful.
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) Provide a verbal report to the nurse on the new unit. The ICU nurse gives a verbal report about the patient's condition and nursing care needs to the nurse on the new unit. This information is not given to a unit secretary, nor is it delegated to others. the medical record is transferred with the patient; a copy is not made.
The Joint Commission has established standards for admission to a hospital dictating that: (select all that apply) a) every patient should be assessed thoroughly by a registered nurse upon admission. b) the admission process may be safely delegated to unlicensed care providers. c) high-acuity patients must be admitted to a single-bed room. d) a physician must perform a physical assessment of a patient within 3 hours of admission.
a) every patient should be assessed thoroughly by a registered nurse upon admission. b) the admission process may be safely delegated to unlicensed care providers. The Joint Commission has established standards for hospital admission stating that each patient must be assessed by and RN upon admission. This initial assessment cannot safely be delegated. Patients are frequently required to share rooms, even when their acuity is high, and a physician does not necessarily perform a physical assessment after each patient's admission.
What is the primary purpose of the identification bracelet worn by hospitalized patients? a) safety b) communication c) advocacy d) legality
a) safety The identification bracelet is a safety measure ensuring that the correct patient is given medications, has surgery, and so forth.
Which of the following 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) "What are your expectations for recovery from your surgery?" It is important to assess the expectations of the patient (and family) when assessing healthcare needs for discharge planning.
Which of the following nursing actions is the clearest example of a nurse applying the principles of community-based care? a) A nurse organizes a blood pressure screening clinic at a busy shopping mall. b) A nurse provides wound care for a patient's venous ulcer at an ambulatory clinic near the patient's home. c) A nurse cares for a high-risk pregnant patient from a rural area at a tertiary care hospital that is in a large, urban center. d) A nurse educates high school students on safer sex practices at a series of inschool workshops.
b) A nurse provides wound care for a patient's venous ulcer at an ambulatory clinic near the patient's home. A central component of community-based care is providing care for acute and chronic illnesses in the geographic region near the patient's home. Blood pressure screening and health-maintenance education are population-based and community health initiatives that are distinct from community-based care.
In preparing for a patient's admission to the unit, what is the nurse's responsibility? a) Ensuring that all staff caring for the patient are in the patient's room when he/she arrives onto the unit. b) Ensuring that room preparation responsibilities that may have been delegated to ancillary staff have been completed c) Greeting the patient in the emergency room or admitting office d) Delegating the admission assessment to a nursing assistant
b) Ensuring that room preparation responsibilities that may have been delegated to ancillary staff have been completed Although the nurse might delegate most of the activities in preparing the room for admission, it is the nurse's responsibility to ensure that the other personnel complete the preparation. It is not necessary for all care staff to be present when the patient arrives and, in fact, it might be quite overwhelming to the patient to have them all present. The nurse will greet the patient and family members upon their arrival to the unit. An admission assessment is the responsibility of the nurse, not a nursing assistant, who is not educated to perform the skill.
A patient has been admitted to the hospital the morning of his scheduled transurethral prostatic resection (TUPR). The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires the care team to do which of the following upon the patient's admission? a) Explain the potential risks and benefits of the patient's scheduled surgery and have him sign a document acknowledging these. b) Explain how the patient's health information will be protected and obtain his signature acknowledging this teaching. c) Teach the patient what measures are taken to ensure that all members of the care team are accountable for the care they provide. d) Explain to the patient that his choice of health insurance provider and level of coverage will not impact the care he receives.
b) Explain how the patient's health information will be protected and obtain his signature acknowledging this teaching. HIPAA requires that all patients entering a healthcare setting of any type must sign a statement that they understand the protection of their medical information. The informed consent process is not within the scope of HIPAA and the care team is not obliged to explain the specific measures taken to foster accountability for practice. Variations in health insurance coverage are known to have tangible effects on the care that patients receive.
The nurse is preparing for the admission of a patient on a stretcher. In what position should the nurse place the bed? a) Middle position b) Highest position c) Lowest position d) High-Fowler's position
b) Highest position Place the bed in the highest position, if the patient will arrive on a stretcher. For ambulatory patients, the bed should be in the lowest position. The High-Fowler's position is often used for patients with respiratory difficulties.
In preparation for discharge, the nurse is reviewing information related to new dietary guidelines with the patient. This is an example of which step in discharge planning? a) Making home healthcare referrals b) Providing patient teaching c) Developing goals with the patient d) Assessing the patient's needs and identifying problems
b) Providing patient teaching The nurse is teaching the patient important information about self-care at home prior to the patient's discharge. The initial step in discharge planning is collecting and organizing data about the patient, as this provides information on the patient's healthcare needs. Home referrals may be made after the teaching process, based upon orders provided by the physician. Developing goals may occur after the teaching process, as the goals need to be realistic.
