Discharge And Transfer Participation
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NCLEX-PN › Discharge And Transfer Participation
A 66-year-old client with a left hip fracture status post repair is being transferred from the hospital to an inpatient rehabilitation center. The client is stable, has a surgical dressing that is clean and dry, uses a walker with two-person assist, and has scheduled pain medication; the LPN/VN is giving the handoff report to the receiving nurse and coordinating with physical therapy and the RN. What information should the nurse include in the handoff report to the receiving facility?
A detailed explanation of the surgical technique used for the hip repair
The client’s weight-bearing status, last pain medication dose/time, and current mobility assistance needs
The client’s preferred television channel and usual bedtime routine
A plan to change the postoperative medication regimen if pain increases
Explanation
This question tests skills in discharge and transfer participation within coordinated care during facility-to-facility transfer. The priority concern is ensuring safety and continuity of care by communicating essential clinical information. Weight-bearing status, last pain medication dose/time, and current mobility assistance needs are the best choices because they directly impact immediate care decisions and safety at the receiving facility, preventing falls and ensuring appropriate pain management. Television preferences and bedtime routine (A) are comfort measures but not safety priorities; surgical technique details (C) are not necessary for immediate care; and changing medication regimens (D) is beyond the LPN/VN scope and should be communicated through proper channels. The decision-making principle is that handoff communication must include current functional status and time-sensitive information that affects immediate care. A transferable strategy is to use structured communication tools like SBAR to ensure all critical safety and care continuity information is communicated during transfers.
A 71-year-old client is being discharged home after a transient ischemic attack; current status: neurologically intact, started on an antiplatelet medication, spouse present for teaching. The LPN/VN is reinforcing warning signs and follow-up needs per the RN’s plan. Which discharge instruction is MOST important to reinforce with the client?
Stop the antiplatelet medication if minor bruising occurs
Avoid all physical activity permanently to prevent another event
Wait 24 hours to see if symptoms improve before seeking help
Call emergency services immediately for sudden face droop, arm weakness, speech difficulty, or severe headache
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is recognizing stroke symptoms post-TIA for prompt intervention. Reinforcing to call emergency for FAST signs or headache is most important for safety. Waiting 24 hours delays care; stopping antiplatelet for bruising is unsafe; avoiding activity permanently is excessive. Discharge planning emphasizes warning signs. A principle is teaching time-sensitive responses. A transferable strategy is to use acronyms like FAST in education for neurological events.
A 79-year-old client with type 2 diabetes is being discharged home after a short hospitalization for dehydration. The client is stable, has a new prescription for insulin glargine once daily, and the adult child will assist with care; the RN initiated teaching, and the LPN/VN is reinforcing injection technique and coordinating follow-up with the primary care provider. Which discharge instruction is MOST important to reinforce with the client and family?
Store opened insulin at room temperature next to a sunny window for easy access
Rotate injection sites and report signs of hypoglycemia such as sweating, shakiness, or confusion
Skip insulin doses on days when appetite is poor without checking blood glucose
Use the same injection site daily to reduce discomfort
Explanation
This question tests skills in discharge and transfer participation within coordinated care for diabetes management. The priority concern is preventing hypoglycemia and ensuring safe insulin administration in the home setting. Teaching about injection site rotation and hypoglycemia recognition addresses the most immediate safety risks with insulin therapy, as hypoglycemia can be life-threatening and injection site problems can affect absorption. Skipping doses without checking glucose (B) risks hyperglycemia and complications; storing insulin by a sunny window (C) degrades the medication; and using the same site daily (D) causes lipodystrophy affecting absorption. The decision-making principle is that discharge planning for new insulin users must prioritize safety through proper technique and complication recognition. A transferable strategy is to demonstrate and have clients return-demonstrate injection technique while verbalizing safety precautions, ensuring competency before discharge with new high-risk medications.
A 47-year-old client is being discharged home with a new prescription for an opioid analgesic after a fracture; current status: pain controlled, alert, no respiratory issues. The LPN/VN is reinforcing medication safety teaching. Which discharge instruction is MOST important to reinforce with the client?
Store the medication in an unlocked kitchen drawer for easy access
Stop using stool softeners because constipation is not expected
Take an extra dose if pain returns within 1 hour of the last dose
Do not drive or drink alcohol while taking this medication, and take it only as prescribed
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is safe opioid use post-discharge for fracture pain. Reinforcing no driving/alcohol and taking as prescribed is most important to prevent overdose or accidents. Extra doses risk toxicity; unlocked storage is unsafe; stopping softeners ignores constipation risk. Discharge planning emphasizes safety and adherence. A principle is addressing misuse potential. A transferable strategy is to teach side effects and precautions for controlled substances to ensure safe home use.
A 74-year-old client with mild dementia is being discharged home with a family caregiver after a urinary tract infection; current status: improved confusion, needs reminders for medications. The LPN/VN is collaborating with the RN and social worker. Which action by the nurse ensures continuity of care?
Instruct the caregiver to stop antibiotics if diarrhea occurs without notifying anyone
Tell the client to manage medications independently to maintain autonomy
Provide a written medication schedule, use teach-back with the caregiver, and confirm who will pick up prescriptions
Arrange for the LPN/VN to change the antibiotic dose at home based on urine odor
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is medication adherence for the client with dementia and caregiver support. Providing a written schedule, using teach-back, and confirming prescription pickup ensures continuity. Promoting full independence may lead to errors; stopping for diarrhea without notice is unsafe; changing doses exceeds scope. Discharge planning involves family collaboration. A principle is assessing support systems. A transferable strategy is to engage caregivers in education and planning for dependent clients.
