Chapter 11 : Admission, Transfer, and Discharge

The patient tells the nurse that he would like to be transferred to hospital X, because his cardiologist doesn't come to hospital Y. What would the nurse do? 1. Obtain an AMA form and have the patient sign it. 2. Call hospital X and advise that the patient desires transfer. 3. Advise the patient that the cardiologists in hospital Y are good. 4. Advise the patient that a transfer requires an order from the HCP.

Advise the patient that a transfer requires an order from the HCP. Rationale: A transfer requires an order from the HCP, and the HCP must speak directly to accepting HCP at the receiving hospital. Merely informing the patient that the cardiologists in hospital Y are good does not address the patient's request. An AMA form would not be utilized at this time as the patient is not requesting to leave against medical advice.

What is the role of the LPN when a patient is admitted to a health care facility? 1. Take the initial health history and assessment. 2. Assist with the plan of care and recommend revisions as necessary. 3. Do only the evaluation phase of the plan of care. 4. Implement the interventions of the care plan.

Assist with the plan of care and recommend revisions as necessary. Rationale: As an LPN, you can assist with the plan of care and recommend any revisions as necessary. The initial health history and assessment is to be performed by an RN. Evaluation and implementing the plan of care are the responsibilities of both the RN and LPN, and they are done after the admission process is completed.

A patient is being transferred to a long-term care facility for rehabilitation. What is the nurse's responsibility in providing continuity of care for this patient? 1. Call the admitting nurse at the facility and give a brief summary of the patient's medical diagnosis, treatment care plan, and medications. 2. Make sure all the patient's belongings are gathered together and sent with the patient. 3. You do not need to do anything; all patient care and treatments stop when leaving the hospital and being admitted to a long-term care facility. 4. Call the immediate family to let them know when the patient is leaving and when the patient should arrive at the long-term care facility.

Call the admitting nurse at the facility and give a brief summary of the patient's medical diagnosis, treatment care plan, and medications. Rationale: Documentation and communication between the health care staffs are very important to provide this patient with continuity of care from one facility to another.

The patient has an old head injury and demonstrates occasional intermittent episodes of belligerence and confusion interspersed with appropriate behavior. He is currently angry and wants to leave AMA. The nurse is unable to reach the HCP. What would the nurse do first? 1. Explain the AMA form and consequences to the patient. 2. Call the supervising RN, because the patient now has acute needs. 3. Notify the family and ask them to take responsibility 4. Contact the risk manager and ask for permission to detain.

Call the supervising RN, because the patient now has acute needs. Rationale: A patient with a stable prior head injury could be assigned to the LPN/LVN; however, with a change in mental status or behavior, and the intention to leave the hospital against medical advice (AMA), it would be appropriate for the LPN/LVN to notify the supervising RN as a first step. The health care provider would need to be notified. Risk management, the family and social worker may all be involved in this process. A determination would need to be made whether the patient is competent and if he is a risk to himself or others.

Which tasks related to admitting a new patient can be delegated to the UAP? Select all that apply. 1. Obtain personal care items, such as water pitcher or packaged cleansing cloths. 2. Position the bed for transfer from stretcher or wheelchair. 3. Hang signs above the bed related to care, such as "nothing by mouth" 4, Ask the patient if they need special equipment, such as a walker. 5. Store belongings, such as jewelry, watch, or wallet, in bedside table. 6. Assist the patient to arrange desired items, such as eyeglasses, within reach.

Obtain personal care items, such as water pitcher or packaged cleansing cloths. Position the bed for transfer from stretcher or wheelchair. Assist the patient to arrange desired items, such as eyeglasses, within reach. Rationale: Needs should be assessed by the nurse and then signs, equipment, or other items can be obtained. Items of value should not be stored in the bedside table.

During the admission of a patient to health care facility, what are the responsibilities of the admission department representative? Select all that apply. 1. Obtaining identifying information 2. Giving information on the Health Insurance Portability and Accountability Act 3. Placing the correct identification band on the patient's wrist. 4. Obtaining a list of current medications 5. Obtaining emergency contact information 6. Gathering insurance information

Obtaining identifying information. Giving information on the Health Insurance Portability and Accountability Act. Placing the correct identification band on the patient's wrist. Obtaining emergency contact information. Gathering insurance information. Rationale: Discussions about medication and other health-related matters should be done by the nursing staff.

An experienced LPN/LVN is working on a medical-surgical unit. The LPN/LVN sees that a new RN has not completed the admission assessment on a patient who arrived 20 hours ago. What would the LPN/LVN do first? 1. Wait to see if the new RN completes the admission assessment. 2. Mention the incomplete admission assessment to the nurse manager. 3. Remind the RN that the Join Commission requires admission assessment within 24 hours. 4. Offer to collect data so that the new nurse can complete the admission assessment.

