- A 74-year-old client with heart failure with reduced ejection fraction is transitioning from the hospital to home after treatment for fluid overload with intravenous diuretics. Current status: weight down 2.5 kg since admission, lungs clear, oxygen saturation 95% on room air, and the client is stable on oral furosemide; mild forgetfulness is noted. The client lives with an adult daughter who works daytime hours and the client has limited transportation. What is the nurse's PRIORITY when planning for this client's discharge?
Answer: Arrange home health nursing to assess weight, edema, and medication adherence within 48 hours
This question tests discharge planning and continuity of care for a heart failure patient with multiple risk factors for readmission. The primary goal of discharge planning is to establish appropriate follow-up care that addresses the patient's specific needs and vulnerabilities. The correct answer (A) addresses the highest priority need by arranging early home health assessment to monitor critical parameters and ensure medication adherence, especially important given the client's mild forgetfulness and limited daytime supervision. Option B (avoiding all activity) is incorrect and could worsen deconditioning; Option C (increasing diuretic dose) requires assessment data first and shouldn't be done preemptively; Option D (cooking recipes) is helpful but doesn't address the immediate monitoring needs. Effective discharge planning matches the intensity of follow-up services to the patient's risk level and support system. When planning safe discharges for chronic disease patients, prioritize early professional monitoring over self-management strategies when cognitive or social support limitations exist.
- A 79-year-old client is being discharged after an ischemic stroke with mild right-sided weakness and dysphagia; history includes atrial fibrillation and hyperlipidemia. Current status: stable vital signs, tolerates a mechanical-soft diet with thickened liquids, and is newly prescribed apixaban; the client needs assistance transferring from bed to chair. The client will return home with an adult son who works nights and the client has limited ability to manage medications independently. What is the nurse's PRIORITY when planning for this client's discharge?
Answer: Ensure a swallow-safe diet plan and medication administration support are arranged before discharge
This question tests discharge planning and continuity of care for a stroke patient with multiple safety risks. The primary goal of discharge planning is to address the most critical safety needs that could lead to serious complications. The correct answer (A) addresses the highest priority needs by ensuring safe nutrition/hydration and proper medication administration, critical for preventing aspiration and stroke recurrence. Option B (thin liquids) is dangerous and contradicts the swallow evaluation findings; Option C (taking apixaban only when irregular) is incorrect and dangerous as anticoagulation must be continuous; Option D (delaying speech therapy) is inappropriate as early intervention improves outcomes. Effective discharge planning coordinates multiple services to address complex needs, prioritizing life-threatening risks like aspiration and medication errors. When planning safe discharges for stroke patients, ensure swallow safety and medication management are addressed before focusing on mobility or other rehabilitation needs.
- A 72-year-old client with type 2 diabetes is being discharged after treatment for a foot ulcer and cellulitis; the client will complete oral antibiotics and has a new order for daily wound care. The client's glucose is controlled with insulin, and the client has decreased vision and limited ability to bend. The client lives with an adult daughter who works days and can assist in the evenings. Which referral is MOST appropriate for the client's discharge needs?
Answer: Home health nursing for wound assessment, dressing changes, and teaching
The discharge priority is to maintain continuity of skilled wound care: this client has an active foot ulcer requiring daily dressing changes, insulin-dependent diabetes, limited vision and bending, and a daughter only available in the evenings. Home health nursing can assess wound healing, perform dressing changes, and teach the client and daughter to recognize infection, which addresses the highest-risk need. Outpatient dermatology is for routine skin cancer surveillance, not for an acute wound, and does not meet the daily skilled-care requirement. Cardiac rehabilitation targets endurance and circulation but is not indicated without a cardiac diagnosis and cannot provide wound care or teaching. Speech-language pathology evaluates swallowing and oral motor function, but there is no report of dysphagia or aspiration risk; it does not treat the foot ulcer or help with dressing changes. The correct referral is therefore home health nursing.
- A 67-year-old client is being discharged 2 days after a total hip arthroplasty for osteoarthritis; the client's pain is controlled with oral medications, vital signs are stable, and the incision is clean and dry. The client will go home with a spouse who can assist, and home physical therapy is scheduled. The client asks what to watch for at home. Which discharge instruction is MOST important for the client?
