CH 23 Admitting, Transferring, and Discharging Patients
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The nurse is aware that patients who are admitted to the acute care facility as a routine admission under a managed care plan must:
have Medicare.
be preapproved
be able to pay the deductible.
be admitted several days prior to the procedure.
ANS: B
Managed care insurance programs require that all routine admissions be preapproved. Often the patient is required to come to the acute care facility several days prior to the admission to complete paperwork or laboratory procedures.
DIF: Cognitive Level: Comprehension
REF: p. 398
OBJ: Theory #1
TOP: Managed Care
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
A patient is scheduled to have a diagnostic procedure performed on an outpatient basis at
9:00 AM. The nurse will advise the patient to:
arrive 2 hours before the scheduled procedure.
wear comfortable clothing.
read printed materials about the procedure.
be prepared to pay at least 10% of the predicted cost of the hospitalization.
ANS: A
Patients are usually required to arrive 1 to 2 hours before a scheduled procedure to complete the necessary paperwork. The patient may be requested to pay a co-pay or a deductible, but there is no set amount.
DIF: Cognitive Level: Comprehension
REF: p. 399
OBJ: Theory #1
TOP: Outpatient Admission
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
If there is a prior authorization for hospitalization required for a routine admission, the nurse explains that the notification to the insurance company is the responsibility of the:
patient.
admissions department of the health facility.
patient, primary care provider, and the admissions department.
office of the admitting primary care provider.
ANS: D
The office of the admitting primary care provider is the usual agent to get prior approval for a hospitalization. The admissions department confirms that all preadmission requirements are met.
DIF: Cognitive Level: Knowledge
REF: p. 399
OBJ: Theory #1
TOP: Admission Procedures
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse orienting a new patient to the unit would include:
expected cost of the room per day.
location of call bell and how to use it.
calling the patient by their first name for less formality.
times of the shift changes.
ANS: B
Newly admitted patients should be treated with respect without familiarity. The physical arrangement of the room and bath, how to work all controls, such as the call bell, and the names of the nurses who will be giving care should be included in the orientation.
DIF: Cognitive Level: Comprehension
REF: p. 400
TOP: Admission KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
OBJ: Clinical Practice #1
A patient admitted to the acute care facility through the emergency department has jewelry and a large amount of money. The most efficient intervention about these valuables would be:
send them home with a family member.
put them away quickly in the patient's closet.
lock them in the narcotics cabinet on the nursing unit.
place them in a valuables envelope and have them locked in the agency safe.
ANS: A
Valuables such as credit cards, money, or jewelry should be sent home with a family member.
DIF: Cognitive Level: Application
REF: p. 400
TOP: Admission
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
OBJ: Clinical Practice #1
While admitting a patient from home to the skilled nursing facility, the nurse notes that the patient has brought medications that are not included on the primary care provider's medication order sheet. The nurse's best initial action is to:
send the medications home with a family member.
seal the medications in an envelope and lock it in the medicine cart.
administer the medications with the ordered medications.
notify the physician about the medications the patient has been taking.
ANS: D
It is important to notify the primary care provider of any medications the patient has been taking at home that are not included in the present orders.
DIF: Cognitive Level: Application
REF: p. 401
OBJ: Clinical Practice #1
TOP: Admission KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
New orders have been written by the primary care provider for a patient admitted to a skilled nursing facility. After transcription, the orders will be verified by the:
unit secretary.
administrative RN.
LPN/LVN in charge.
director of nurses.
ANS: C
In most skilled nursing facilities, verification of orders (checking and signing them) is performed by the LPN/LVN.
DIF: Cognitive Level: Application
REF: p. 402
OBJ: Clinical Practice #1
TOP: Orders in Skilled Nursing Facility KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
When the nurse discovers that the patient's consent form for an invasive procedure was transcribed incorrectly, the nurse should:
cross out the incorrect information and write error, and then write in the correct information.
destroy the incorrect form and write a new one correctly.
cross out the entire form, but leave it in the medical record as a permanent record.
notify the primary care provider of the error and clarify what the primary care provider prefers to be done.
ANS: B
The consent form is considered a legal document and should be transcribed accurately to prevent errors; the incorrect one should be destroyed.
DIF: Cognitive Level: Application
REF: p. 401
OBJ: Clinical Practice #1
TOP: Consent Forms
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
A patient's condition warrants a transfer from intensive care to a regular nursing unit in the same acute care facility. Before assisting with the patient's move, the nurse notes that the transfer has been authorized by the:
patient.
charge nurse.
primary care provider.
family.