The nurse recognizes that discharge planning begins upon admission and the initial step in discharge planning is: a) providing home healthcare referrals b) collecting and organizing data about the patient c) establishing goals with the patient d) teaching the patient self-care activities that are to be conducted in the home setting
b) collecting and organizing data about the patient The initial step in discharge planning is collecting and organizing data about the patient, as this provides information on the patient's healthcare needs. Establishing goals, patient teaching, and providing home healthcare referrals are steps that will follow the collection and organization of data.
In anticipation of discharge, a nurse is teaching the daughter of an elderly patient how to change the dressing on her mother's venous ulcer. Which of the following teaching strategies is most likely to be effective? a) Provide explicit written and verbal instructions and ask the daughter to explain back to the nurse how she would perform the dressing change. b) Explain the procedure clearly and slowly while providing multiple opportunities for the daughter to ask questions. c) Demonstrate and explain the procedure and then have the daughter perform it. d) Use a multimedia strategy that combines animation with narration.
c) Demonstrate and explain the procedure and then have the daughter perform it. All steps of a procedure such as a dressing change should be demonstrated, practiced, and provided in writing. The patient or caregiver should then perform the procedure or treatment in the presence of the nurse to demonstrate his or her understanding and ability to carry out the procedure. This is more likely to facilitate success than providing a passive multimedia resource, explaining, or providing written instructions alone without reciprocal demonstration.
A nurse who provides care on a postsurgical unit is performing discharge teaching as a component of her effort to ensure continuity of care. Which of the following is the primary goal of continuity of care? a) Controlling costs and maximizing patient outcomes after discharge from hospital b) Increasing patients' knowledge base and health maintenance behaviors c) Ensuring a smooth and safe transition between different healthcare settings d) Minimizing nurses' legal liability during patient transitions between healthcare institutions.
c) Ensuring a smooth and safe transition between different healthcare settings Continuity of care exists primarily to ensure smooth, safe transitions so that patients may maximize recovery and health. Nurses build patients' knowledge bases in order to achieve this goal. Minimizing nurse liability and healthcare costs are not key justifications for continuity of care.
Which of the following phrases best describes the philosophy of community-based care? a) It considers the healthcare needs of the community as a whole. b) It centers on individuals and families with acute and chronic illness needs. c) It has a population-based focus, with an emphasis on illness prevention. d) It provides direction for the roles of the nurse in the acute care setting.
c) It has a population-based focus, with an emphasis on illness prevention. Making appropriate referrals for patients as they move from acute care to home care is an essential component of discharge planning for continuity of care.
A patient informs the nurse that he is interested in attending a weight loss support group prior to his discharge from treatment for a myocardial infarction. In preparing a care plan for this patient, an appropriate nursing diagnosis would include which of the following? a) Imbalanced Nutrition: Less Than Body Requirements b) Ineffective Denial c) Readiness for Enhanced Therapeutic Regimen Management d) Health-seeking Behaviors
c) Readiness for Enhanced Therapeutic Regimen Management Based on the patient's desire to lose weight and comply with the therapeutic regimen for myocardial infarction, and appropriate nursing diagnosis for this patient is Readiness for Enhanced Therapeutic Regimen Management. Health-seeking Behaviors, Ineffective Denial, and Imbalanced Nutrition: Less Than Body Requirements are not appropriate nursing diagnoses based upon the patient's desire to improve his nutritional intake and weight.
The Patient Care Partnership form, given to patients on admission to the hospital, includes several specific rights during hospitalization. Which of the following is included in this form? a) The right to wear one's own bed clothing. b) The right to use a personal cell phone. c) The right to have help when leaving the hospital. d) The right to take medications brought from home.
c) The right to have help when leaving the hospital. One item on the Patient Care Partnership form is the right to have help when leaving the hospital.
A patient who decides to leave the hospital against medical advice (AMA) must sign a form. What is the purpose of this form? a) To indicate the patient's wishes. b) To use in the event of readmission. c) To release the physician and hospital from legal responsibility for the patient's health status. d) To ethically illustrate that the patient has control of his or her own care and treatment.
c) To release the physician and hospital from legal responsibility for the patient's health status. Patients who leave the hospital AMA sign a form releasing the physician and hospital from legal responsibility for their health status. This signed form becomes part of the medical record.
Based on the Health Insurance Portability and Accountability Act (HIPAA), a patient admitted to a healthcare facility must be provided with a written explanation of: a) the names and addresses of responsible providers b) a Patient's Bill of Rights c) how health information will be used and disclosed d) how often family members or friends may visit or call
c) how health information will be used and disclosed HIPAA ensures privacy of information use and disclosure.
A nurse is the discharge planner at a large metropolitan hospital. What would the nurse do to ensure continuity of care as patients move from acute care to home care? a) perform an admission health assessment b) participate in the transfer of patients to the ICU c) make referrals to appropriate agencies d) maintain records of patient satisfaction with services
c) make referrals to appropriate agencies Making appropriate referrals for patients as they move from acute care to home care is an essential component of discharge planning for continuity of care.