Offer to collect data so that the new nurse can complete the admission assessment. Rationale: The assessment should be completed and documented within 24 hours of admission. An experienced nurse recognizes that new personnel need support and assistance, so gently offering help would be the first action. The other options are also possible, but less constructive and more likely to make the new nurse feel isolated.

The nurse is admitting a patient with limited English language ability who smiles and nods in response to the nurse's questions. What would be the best action by the nurse? 1. Ask the patient's teen daughter who is present to translate. 2. Call the patient's English-speaking husband and ask him to check that his wife has understood everything. 3. Ask the UAP on the floor who speaks the patient's language to translate. 4. Utilize the video translation service provided by the hospital.

Utilize the video translation service provided by the hospital. Rationale: A hospital video translation service generally uses certified medical translators and has numerous languages available. This approach is preferred over use of a family member, which can compromise patient confidentiality and may limit what the patient will disclose. A certified medical translator is preferred over a staff member who speaks the patient's language for an in-depth interview. During the admission interview, it is vital to have all information correct to avoid potential errors based on incomplete or misunderstood questions and answers.

The LPN is assisting the RN with a newly admitted female patient. What is the most appropriate way to address the patient? 1. "Hello, Susie, my name is ..." 2. "Hello, Miss Kate, my name is ..." 3. "Hello, Ms. Green, my name is ..." 4. "Hi Honey, my name is ..."

"Hello, Ms. Green, my name is ..." Rationale: All patients need to be addressed by Mr., Mrs., Ms., and the last name unless otherwise directed. It is not appropriate to use Honey, Sweetie, or Dear when addressing patients.

A frail older woman has been admitted to the hospital during a time of pandemic with a no visitor policy in place. The patient's daughter asks to accompany her mother just to "help her get settled and decrease her fear." How would the nurse response to this request? 1. "You can come in just for a few moments, to help her; but then, I am sorry, you must leave." 2. "I'm sorry, but due to the pandemic, you cannot come in, but I will set up a video visit with your mother in just a few minutes so you can help her with the admission process." 3. "There is a pandemic going on, and I am sorry, but you cannot enter the hospital. I will call you later with information about how your mother is doing." 4. "I will ask your mother if she feels the need to have you with her during her admission."

"I'm sorry, but due to the pandemic, you cannot come in, but I will set up a video visit with your mother in just a few minutes so you can help her with the admission process." Rationale: This option addresses the daughter's very understandable wish to help her mother at this difficult time. The nurse explains the reason why she can't come in but offers another option for the daughter to help. Having the daughter come in for a few minutes is not acceptable as the purpose of the restrictive visitor policy is to lessen exposure of all within the hospital to pathogens. Calling the daughter later with information does not meet the need of the daughter to help her mother now. Asking the mother if wants the daughter present is not a good choice because the daughter's presence is not an option due to the pandemic.

The nurse is placing an identification band on a patient who was admitted through the emergency department. What is best to say as the band is applied? 1. "This is your assigned hospital identification number." 2. "The primary purpose of the band is to maintain safety." 3. "All patients have to wear these; it's standard procedure." 4. "We don't want to lose you while you are in the hospital."

"The primary purpose of the band is to maintain safety." Rationale: Explaining that the band is for safety reassures the patient that the band is for their benefit and not just a standard method of classification, and that they are not viewed as just an assigned number. Joke with patients is often appropriate, but first the nurse should establish rapport with the patient; otherwise they may believe that there is real possibility of getting lost or displaced.

A patient with Alzheimer's disease is being transferred from a long-term care facility to an acute care hospital for possible sepsis and change in mental status. Which question is the most important to ask the nurse who is giving the report? 1. "Has the family been advised about the reason for the transfer?" 2. "What is the patient's baseline mental status and behavior?" 3. "When is the patient scheduled to be transferred?" 4. "Will the patient be accompanied by a nurse or family member?"

"What is the patient's baseline mental status and behavior?" Rationale: For any patient who has change of mental status, knowing baseline behavior is important. For a patient with dementia, knowledge of baseline behavior is especially important, because delirium and dementia can have some similarities. The other information is also relevant, but not as critical as understanding the patient's normal baseline to allow for accurate assessment upon arrival.

The patient is newly admitted and seems anxious, but also appears very hesitant to ask questions. Which statement by the nurse best demonstrates empathy? 1. "Call me if you need anything; I'll be happy to help you." 2. "There's nothing to worry about; we'll take good care of you." 3. "I know you must have a lot of questions; I know I would." 4. "You seem a little uncertain; do you have some questions?"

"You seem a little uncertain; do you have some questions?" Rationale: First the nurse reflects the patient's feelings of anxiety and then directly invites the patient to ask questions. Indicating when to call and willingness to help is a good thing to say after the patient appears to be comfortable and settled in their surroundings. Telling the patient "not to worry" does not address their specific concerns. "I know I would" switches the focus to the nurse.