Answer: Report calf pain, warmth, swelling, or sudden shortness of breath immediately
This question tests discharge planning and continuity of care in a postoperative client after total hip arthroplasty. The primary goal of discharge planning is to ensure a safe transition home by addressing potential complications and promoting recovery. Reporting signs of deep vein thrombosis or pulmonary embolism, such as calf pain, warmth, swelling, or sudden shortness of breath, addresses the highest priority need because immobility increases the risk of thromboembolism, which can be life-threatening. Using an incentive spirometer is important for lung expansion but is lower priority than monitoring for clots; changing the dressing daily is unnecessary for a clean, dry incision; limiting fluids after 6 PM may reduce fall risk but does not address the most critical complication. Effective discharge planning involves assessing the client's support system and scheduling follow-up services like physical therapy. It also includes educating on signs of complications and when to seek immediate care. A transferable strategy for planning safe discharges is to prioritize teaching on life-threatening risks and ensure access to emergency resources.
- A 56-year-old client with chronic kidney disease stage 4 is being discharged after treatment for hyperkalemia. Potassium is now within normal range, and the client is prescribed sodium polystyrene sulfonate as needed and instructed on a low-potassium diet. The client lives with a spouse and is unsure which foods to avoid. Which discharge instruction is MOST important for the client?
Answer: Avoid high-potassium foods such as bananas, oranges, tomatoes, and potatoes unless approved by the provider
This question tests discharge planning and continuity of care in a client with chronic kidney disease and hyperkalemia. The primary goal of discharge planning is to prevent electrolyte imbalances through dietary education. Instructing to avoid high-potassium foods addresses the highest priority need to maintain safe potassium levels. Increasing salt substitutes often adds potassium; excess water doesn't flush potassium; daily SPS is not routine. Effective discharge planning includes specific food lists and examples. It also involves follow-up lab monitoring. A transferable strategy for planning safe discharges is to tailor dietary teaching to the client's condition and confirm comprehension.
- A 26-year-old client is being discharged after treatment for pelvic inflammatory disease and is prescribed doxycycline. The client reports inconsistent condom use and has a new partner; the client lives with a roommate and has no primary care provider. Which discharge instruction is MOST important for the client?
Answer: Complete the full antibiotic course, avoid sexual activity until treatment is finished, and ensure partner evaluation/treatment
This question tests discharge planning and continuity of care in the context of treating pelvic inflammatory disease (PID). The primary goal of discharge planning is to ensure the client understands how to complete treatment effectively, prevent reinfection, and promote long-term health outcomes. The correct answer, completing the full antibiotic course, avoiding sexual activity until treatment is finished, and ensuring partner evaluation/treatment, addresses the highest priority need by reducing the risk of reinfection, complications like infertility, and transmission of sexually transmitted infections that commonly cause PID. Option A is incorrect because while doxycycline causes photosensitivity, avoiding sunlight entirely for 6 months is unnecessary as treatment duration is typically 14 days; option C is wrong as stopping antibiotics prematurely increases resistance and recurrence risk, not reduces yeast infections; and option D is harmful since douching disrupts vaginal flora and heightens infection risk. A key principle of effective discharge planning is assessing the client's social situation, such as inconsistent condom use and lack of a primary care provider, to tailor instructions that promote adherence and follow-up. Another principle is incorporating education on medication side effects, lifestyle modifications, and when to seek medical help to foster self-management. A transferable strategy for planning safe discharges is to prioritize instructions that address immediate risks like reinfection while connecting clients to resources, such as sexual health clinics, for ongoing care.
- An 81-year-old client is being discharged after a fall with a wrist fracture treated with a splint; the client has mild cognitive impairment and reports dizziness when standing. The client lives alone, and a neighbor checks in occasionally. What is the nurse's PRIORITY when planning for this client's discharge?
Answer: Arrange a home safety evaluation and confirm a reliable caregiver plan before discharge
This question tests discharge planning and continuity of care in an elderly client post-fall with cognitive and mobility issues. The primary goal of discharge planning is to ensure a safe home environment and adequate supervision. Arranging a home safety evaluation and caregiver plan addresses the highest priority need to prevent recurrent falls. Encouraging sleep aids risks side effects; removing rugs after healing delays safety; limiting fluids risks dehydration. Effective discharge planning includes assessing living situations for risks. It also involves coordinating community services. A transferable strategy for planning safe discharges is to evaluate home safety and support before release.
- A 63-year-old client with chronic obstructive pulmonary disease is being discharged after an exacerbation treated with nebulized bronchodilators and oral prednisone. The client is stable on 2 L/min oxygen by nasal cannula at rest and becomes mildly short of breath with exertion. The client lives with a spouse who can help but reports confusion about inhaler use. Which discharge instruction is MOST important for the client?