ANS: C
In general, transfers from one nursing area to another require a specific order by the primary care provider. The charge nurse of the receiving unit should be notified as well as the patient and family.
DIF: Cognitive Level: Application
REF: p. 402
TOP: Transfer
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: Clinical Practice #3
A newly admitted patient has his own walker that he wishes to use during this acute care facility stay. The responsibility of the nurse to this piece of durable equipment is to:
write the patient's name on a wide piece of tape and affix it to the walker.
list the walker as part of the patient's personal belongings and place the list in his medical record.
tell the patient that personal walkers cannot be used in the acute care facility for safety reasons.
document a note in the nursing care plan that the patient has his own walker.
ANS: A
All equipment brought to the acute care facility by the patient should be clearly labeled, usually with a wide piece of tape on which the patient's name is written in large letters.
DIF: Cognitive Level: Application
REF: p. 402
TOP: Admission
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
OBJ: Theory #3
The nurse helping to organize the transfer of an older adult patient from the acute care facility to an extended care facility will be sure to:
check drawers and shelves for personal items.
give unused medications to the patient.
ask the business office to send stored valuables to the receiving facility.
send a small snack with the patient.
ANS: A
Checking drawers and shelves for personal items prior to a transfer is helpful in preventing loss.
DIF: Cognitive Level: Knowledge
TOP: Transfer
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: Clinical Practice #3
p. 402
As a member of the health care team, the LPN/LVN understands that discharge planning for the hospitalized patient begins:
the day before discharge.
at the time of admission.
immediately following diagnostic procedures or surgery.
as soon as a family meeting is scheduled.
ANS: B
Discharge planning begins at admission, especially if the diagnosis indicates that the patient will need rehabilitation or long-term assistance.
DIF: Cognitive Level: Comprehension REF: p. 403
TOP: Discharge
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: Theory #5
A patient who is scheduled for discharge has items that were stored in the hospital safe.
After retrieving them, the nurse should document their return to the patient by:
making an entry in the primary care provider progress notes.
writing a note to the charge nurse.
having the patient sign for them as per policy.
asking the unit secretary to place a note in the chart.
ANS: C
Retrieve any valuables stored in the acute care facility safe before discharge and have the patient sign according to policy and procedure.
DIF: Cognitive Level: Application
REF: p. 403
TOP: Discharge
KEY: Nursing Process Step: Implementation
OBJ: Theory #5
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
A patient has an acute care facility discharge order for later that day. The LPN/LVN understands that part of the discharge process to be performed by the registered nurse is:
packing the patient's personal belongings.
writing the discharge instructions.
assisting the patient to get dressed
accompanying the patient to the acute care facility entrance.
ANS: B
Written discharge instructions are prepared by the RN. The remaining duties can be performed by the LPN/LVN.
DIF: Cognitive Level: Application
REF: p. 403
OBJ: Theory #5
TOP: Discharge
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
A patient who has questions about the availability of home health services after hospital discharge should be referred to the:
primary care provider.
registered nurse.
occupational therapist.
medical social worker (MSW).
ANS: D
An MSW can provide information about long-term planning, financial assistance, and community services available after discharge.
DIF: Cognitive Level: Application C
REF: p. 404
TOP: Discharge
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: Clinical Practice #5
A hospitalized patient tells the nurse that he intends to leave the acute care facility, against medical advice. The nurse's initial action(s) should be to:
listen to the patient, answer questions, and offer to have the supervisor or physician speak with the patient.
advise the patient that this may mean that insurance would not pay for this hospitalization.
obtain a written explanation of the reasons from the patient and have the patient sign at the bottom of the sheet.
call both the supervisor and a family member to try to get the patient to reconsider.
ANS: A
It is the responsibility of the health team to help patients understand the significance of leaving against medical advice. Listen to what the patient has to say and offer to help get the problem resolved without resorting to a discharge. If the ultimate decision is to leave, the primary care provider is notified and the patient is asked to sign a form indicating that he or she is leaving against medical advice.
DIF: Cognitive Level: Application
REF: p. 404
TOP: Discharge Against Medical Advice (AMA)
KEY: Nursing Process Step: Implementation
OBJ: Theory #5
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
A patient is near death and the family is upset and disorganized. The most helpful intervention for the patient and the family would be for the nurse to:
ask the family the name of their mortician.
offer to call the spiritual advisor (eg, priest, minister, or rabbi).
encourage the family to perform their rituals
encourage the family to visit the chapel.