Which newly admitted patient is most likely to need and benefit from an individualized explanation of the bathroom facilities? 1. A 75-year-old woman with advanced Alzheimer's disease. 2. A 20-month-old child who has just started toilet training. 3. A 65-year-old man who recently emigrated from a remote rural area in a poor country 4. A 50-year-old woman who has stress incontinence

A 65-year-old man who recently emigrated from a remote rural area in a poor country. Rationale: While all patients benefit from an individualized approach, the man from the remote rural area of a poor country is most likely to be unfamiliar with plumbing conditions in a modern hospital. The patient with Alzheimer's disease may not be able to comprehend or remember new information. Children who are just starting to toilet-train are likely to need diapers during hospitalization, because the stress may cause them to revert to earlier behavior. The woman with stress incontinence needs evaluation as to the etiology of her condition and then appropriate interventions rather than an explanation of bathroom facilities.

Which patient is likely to have the most complex discharge plan? 1. A 73-year-old man with chronic disease who has no family in the area. 2. A 23-year-old mother who just delivered her first healthy baby. 3. A 17-year-old adolescent who broke his leg during a ski trip. 4. A 35-year-old woman who had an emergency appendectomy.

A 73-year-old man with chronic disease who has no family in the area. Rationale: An older patient with chronic disease and fewer personal resources is likely to have the most complex discharge plan, which may include social services, nursing, physical therapy, and home health aides. He is more likely to need help with issues such as transportation, shopping, preparing food, and assistance with activities of daily living. He is also likely to be taking more medications and have more ongoing health problems.

A male patient has his call light on. As the nurse enters the room, the patient is fully dressed and ready to leave. He begins yelling and asking to remove his IV because he is going home. What term best describes a patient's intent to leave a health care facility without a health care provider's order? 1. APA (against health care provider's advice) 2. WDO (without health care provider's order) 3. ELO (elopement) 4. AMA (against medical advice)

AMA (against medical advice) Rationale: When a patient leaves a long-term care or acute care setting without a health care provider's order, it is considered "leaving AMA" (against medical advice). A form acknowledging that the patient is choosing to leave against the health care providers advice is usually signed by the patient prior to leaving the health care facility.

The nurse is giving instructions to a family caregiver of an older patient who will need help after discharge from the hospital. The nurse senses tension, resentment, and unwillingness from the caregiver. What would the nurse do first? 1. Continue to give the instructions and ask for feedback from the caregiver. 2. Notify the provider for an order for home health nursing. 3. Get a social service consult to resolve family tensions and problems. 4. Assess the caregiver's attitude toward the patient and the circumstances.

Assess the caregiver's attitude toward the patient and the circumstances. Rationale: The nurse would first attempt to assess the caregiver's attitude. Based on the assessment findings, the nurse could use the other options.

The patient is being transferred from the medical-surgical unit to a long-term care center. Which tasks can be delegated to the unlicensed assistive personnel (UAP)? Select all that apply. 1. Change soiled dressings. 2. Bathe an incontinent patient. 3. Assist to collect personal items. 4. Take a final set of vital signs. 5. Review transfer details with family

Bathe an incontinent patient. Assist to collect personal items. Take a final set of vital signs. Rationale: UAP can bathe the patient, assist the patient to collect personal items, and take a set of vital signs. Dressing change should be performed by the nurse to include a final assessment by the nurse to include a final assessment of wound site. The nurse should discuss the transfer with the patient and family and answer questions as needed.

The nurse is admitting a new patient to the diagnostic and surgical center. What would the nurse do first? 1. Assess immediate needs. 2. Take vita signs. 3. Check identification bands. 4. Orient patient to the facility routines.

Check identification bands. Rationale: The patient is no apparent distress, the nurse should check the identification first. Identifying the patient is necessary to give correct information about procedures, plan of care, etc. Checking identification could be done simultaneously as the nurse is introducing self. The other actions are also necessary. If the patient was in apparent distress, the nurse would quickly assess needs and intervene.

Nurses today care for patients from many different cultures and backgrounds. Which ideas/beliefs from the Japanese culture are accurate related to causing illness? (Select all that apply.) 1. Contact with blood 2. Contact with skin disease 3. Not praying 4. Improper care of the body 5. Ingesting of alcohol 6. Lack of sleep

Contact with blood Contact with skin disease Improper care of the body Lack of sleep

To effectively assess and plan for a patient's continuing needs, when should the nurse begin the discharge process? 1. Before being hospitalized 2. During hospitalization 3. After going home 4. During a surgical procedure

During hospitalization Rationale: Discharge planning occurs during hospitalization, beginning shortly after a patient is admitted

A patient has arrived at the outpatient surgery department before a scheduled surgery. What must the nurse accomplish before the patient goes to surgery? 1. Determine if the patient has been NPO for 12 hours. 2. Ensure the operative consent is signed. 3. Administer pain medication. 4. Log all the patient's belongings.