Answer: Use the rescue inhaler first, then the maintenance inhaler as prescribed, and demonstrate correct technique
This question tests discharge planning and continuity of care in a client with COPD post-exacerbation. The primary goal of discharge planning is to optimize respiratory management and prevent readmissions through proper medication use. Teaching correct inhaler technique and sequence addresses the highest priority need by ensuring effective symptom control and adherence. Avoiding all activity risks deconditioning; increasing oxygen flow can cause retention; stopping prednisone abruptly risks rebound. Effective discharge planning involves hands-on demonstration of skills like inhaler use. It also includes assessing home support for monitoring symptoms. A transferable strategy for planning safe discharges is to verify client competency in self-care tasks and provide action plans for exacerbations.
- A 74-year-old client is being discharged after a transurethral resection of the prostate. The client is voiding with light pink urine, has stable vital signs, and will go home with a spouse. The client asks what symptoms require immediate follow-up. Which discharge instruction is MOST important for the client?
Answer: Seek care for inability to urinate, heavy bleeding, fever, or increasing pain
This question tests discharge planning and continuity of care in a client post-TURP. The primary goal of discharge planning is to monitor for postoperative complications like bleeding or infection. Instructing to seek care for inability to urinate or heavy bleeding addresses the highest priority need for prompt intervention. Expecting bright red urine with clots is abnormal; restricting fluids risks clots; resuming heavy lifting risks hemorrhage. Effective discharge planning includes urinary symptom education. It also involves support confirmation. A transferable strategy for planning safe discharges is to provide specific symptom thresholds for returning to care.
- A 34-year-old client with newly diagnosed type 2 diabetes is being discharged after education and initiation of metformin. The client is stable, motivated, and lives with a supportive partner but has limited health literacy. Which discharge instruction is MOST important for the client?
Answer: Take metformin with meals and report severe diarrhea, vomiting, or signs of dehydration
This question tests discharge planning and continuity of care in a client with new type 2 diabetes on metformin. The primary goal of discharge planning is to promote safe medication use and symptom recognition. Instructing to take with meals and report severe GI symptoms addresses the highest priority need to prevent lactic acidosis. Skipping meals risks instability; stopping for exercise is incorrect; checking for negative ketones is misguided. Effective discharge planning includes side effect education. It also involves health literacy assessment. A transferable strategy for planning safe discharges is to simplify instructions and confirm understanding of warning signs.
- A 58-year-old client with type 2 diabetes is being discharged after treatment of a foot cellulitis and is newly prescribed basal insulin at bedtime in addition to metformin. The client's fasting blood glucose this morning was 168 mg/dL, the wound is improving, and the client demonstrates difficulty drawing up insulin due to poor vision. The client lives with a spouse who is willing to help and has a primary care follow-up scheduled in 2 weeks. What should the nurse include in the discharge teaching for this client?
Answer: Demonstrate insulin pen use and teach signs and treatment of hypoglycemia before discharge
This question tests discharge planning and continuity of care for a diabetic patient starting new insulin therapy. The primary goal of discharge planning is to ensure patients have the knowledge and skills needed to safely manage new treatments at home. The correct answer (B) addresses the highest priority need by teaching proper insulin administration technique and hypoglycemia management, which are essential safety skills before discharge. Option A (skipping insulin) is dangerous and incorrect; Option C (stopping metformin) is incorrect as both medications are often used together; Option D (checking urine ketones daily) is unnecessary for type 2 diabetes patients on basal insulin. Effective discharge planning includes hands-on demonstration and return demonstration of critical skills, especially for vision-impaired patients who may benefit from insulin pens over syringes. When planning safe discharges with new medications, always verify the patient or caregiver can demonstrate proper technique and verbalize safety precautions before leaving the hospital.
- A 67-year-old client with chronic obstructive pulmonary disease is being discharged after an exacerbation treated with bronchodilators, steroids, and antibiotics. Current status: oxygen saturation 90% on 2 L/min nasal cannula, uses pursed-lip breathing effectively, and is prescribed a new long-acting inhaler; the client becomes short of breath walking to the bathroom. The client lives with a spouse who smokes and the client has no home oxygen equipment yet. Which referral is MOST appropriate for the client's discharge needs?