ANS: B
If death is anticipated, many people derive significant comfort from spiritual or religious beliefs or practices.
DIF: Cognitive Level: Application
REF: p. 404
OBJ: Clinical Practice #6
TOP: Death of a Patient
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
For the nurse to provide support to families of patients who have died, it is most important to:
have an understanding that all people deal with death in due time.
read a number of articles about death and dying.
have a personal experience of a similar nature.
deal with personal feelings about death and dying.
ANS: D
Before someone can be a support person to someone who has lost a loved one, he or she must have dealt with personal feelings about death.
DIF: Cognitive Level: Comprehension REF: p. 404
OBJ: Clinical Practice #6
TOP: Death of a Patient
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation
A nurse who was present at the time of the death of a patient should document:
time of death.
time at which life signs ceased.
notification of the mortuary.
which family members were notified.
ANS: B
It is still required in most states for a physician to pronounce death. The nurse should document when all signs of life ceased. The name of the person making the pronouncement and the time should be documented.
DIF: Cognitive Level: Knowledge
REF: p. 404
OBJ: Theory #6
TOP: Pronouncement of Death
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
A young patient has died in the emergency department after suffering severe trauma. The nurse understands that this patient's family may take comfort from the opportunity to:
allow donation of the patient's organs.
view all of the injuries to the patient's body.
plan the funeral before leaving the acute care facility.
donate the patient's belongings to charity.
ANS: A
When handled sensitively, requests for organ donation can be an opportunity for the family to allow something good to come out of a personal tragedy.
DIF: Cognitive Level: Application
REF: p. 405
OBJ: Clinical Practice #6
TOP: Organ Donation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
A blind, older adult patient is admitted to the acute care facility for dehydration and weakness. The nurse can make the admission process less stressful by:
sending all personal belongings home with family members.
performing the initial assessment in a nonhurried manner.
providing a printed orientation handout regarding acute care facility policy.
performing a quick assessment before orienting the patient to the unit.
ANS: B
Older adult patients need time and support in adjusting to an acute care facility stay. An unhurried manner will show support and give the patient a little more time to adjust to the change.
DIF: Cognitive Level: Application
REF: p. 400
TOP: Admission KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation
OBJ: Clinical Practice #3
It is determined that a patient is brain dead after suffering a massive cerebral bleed. The primary care provider has just talked to the family about removing the patient from life support. The nurse would anticipate:
calling the coroner's office.
calling the insurance company.
contacting the organ donation team.
asking about an autopsy.
ANS: C
Requests for organ donation are usually done by a primary care provider or a nurse trained for making such requests.
DIF: Cognitive Level: Comprehension
TOP: Organ Donation
MSC: NCLEX: Psychosocial Integrity
REF: p. 405
OBJ: Clinical Practice #6
KEY: Nursing Process Step: Implementation
The nurse recognizes that an autopsy must be performed when the patient:
is over 52.
died suddenly, unexpectedly, or suspiciously.
has requested it on admission.
has died of a brain tumor.
ANS: B
Autopsies are performed when a death is sudden or unexpected, the result of injury or suspicious circumstances (such as suspected homicide). A family may request an autopsy, but they may have to incur the costs.
DIF: Cognitive Level: Knowledge
REF: p. 405
TOP: Autopsy
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
OBJ: Theory #2
The nurse is performing an initial assessment on a patient with respiratory difficulty. The nurse would anticipate documenting signs and symptoms such as:
alteration in sensation.
use of accessory muscles.
regular respiratory pattern.
excessive dryness.
ANS: B
An example of signs found in a patient with respiratory difficulty is use of accessory muscles of respiration.
DIF: Cognitive Level: Comprehension
OBJ: Clinical Practice #2
REF: p. 401|Table 23-1
TOP: Assessment
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity: Physiological Adaptation
The nurse is assisting with an admission assessment of a patient with hypertension. While the nurse is preparing to weigh the patient, the patient states, "It is not necessary to weigh me, because I weighed 130 pounds last week." What would be the nurse's best response?
"Are you sure that your weight has not changed?"
"I will write down your stated weight."
"It is important to get a more recent weight."
"Don't worry; your weight is confidential."