A 39-year-old client is being discharged home after laparoscopic gallbladder removal; current status: tolerating diet, pain controlled with oral medication, incision sites clean with steri-strips. Which discharge instruction is MOST important to reinforce with the client?
Report fever, increasing redness, drainage, or worsening pain at incision sites
Take all pain medication on an empty stomach to improve absorption
Avoid walking for 2 weeks to prevent bleeding
Remove steri-strips immediately when you get home
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is infection prevention post-laparoscopic surgery. Reinforcing to report signs of infection like fever or worsening pain is most important for early detection. Removing steri-strips prematurely risks dehiscence; avoiding walking is unnecessary; taking on empty stomach may cause GI upset. Discharge planning emphasizes symptom recognition. A principle is teaching when to seek care. A transferable strategy is to provide written signs of complications for all surgical discharges to ensure safety.
A 76-year-old client with cataract surgery is being discharged home the same day; current status: vital signs stable, eye shield in place, prescribed antibiotic eye drops. The LPN/VN is reinforcing instructions with the client and adult child. The nurse should PRIORITIZE which task when preparing the client for discharge?
Instruct the client to drive home if vision seems clear enough
Tell the client to skip follow-up visits if there is no pain
Encourage heavy lifting to strengthen the arms and improve balance
Teach proper eye drop administration and reinforce not rubbing the eye and wearing the shield as instructed
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is post-operative eye care and complication prevention after cataract surgery. Prioritizing teaching drop administration, not rubbing, and shield use is key for safety. Heavy lifting risks pressure; driving with impaired vision is dangerous; skipping visits risks undetected issues. Discharge planning reinforces procedure-specific instructions. A principle is hands-on demonstration. A transferable strategy is to involve family in teaching for same-day surgeries to ensure adherence.
A 63-year-old client is being transferred from a medical-surgical unit to a skilled nursing facility after a stroke with right-sided weakness and mild dysphagia. The client is stable, requires assistance with feeding, and is on a mechanical-soft diet with thickened liquids; the LPN/VN is providing the transfer report and collaborating with speech therapy, dietary, and the RN. What information should the nurse include in the handoff report to the receiving facility?
An order to discontinue thickened liquids if the client requests water
A recommendation to advance the diet to regular foods as tolerated without evaluation
The client’s preferred visitors and favorite foods prior to hospitalization
The client’s swallowing precautions, current diet consistency, and need for supervision during meals
Explanation
This question tests skills in discharge and transfer participation within coordinated care for a client with dysphagia. The priority concern is preventing aspiration and ensuring nutritional safety during the facility transfer. Communicating swallowing precautions, diet consistency, and supervision needs provides critical safety information to prevent aspiration pneumonia and ensure appropriate nutrition support. Preferred visitors and foods (A) are important for quality of life but not immediate safety; advancing diet without evaluation (C) risks aspiration; and discontinuing thickened liquids per client request (D) bypasses necessary swallowing assessments. The decision-making principle is that transfer communication must include all safety precautions and functional limitations that affect daily care. A transferable strategy is to include specific dietary restrictions, supervision requirements, and positioning needs in standardized transfer documentation to ensure continuity of safe nutritional care.
A 33-year-old client is being discharged home with a new diagnosis of gastroesophageal reflux disease; current status: stable, started on a proton pump inhibitor. The LPN/VN is reinforcing lifestyle teaching. Which discharge instruction is MOST important to reinforce with the client?
Lie flat immediately after meals to help digestion
Stop the medication once heartburn improves for one day
Avoid lying down right after eating and elevate the head of the bed if symptoms occur at night
Eat large meals late in the evening to prevent hunger overnight
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is lifestyle modifications for GERD management post-discharge. Reinforcing to avoid lying down after eating and elevate bed head is most important to reduce reflux. Lying flat worsens symptoms; large late meals exacerbate; stopping medication early risks recurrence. Discharge planning includes non-pharmacologic teaching. A principle is promoting adherence to habits. A transferable strategy is to reinforce behavioral changes with rationale for chronic conditions.
A 80-year-old client with a stage 2 pressure injury is being transferred to a skilled nursing facility; current status: wound covered with ordered dressing, incontinent of urine, requires turning assistance. The LPN/VN is preparing the transfer report and coordinating with the wound care nurse. What information should the nurse include in the handoff report to the receiving facility?
The client’s preferred brand of soap for bathing
A request that the receiving facility leave the wound open to air to dry it out
Wound location/stage, current dressing type and change schedule, turning schedule, and incontinence care plan
A plan for the LPN/VN to debride the wound at the receiving facility
Explanation
This question tests skills in discharge and transfer participation within coordinated care. The priority concern is wound healing and prevention of pressure injury progression during transfer. Including wound details, dressing schedule, turning, and incontinence plan is best for continuity. Preferred soap is minor; leaving open to air risks drying; debriding exceeds LPN/VN scope at transfer. Decision-making focuses on care continuity. Principles include coordinating with specialists. A transferable strategy is to document preventive measures in reports for skin integrity maintenance.