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Chapter 2: Admitting, Transfer, and Discharge
MULTIPLE CHOICE
1. 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?
a. Provide him with information on health care websites.
b. Provide him with written information on what he has to do.
c. Sit and carefully explain what is required before his follow-up.
d. Use a combination of verbal and written information.
ANS: D
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.
DIF: Cognitive Level: Application REF: Text reference: p. 12
OBJ: Identify the ongoing needs of patients in the process of discharge planning.
TOP: Admission to Discharge Process KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
2. 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:
a. the patient’s willingness to go home.
b. the family’s perceived ability to care for the patient.
c. the patient’s ability to live alone.
d. allowing the patient to make her own arrangements.
ANS: B
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.
DIF: Cognitive Level: Analysis REF: Text reference: p. 22
OBJ: Identify the ongoing needs of patients in the process of discharge planning.
TOP: Medication Reconciliation KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity
3. 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?
a. Summon the nurse technician to hold the arm down while the IV is inserted.
b. Use a numbing medication before inserting the IV.
c. Document the patient’s refusal and notify the physician.
d. Tell the patient that she will be discharged without care unless she complies.
ANS: C
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.
DIF: Cognitive Level: Application REF: Text reference: p. 13
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility.
TOP: Patient Self-Determination Act KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
4. An unconscious patient is admitted through the emergency department. How and
when is identification of the patient made?
a. Determined only when the patient is able
b. Postponed until family members arrive
c. Given an anonymous name under the “blackout” procedure
d. Determined before treatment is started
ANS: B
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.
DIF: Cognitive Level: Application REF: Text reference: p. 12
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: The Unconscious Patient
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5. 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?
a. Use hand gestures to explain.
b. Request and wait for an interpreter.
c. Work with the family to gather information.
d. Complete as much of the admission assessment as possible using simple phrases.
ANS: B
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.
DIF: Cognitive Level: Application REF: Text reference: p. 15
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility.
TOP: The Patient Who Does Not Speak English
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
6. 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?
a. She is safe in the hospital, and she needs to provide her name.
b. She can be admitted to the hospital without anyone knowing it.
c. Her records will be used as evidence in the trial.
d. Since she has come to the hospital, she has to be examined by the doctor.
ANS: B
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 SelfDetermination Act prohibits the hospital from requiring her to submit to an
examination.
DIF: Cognitive Level: Analysis REF: Text reference: pp. 13-14
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Victim of Crime
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
7. 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:
a. examining the patient and treating the pain.
b. orienting the family to the ICU visitation policy.
c. making sure that the consent forms are signed.
d. informing the patient of his HIPAA rights.
ANS: A
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.
DIF: Cognitive Level: Analysis REF: Text reference: p. 15
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Role of the Nurse
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. 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 earlier that morning, but the pain has finally gone since he received a “pain shot”
in the emergency department. What does this information prompt the nurse to do
next?
a. Provide the patient with an allergy arm band and document his allergies.
b. Postpone routine admission procedures immediately.
c. Ask the patient if he wants a smoking room.
d. Have all family or friends leave the room.
ANS: A
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.
DIF: Cognitive Level: Analysis REF: Text reference: p. 16
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Allergies
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
9. At what age is separation anxiety a common problem?
a. School-aged children
b. Preschoolers
c. Middle infancy
d. Newborns
ANS: C
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.
DIF: Cognitive Level: Synthesis REF: Text reference: p. 18
OBJ: Explain the role of the patient’s family in the admission, transfer, or discharge process.
TOP: Pediatric Considerations KEY: Nursing Process Step: Assessment
MSC: NCLEX: Psychosocial Integrity
10. 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)?
a. Helping the patient get dressed
b. Gathering IV equipment to go with the patient
c. Escorting the patient to the transport area
d. Assessing the patient’s respiratory status before transport
ANS: D
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.
DIF: Cognitive Level: Application REF: Text reference: p. 19
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Delegation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
11. When does the plan for patient discharge from a health care facility begin?
a. At admission
b. After a medical diagnosis has been determined
c. When the patient’s physical needs are identified
d. After a home environment assessment is completed
ANS: A
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.
DIF: Cognitive Level: Comprehension REF: Text reference: p. 22
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Discharge Planning
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
12. The phase of the discharge process where medical attention dominates discharge
planning efforts is known as the _____ phase.
a. transitional
b. continuing
c. acute
d. multidisciplinary
ANS: C
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.
DIF: Cognitive Level: Comprehension REF: Text reference: p. 22
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Discharge Planning
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
13. Once a patient’s discharge has been completed, which activity may be delegated to
assistive personnel?
a. Provision of prescriptions to the patient
b. Completion of the discharge summary
c. Gathering of the patient’s personal care items
d. Provision of instructions on community health resources
ANS: C
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.
DIF: Cognitive Level: Application REF: Text reference: p. 22
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Discharge Planning
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
14. 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?
a. Speak with the daughter separately.
b. Cancel the discharge immediately.
c. Order a visiting nurse consult.
d. Notify the physician.