Answer: Durable medical equipment provider to deliver oxygen and teach safe home use before discharge
The client cannot be safely discharged until home oxygen is available and the client/spouse understand safe use, especially because a household member smokes. Arranging for a durable medical equipment provider to deliver oxygen and teach safe use before discharge directly addresses this priority; no other option does. The psychiatric consultation targets anxiety that is not documented in the scenario; even if the client is anxious, anxiety is not the critical safety issue and oxygen availability is. The orthopedic referral evaluates musculoskeletal causes of limited activity, but this client's dyspnea on walking is caused by COPD and deconditioning; orthopedic assessment would not solve the home oxygen gap. The dermatology referral aims at potential nasal-cannula skin breakdown, but there is no current breakdown and skin care is secondary to ensuring oxygen therapy is available, prescribed correctly, and safe to use at home. Therefore, the first and highest priority discharge referral is to the durable medical equipment provider.
- A 64-year-old client is being discharged after coronary stent placement for stable angina. The client is stable, radial access site is without bleeding, and the client will go home with an adult son. New prescriptions include aspirin and clopidogrel. Which discharge instruction is MOST important for the client?
Answer: Take both antiplatelet medications exactly as prescribed and do not stop without provider guidance
This question tests discharge planning and continuity of care in a client post-coronary stent placement. The primary goal of discharge planning is to prevent stent thrombosis through medication adherence. Instructing to take antiplatelets as prescribed addresses the highest priority need to avoid life-threatening clots. Avoiding vitamin K is irrelevant; expecting daily chest pain requires evaluation; using ibuprofen increases bleeding risk. Effective discharge planning includes medication education and side effect monitoring. It also involves family support for compliance. A transferable strategy for planning safe discharges is to emphasize the importance of not discontinuing critical medications without guidance.
- A 41-year-old client is being discharged after bariatric surgery. The client is tolerating clear liquids, has stable vital signs, and has a follow-up appointment scheduled in 1 week. The client lives with a supportive partner but is unsure about nutrition and vitamin needs. What should the nurse include in the discharge teaching for this client?
Answer: Follow the staged diet plan, prioritize protein, and take prescribed vitamin and mineral supplements
This question tests discharge planning and continuity of care in a client post-bariatric surgery. The primary goal of discharge planning is to support nutritional adaptation and prevent deficiencies. Instructing on staged diet, protein, and supplements addresses the highest priority need for healing and weight loss success. Advancing to solids quickly risks complications; avoiding activity delays recovery; drinking with meals causes dumping. Effective discharge planning includes detailed nutrition plans. It also involves follow-up scheduling. A transferable strategy for planning safe discharges is to provide procedure-specific guidelines and resource lists.
- A 62-year-old client is being discharged home 2 days after a total hip arthroplasty for osteoarthritis; history includes hypertension and obesity. The incision is clean and dry, pain is controlled with oral medications, and the client ambulates short distances with a walker but reports mild calf tightness. The client lives alone in a second-floor apartment and a neighbor can check in once daily. Which discharge instruction is MOST important for the client?
Answer: Call the provider immediately for new calf pain, swelling, warmth, or sudden shortness of breath
This question tests discharge planning and continuity of care for a post-surgical patient with risk factors for complications. The primary goal of discharge planning is to ensure patient safety and prevent complications during the transition from hospital to home. The correct answer (B) addresses the highest priority need by teaching the client to recognize and respond to signs of deep vein thrombosis or pulmonary embolism, which are life-threatening complications after hip surgery. Option A (incentive spirometer use) is important but less urgent than recognizing emergency symptoms; Option C contains incorrect information as incisions should be kept clean and dry without lotion; Option D (limiting fluids) could increase thrombosis risk and is contraindicated. Effective discharge planning prioritizes teaching about life-threatening complications over routine care instructions. When planning safe discharges, always ensure patients can recognize and respond to emergency warning signs before addressing routine self-care activities.
- A 62-year-old client is being discharged after a new diagnosis of deep vein thrombosis and initiation of apixaban. The client's leg swelling has improved, and the client will go home with a spouse. What should the nurse include in the discharge teaching for this client?
Answer: Use a soft toothbrush and report signs of bleeding such as black stools or unusual bruising
This question tests discharge planning and continuity of care in a client on apixaban for DVT. The primary goal of discharge planning is to minimize bleeding risks through safety measures. Instructing on soft toothbrush and bleeding signs addresses the highest priority need for anticoagulation safety. Stopping for dental without guidance risks clots; ibuprofen increases bleeding; avoiding walking risks progression. Effective discharge planning includes bleeding precaution education. It also involves family monitoring. A transferable strategy for planning safe discharges is to teach practical safety tips and reporting criteria.