ANS: C
The patient should be weighed and measured rather than the stated height and weight being accepted.
DIF: Cognitive Level: Application
REF: p. 401|Table 23-1
OBJ: Clinical Practice #2
TOP: Assessment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and Comfort
The nurse reminds a patient that if enrolled in a managed care program, some procedures will not be approved for payment, such as:
cosmetic surgery to repair a scar from an accident.
breast augmentation.
emergency admission for shortness of breath.
postmastectomy breast implants.
ANS: B
Elective cosmetic surgeries are not covered by managed care companies.
DIF: Cognitive Level: Comprehension REF: p. 399
OBJ: Theory #1
TOP: Nonpayment for Procedures
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
When the orders have been verified, the nurse:
draws a line below the orders and signs his or her name and the date.
signs his or her name in red immediately below the primary care provider's signature.
documents, "Transcribed by A Nurse at 0900."
draws a line down the left margin; then signs, dates, and times the transcription.
ANS: D
After the verification of the order, the nurse draws a line down the left-hand margin; then the nurse signs, dates, and times the transcription.
DIF: Cognitive Level: Application
REF: p. 402
OBJ: Clinical Practice #2
TOP: Documentation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse is orienting an older adult patient newly admitted to the nursing unit. Which are appropriate interventions to apply to alleviate the patient's anxiety? (Select all that apply.)
Call the patient by his first name.
Instruct the patient on the use of the call light.
Encourage the patient to ask questions regarding admission.
Allow extra time for the patient to process any new information.
Lock all patient valuables in the facility's safe storage.
ANS: B, C, D
Respectful and proper communication, especially during orientation of the patient to the facility, alleviates anxiety. It is best to orient the patient to the room, including the use of the call light, and to allow the patient time to process information and ask questions.
DIF: Cognitive Level: Application
REF: p. 400
OBJ: Theory #3
TOP: Health Education
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
A patient dies after suffering a severe cerebrovascular accident (CVA). The family members are informed of his demise and are at the bedside. What documentation should be noted in the patient's medical record? (Select all that apply.)
Results of the autopsy
Who pronounced the patient
Official time of death
Time vital signs ceased
Why the patient died
ANS: B, C, D
Death must be accurately noted in the medical record and should include who pronounced the patient's death, the time vital signs ceased, and the official time of death.
DIF: Cognitive Level: Application
TOP: Pronouncement of Death
MSC: NCLEX: Physiological Integrity
REF: p. 404
OBJ: Clinical Practice #6
KEY: Nursing Process Step: N/A
The nurse appreciates that a routine acute care facility admission differs from an emergency admission in that a routine admission: (Select all that apply.)
is scheduled in advance.
is not stressful.
is completely covered by insurance.
has a predictable outcome.
allows time to arrange for disruptions in routine.
ANS: A, E
Routine admissions are scheduled in advance with the full knowledge and permission of the third-party payer. Routine admissions allow for time to arrange for disruptions in a family's routine. All acute care facility admissions can be stressful and potentially have unpredictable outcomes. Insurance may not completely cover the expense.
DIF: Cognitive Level: Comprehension REF: p. 398
OBJ: Theory #1
TOP: Routine Admissions
KEY: Nursing Process Step: Planning
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
The nurse explains that the Admitting Department of the acute care facility has a number of significant duties, which include: (Select all that apply.)
arranging for preadmission laboratory work and radiographs.
notifying the patient's spiritual counselor of the admission.
confirming that all admission criteria are met.
arranging for special diets.
making arrangements for co-pays and deductibles.
ANS: C, E
The Admitting Department handles all the paperwork necessary for hospitalization prior to the actual admission. They confirm that all preadmission studies have been done and the insurance company is in accordance with the admission. They will also keep track of co-pays and deductibles of the patient's insurance.
DIF: Cognitive Level: Comprehension REF: p. 399
OBJ: Theory #2
TOP: Admitting Department
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated Care
An examination of the remains of a body by a pathologist to determine the cause of death is a(n)_______________.
ANS: autopsy
An autopsy is an examination of the remains by a pathologist to determine the cause of death. An autopsy is usually performed when the patient has died of unknown causes, has died at the hands of another, or has not been seen within a specific period of time by a primary care provider.
DIF:
Cognitive Level: Knowledge
TOP: Post Mortem
REF: p. 405
OBJ: Theory #6
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
Note 
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