Discharge Planning And Continuity Of Care
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NCLEX-RN › Discharge Planning And Continuity Of Care
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?
Outpatient dermatology for routine skin cancer screening
Speech-language pathology to evaluate swallowing and aspiration risk
Home health nursing for wound assessment, dressing changes, and teaching
Cardiac rehabilitation to improve endurance and circulation
Explanation
This question tests discharge planning and continuity of care in a diabetic client with a foot ulcer requiring ongoing wound management. The primary goal of discharge planning is to ensure continuity of specialized care to prevent complications like infection or amputation. Referring to home health nursing for wound assessment and teaching addresses the highest priority need given the client's physical limitations and need for daily care. Cardiac rehabilitation is not indicated without cardiac issues; speech pathology is irrelevant without swallowing concerns; dermatology screening is routine but lower priority than wound care. Effective discharge planning involves evaluating the client's mobility and support system for task assistance. It also includes coordinating referrals that match the client's specific health needs. A transferable strategy for planning safe discharges is to prioritize referrals that address ongoing skilled needs and involve family in the care plan.
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?
Limit fluids after 6 PM to prevent nighttime urination and falls
Report calf pain, warmth, swelling, or sudden shortness of breath immediately
Change the dressing daily and apply antibiotic ointment to the incision
Use an incentive spirometer every 2 hours while awake for the next 2 weeks
Explanation
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 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?
Arrange a social work consult to address medication access and follow-up transportation
Teach the client to take an extra diuretic dose whenever swelling increases
Encourage the client to purchase a pulse oximeter to monitor oxygen levels
Provide written instructions on a low-sodium diet and daily exercise goals
Explanation
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 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?
Use a soft toothbrush and report signs of bleeding such as black stools or unusual bruising
Take ibuprofen routinely for leg pain because it is safer than acetaminophen
Avoid walking until all swelling is gone to prevent clot migration
Stop apixaban for 2 days before any dental cleaning without notifying the provider
Explanation
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 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?
Use douching daily to prevent recurrence of infection
Stop antibiotics when pelvic pain resolves to reduce yeast infection risk
Complete the full antibiotic course, avoid sexual activity until treatment is finished, and ensure partner evaluation/treatment
Avoid sunlight entirely for 6 months while taking doxycycline
Explanation
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.
A 50-year-old client with major depressive disorder is being discharged after inpatient stabilization; the client denies suicidal ideation, has a safety plan, and is prescribed sertraline. The client lives with a sister who can help monitor symptoms. Which discharge instruction is MOST important for the client?
Report worsening depression, new agitation, or suicidal thoughts, especially in the first few weeks
Stop sertraline when sleep improves to prevent dependence
Expect mood improvement immediately after the first dose of sertraline
Avoid all carbohydrates to reduce medication side effects
Explanation
This question tests discharge planning and continuity of care in a client with depression on sertraline. The primary goal of discharge planning is to ensure safety through symptom monitoring. Instructing to report worsening or suicidal thoughts addresses the highest priority need due to initial medication risks. Expecting immediate improvement is unrealistic; stopping when better risks relapse; avoiding carbs is unnecessary. Effective discharge planning includes safety plans. It also involves family involvement. A transferable strategy for planning safe discharges is to highlight black box warnings and crisis resources.
A 29-year-old client is being discharged after an uncomplicated vaginal delivery. The client plans to breastfeed, reports mild perineal discomfort, and has stable vital signs. The client lives with a supportive partner but has a history of depression and reports feeling “overwhelmed.” What is the nurse's PRIORITY when planning for this client's discharge?
Teach perineal care and the use of sitz baths for comfort
Encourage the client to begin jogging within 1 week to improve mood
Screen for postpartum depression symptoms and provide follow-up resources and crisis contacts
Instruct the client to avoid all visitors for the first month to reduce stress
Explanation
This question tests discharge planning and continuity of care in a postpartum client with a depression history. The primary goal of discharge planning is to promote maternal well-being by addressing mental health risks. Screening for postpartum depression and providing resources addresses the highest priority need given the client's history and feelings of being overwhelmed, which can impact bonding and safety. Teaching perineal care is routine but lower priority; encouraging early jogging risks physical strain; avoiding visitors is isolating. Effective discharge planning includes mental health assessment and crisis contacts. It also involves engaging family support for monitoring. A transferable strategy for planning safe discharges is to integrate mental health screening and connect to support services proactively.
A 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?
Teach the client to remove throw rugs after the fracture heals
Recommend limiting fluid intake to reduce trips to the bathroom
Encourage the client to take over-the-counter sleep aids to improve rest
Arrange a home safety evaluation and confirm a reliable caregiver plan before discharge
Explanation
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 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?
Use ibuprofen daily to prevent inflammation in the artery
Take both antiplatelet medications exactly as prescribed and do not stop without provider guidance
Expect mild chest pain daily for several weeks after stent placement
Avoid all foods containing vitamin K to prevent clot formation
Explanation
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 66-year-old client with peripheral arterial disease is being discharged after angioplasty. The groin access site is dry, pulses are palpable, and pain is minimal. The client smokes one pack per day and lives with a spouse who also smokes. What is the nurse's PRIORITY when planning for this client's discharge?
Recommend strict bedrest for 2 weeks to protect the access site
Teach the client to soak the access site in warm water twice daily
Instruct the client to stop antiplatelet therapy if bruising occurs
Provide smoking cessation counseling and referral resources to reduce risk of restenosis and complications
Explanation
This question tests discharge planning and continuity of care in a client post-angioplasty with ongoing smoking. The primary goal of discharge planning is to modify risk factors for long-term vascular health. Providing smoking cessation counseling addresses the highest priority need to prevent restenosis and progression. Soaking the site risks infection; stopping antiplatelets risks clots; bedrest delays recovery. Effective discharge planning includes lifestyle modification education. It also involves family involvement in changes. A transferable strategy for planning safe discharges is to prioritize risk factor reduction and connect to cessation resources.