Ensure the operative consent is signed. Rationale: The patient must sign the operative permit before surgery. Most patients are required to be NPO for 6 to 8 hours not 12 hours and pain medication is usually not administered before surgery. The patient's belongings are usually given to the patient's family.

A rational patient wishes to leave the hospital against medical advice (AMA), despite the nurse's best attempt at therapeutic communication. What is the nurse's first responsibility? 1. Notify the health care provider (HCP) 2. Document the incident. 3. Detain the patient. 4. Obtain an AMA form.

Notify the health care provider (HCP) Rationale: The nurse should notify the HCP, who ideally will come immediately and talk to the patient and have the patient sign the AMA form. The incident should be documented in the nurse's notes. An incident report may also be completed as needed. It is inappropriate to detain a rational patient if he/she wants to leave.

The nurse is trying to explain the bed controls and the call button and other items related to hospitalization, but the older adult patient keeps telling the nurse to "wait for my son to get here." What would the nurse do first? 1. Go find the son or other available family members. 2. Leave written information at the bedside. 3. Give brief information using very simple language. 4. Offer comfort measures and ensure patient safety

Offer comfort measures and ensure patient safety. Rationale: This older patient is refusing information that the nurse believes is necessary; however, the nurse can spend the time making the patient safe and comfortable and then return when the son arrives. At that time, the nurse can assess the family dynamics to determine if the patient relies on the son for decision-making or information retention and filtering.

During discharge planning, which discipline of the health care team assists in rehabilitating and restoring a patient's musculoskeletal function to its highest potential? 1. Speech therapy 2. Clinical nurse specialist 3. Physical therapy 4. Occupational therapy

Physical therapy Rationale: Physical therapy works with a patient's musculoskeletal function to regain strength and to attain its highest functioning level. Speech therapy assists with disorders affecting normal oral communication. A clinical nurse specialist provides instruction to the patient and family who will assume the patient care. Occupational therapy teaches how to adapt to physical handicaps by learning ADLs.

A young child is being admitted to an acute care setting. He has never been hospitalized before. As the nurse enters the room, the child begins to cry and cling to his mother. According to Maslow's hierarchy of needs, what need is the child is exhibiting? 1. Physiologic needs 2. Love and belonging 3. Self-esteem 4. Safety and security

Safety and security Rationale: Fear of the unknown, a common reaction to hospitalization, is related to what Maslow identified as the need for safety and security.

The nurse realizes that an older adult who resides in a long-term care facility can become confused and upset during hospitalization. Which intervention would be most appropriate when caring for this patient? 1. Stand at the bedside, asking detailed questions. 2. Address any questions about the patient to the spouse or other family members. 3. Sit face to face with the patient, conversing slowly and clearly. 4. Call the long-term care facility to see if this is normal behavior.

Sit face to face with the patient, conversing slowly and clearly. Rationale: It takes longer for older adults to process information. They are easily confused in a new environment. Sitting at eye level and talking slowly allows the patient time to process and respond correctly.

There are orders to transfer a patient from the hospital to a long-term care facility. The nurse comes into the room to prepare the patient for transfer and finds the patient crying and stating she wants to go home. What would the nurse do first? 1. Talk to the patient and listen to her concerns about the transfer. 2. Inform the HCP that the patient does not want to be transferred. 3. Ask the hospital social worker to speak again with the patient about the transfer. 4. Call the family of the patient and inform them of the patient's wishes.

Talk to the patient and listen to her concerns about the transfer. Rationale: The first step would be to talk to the patient and try to understand what she wants and if it is a realistic goal. She may have fears of "nursing home placement," financial worries, or feel she was not listened to in the decision-making process. The other options would be appropriate after talking with the patient.

An older adult patient is postoperative for hip surgery. He is transferred by ambulance from the hospital to a rehabilitation (rehab) unit. One hour after he is assisted into bed at the rehab unit, he dies in his sleep. Which documentation provides the best legal protection for the transferring nursing staff? 1. The provider's discharge summary and order to transfer the patient to the rehab unit. 2. The discharge assessment that was performed just before the patient left the hospital. 3. The assessment that was performed by the ambulance team in route to the rehab unit. 4. The partially completed admission assessment performed by the rehab unit nurse.

The discharge assessment that was performed just before the patient left the hospital. Rationale: When a patient is discharged or transferred, the nurse is the last professional team member to assess/see the patient, so it is important that the nurse's documentation reflects that the patient left in stable condition. The other pieces of documentation are also likely to be reviewed in case of a lawsuit. Even if no lawsuit occurs, this death is likely to be investigated as a "sentinel event."