The nurse recognizes that the goals established for a patient's discharge are more likely to be accomplished when: a) the multidisciplinary team develops the goals b) the nurse develops the goals c) the patient assists in developing the goals d)the physician develops the goals
c) the patient assists in developing the goals If the patient is involved in establishing the goals, it is more likely that the expected outcomes of the discharge plan will be met. The patient may fail to follow the plan if the goals are not mutually agreed on or are not based on a complete assessment of the patient's needs.
Which of the following circumstances likely requires the most documentation and communication on the part of the nurse? a) A patient is returning to her assisted-living facility following her colonoscopy earlier that day. b) A patient is being discharged home following a laparoscopic appendectomy 2 days earlier. c) A patient is being transferred from one medical unit of the hospital to another in order to accommodate a patient on isolation precautions. d) A geriatric patient is being transferred from a subacute medical unit to a new long-term care facility following his recovery from pneumonia.
d) A geriatric patient is being transferred from a subacute medical unit to a new long-term care facility following his recovery from pneumonia. Transfer from the hospital setting to a long-term care facility is likely to require significant documentation and communication from the nurses facilitating the transfer. This may include copying the chart or summarizing a large amount of relevant data. Transfers within a hospital typically require somewhat less documentation and communication while discharges home or to an existing facility may not require a formal report of any type.
Mr. Grewal's health maintenance organization (HMO) dictates a fixed, prospective reimbursement to the hospital that will perform his pending hip replacement surgery. This structure of payment may contribute to which of the following? a) Decreased need for home healthcare b) Increased intensity of rehabilitation while in hospital c) Continuity of care d) A shortened length of stay in hospital
d) A shortened length of stay in hospital Prospective reimbursement is a practice that has been identified as a contributor to decreased lengths of hospital stays and a consequent increase in the need for home healthcare. This phenomenon increases the patient's need for continuity of care, but it does not promote the practice in and of itself. Prospective reimbursement does not necessarily result in more intense rehabilitation while the patient is in the hospital.
Which statement best describes community-based care? a) It requires coordination by a physician or healthcare corporation. b) It is population-based and focuses on the health of the community. c) It focuses on the care of an individual in the hospital setting. d) It centers on individual and family healthcare needs.
d) It centers on individual and family healthcare needs. Community-based care is centered on individual and family healthcare needs and is provided to people who live within a defined geographic area. In contrast, community health and public health nursing are population-based and focus on the health of the community. Community-based care considers the continuity of care as an individual moves from one level or setting to another, and the nurse is often the primary person responsible for communicating the patient's needs, teaching self-care, and providing the care.
At what point during a hospital stay should discharge planning be initiated? a) After surgery and successful recovery. b) After the patient is less anxious. c) Immediately before discharge. d) On admission to the acute care setting.
d) On admission to the acute care setting. Effective discharge planning begins on admission.
A postmastectomy patient is due to come up to postsurgical care unit from postanesthetic recovery. Which of the following nursing actions should the nurse prioritize when attempting to establish an effective relationship with her? a) Assess the patient's knowledge of her activity limitations. b) Explain and answer questions about the Health Insurance Protability and Accountability Act (HIPAA). c) Address the patient's potential learning needs. d) Recognize and address the patient's anxiety.
d) Recognize and address the patient's anxiety. An early priority when admitting a patient to a unit and establishing a relationship is to recognize and take steps to reduce the patient's anxiety. Assessing and addressing the patient's learning needs are important goals but should be addressed after the patient has been settled on the unit. HIPAA should have been explained to the patient earlier in her admission.
The nurse is preparing to begin the discharge planning process with a patient whose pulmonary embolism has recently resolved. Which of the following factors should the nurse prioritize during this process? a) The nurse's knowledge base and experience level b) The patient's potential for recurrence c) The NANDA diagnoses relevant to the patient's condition d) The patient's identified needs and goals
d) The patient's identified needs and goals The central focus of patient teaching and the larger discharge planning process should be the identified healthcare needs of the patient and the goals that he or she identifies or acknowledges. The nurse's skills and knowledge, the patient's potential for recurrence, and the relevant NANDA Nursing Diagnoses are all elements that may inform the discharge planning process, but they are superseded by the patient's goals and expressed needs.
What criterion must be met for home care visits to be reimbursed? a) The nurse must visit the patient daily and complete daily documentation of the visit. b) The patient's home must have adequate room for storage of supplies and work space for the healthcare personnel. c) The patient's family must be present for each home care visit and offer to assist. d) The physician must write an order for all services, and the patient must meet eligibility criteria.
d) The physician must write an order for all services, and the patient must meet eligibility criteria. For home healthcare visits to be reimbursed, the physician must write an order for all services and the patient must meet eligibility criteria.
When admitting a patient to the hospital, the nurse may delegate some activities to other members of the healthcare team. Which activity would be appropriate to delegate? a) collecting information for a health history b) performing a physical assessment c) contacting the physician for medical orders d) preparing the bed ad collecting needed supplies
d) preparing the bed ad collecting needed supplies The nurse may delegate preparation of the bed and collection of needed supplies to unlicensed personnel but would perform the other activities listed.