- A 52-year-old client with alcohol use disorder is being discharged after hospitalization for acute pancreatitis; treatment included intravenous fluids, pain control, and nutrition advancement. Current status: tolerating a low-fat diet, pain controlled with oral medication, and lipase levels are improving; the client states, "I can stop drinking on my own" and has had prior relapses. The client lives alone and has limited family support but is motivated to keep their job. Which referral is MOST appropriate for the client's discharge needs?
Answer: Community addiction treatment program (outpatient counseling and support group) with a scheduled intake appointment
The best discharge plan must address the alcohol use disorder as well as the recovering pancreas, especially because the client has relapsed before, lives alone, and says they can stop drinking on their own. A structured community addiction treatment program with a scheduled intake appointment provides the counseling, support, and follow-up needed to prevent recurrence of pancreatitis. Home TPN is not appropriate because the client is already tolerating a low-fat diet and lipase levels are improving; it also does nothing to treat the addiction. A rheumatology referral is off target because the abdominal pain is from pancreatitis rather than a rheumatic, autoimmune, or connective tissue condition. A sports medicine exercise plan may help with stress or conditioning, but it does not deliver addiction-specific treatment or relapse prevention. For a safe discharge, arrange a definite appointment with addiction services rather than relying on the client's self-management alone.
- An 81-year-old client with mild dementia is being discharged after a urinary tract infection and dehydration; history includes osteoarthritis and hearing impairment. Current status: alert to person and place, ambulates with a cane, and is prescribed a 7-day oral antibiotic; the client has fallen twice in the last month. The client's daughter manages finances but lives 45 minutes away and visits on weekends; the client insists on returning home alone. What is the nurse's PRIORITY when planning for this client's discharge?
Answer: Assess home safety and arrange support services (e.g., home health and fall-risk interventions) before discharge
This question tests discharge planning and continuity of care for an elderly patient with cognitive impairment and safety risks. The primary goal of discharge planning is to ensure a safe home environment that matches the patient's functional abilities and support needs. The correct answer (A) addresses the highest priority need by assessing home safety and arranging appropriate support services to prevent falls and ensure medication compliance. Option B (taking antibiotics only for symptoms) is incorrect and promotes incomplete treatment; Option C (stopping cane use) is dangerous and increases fall risk; Option D (immediate nursing home placement) violates patient autonomy and skips necessary assessment steps. Effective discharge planning balances patient autonomy with safety needs through comprehensive assessment and graduated interventions. When planning safe discharges for cognitively impaired elderly patients living alone, prioritize home safety evaluation and support services while respecting the patient's desire for independence.
- A 58-year-old client with heart failure (ejection fraction 30%) is transitioning from the hospital to home after IV diuresis for fluid overload. The client is breathing comfortably on room air, has mild ankle edema, and can ambulate to the bathroom; discharge is planned today. The client lives alone, has limited transportation, and reports difficulty affording medications. What is the nurse's PRIORITY when planning for this client's discharge?
Answer: Arrange a social work consult to address medication access and follow-up transportation
This question tests discharge planning and continuity of care in a client with heart failure facing socioeconomic barriers. The primary goal of discharge planning is to facilitate a smooth transition by identifying and addressing obstacles to self-management and follow-up. Arranging a social work consult for medication access and transportation addresses the highest priority need because limited resources can lead to nonadherence and readmission. Providing diet and exercise instructions is important but lower priority without access to care; teaching extra diuretic doses risks electrolyte imbalance; encouraging a pulse oximeter purchase is unnecessary for stable breathing. Effective discharge planning includes interdisciplinary collaboration to resolve barriers like transportation and finances. It also involves confirming the client's understanding of their condition and management plan. A transferable strategy for planning safe discharges is to assess social determinants of health and connect clients to community resources early.
- A 52-year-old client with newly diagnosed hypertension is being discharged after evaluation for headache; imaging is negative and blood pressure is controlled on a new prescription for lisinopril. The client is otherwise healthy and lives with a roommate; the client does not have a primary care provider. Which follow-up plan is MOST appropriate for continuity of care?
Answer: Schedule a blood pressure check and primary care visit within 1–2 weeks
This question tests discharge planning and continuity of care in a client with new hypertension without a primary provider. The primary goal of discharge planning is to establish ongoing monitoring to prevent complications like stroke. Scheduling a blood pressure check and primary care visit within 1-2 weeks addresses the highest priority need for medication adjustment and follow-up. Returning to the ED monthly is inefficient; stopping medication for dizziness risks uncontrolled pressure; delaying follow-up is unsafe. Effective discharge planning includes linking to primary care resources. It also involves educating on medication adherence. A transferable strategy for planning safe discharges is to arrange timely follow-up appointments and confirm access to care.