ANS: A
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 often is necessary to talk with the patient and family
separately to learn about their true concerns or doubts.
DIF: Cognitive Level: Application REF: Text reference: p. 23
OBJ: Explain the role of the patient’s family in the admission, transfer, or discharge process.
TOP: Discharge Planning KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
15. 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?
a. Agree to be a witness.
b. Refuse to be a witness.
c. Contact social work.
d. Contact the physician.
ANS: C
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.
DIF: Cognitive Level: Application REF: Text reference: p. 14
OBJ: Explain the purpose and importance of advance directives.
TOP: Advance Directives KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
MULTIPLE RESPONSE
1. 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.)
a. Anticipate physical and social deficits to resuming normal activities.
b. Involve the family and significant others in the plan of care.
c. Assist in making health care resources available to the patient.
d. Identify the psychological needs of the patient.
ANS: A, B, C, D
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.
DIF: Cognitive Level: Application REF: Text reference: p. 11
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility.
TOP: Admission to Discharge Process KEY: Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
2. Under the Health Insurance Portability and Accountability Act (HIPAA), a patient
must: (Select all that apply.)
a. provide his true name before he can be treated.
b. be informed of his privacy rights.
c. have his personal health information used for treatment or payment only.
d. have his personal health information used on a need-to-know basis only.
ANS: B, C, D
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.
DIF: Cognitive Level: Knowledge REF: Text reference: pp. 13-14
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: HIPAA
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
3. 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.)
a. Obtaining admission vital signs
b. Preparing the patient’s room
c. Gathering and securing personal care items
d. Orienting patient and family to the nursing unit
ANS: B, C, D
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.
DIF: Cognitive Level: Analysis REF: Text reference: p. 15
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Delegation Considerations
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
4. Which of the following are considered “advance directives”? (Select all that apply.)
a. Living will
b. Power of attorney for health care
c. Notarized handwritten document
d. Nursing progress note
ANS: A, B, C
Advance directives may include a living will, power of attorney for health care, or a
notarized handwritten document.
DIF: Cognitive Level: Analysis REF: Text reference: p. 14
OBJ: Explain the purpose and importance of advance directives.
TOP: Advance Directives KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
5. 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.)
a. providing the receiving nurse with a report before the transfer.
b. determining any equipment needs for the patient during the transfer.
c. providing an updated report after transferring the patient to the receiving unit.
d. making sure a registered nurse accompanies the patient.
ANS: A, B, C
When providing a “handoff” 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.
DIF: Cognitive Level: Application REF: Text reference: p. 19
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Continuum of Care
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
COMPLETION
1. Completing and documenting an accurate medication history from the patient is the
important first step in the _____________ process.
ANS:
medication reconciliation
Medication reconciliation compares the patient’s home medication list versus the
medication orders at admission, transfer, or discharge to avoid medication errors such
as omissions, duplications, dosing errors, or drug interactions.
DIF: Cognitive Level: Knowledge REF: Text reference: p. 17
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Medication Reconciliation
KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity
2. If a patient is having acute physical problems, postpone routine admission
procedures until the patient’s immediate needs are met. A ________________
assessment is needed at this point.
ANS:
focused
If a patient is having acute physical problems, postpone routine admission procedures
until you meet the patient’s immediate needs. Complete a focused assessment at this
point.
DIF: Cognitive Level: Analysis REF: Text reference: p. 15
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Admission Process
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
3. When transferring a patient, the nurse must ensure that the patient will receive
____________.
ANS:
continuity of nursing care
When patients transfer, you need to ensure continuity of nursing care. The aim is to
continue health care so as to avoid therapeutic interruptions that may hinder progress
toward recovery.
DIF: Cognitive Level: Synthesis REF: Text reference: p. 19
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Continuity of Care
KEY: Nursing Process Step: Planning MSC: NCLEX: Safe and Effective Care Environment
4. The greatest challenge in effective discharge planning is _______________.
ANS:
communication
The greatest challenge in effective discharge planning is communication. The
communication problem is minimized when an organization has a discharge
coordinator or a case manager who is responsible for discharge planning.
DIF: Cognitive Level: Comprehension REF: Text reference: p. 22
OBJ: Describe the nurse’s role in maintaining continuity of care through a patient’s admission,
transfer, and discharge from an acute care facility. TOP: Discharge Planning
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe and Effective Care Environment
5. A document that provides a patient’s instructions in terms of future medical care or
that designates another person(s) to make medical decisions if the individual loses
decision-making capacity is known as an ________________.
ANS:
advance directive
An advance directive is a document that provides a patient’s instructions about future
medical care or that designates another person(s) to make medical decisions if the
individual loses decision-making capacity. An advance directive conveys the patient’s
choice in continuing medical care when the patient is unable to speak or make
decisions.
DIF: Cognitive Level: Knowledge REF: Text reference: p. 14
OBJ: Explain the purpose and importance of advance directives.
TOP: Advance Directives KEY: Nursing Process Step: Diagnosis
MSC: NCLEX: Safe and Effective Care Environment
