Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 12 Interprofessional Collaborative Practice and Care Coordination Across Settings

A discharge nurse manager is preparing the plan for a patient returning home after receiving a kidney transplant. What actions will the nurse perform to ensure continuity of care? Select all that apply.

a. Conduct an admission health assessment

b. Evaluate the effectiveness of the current nursing care plan

c. Participate in transferring the patient to the postoperative care unit

d. Make referrals to appropriate facilities

e. Maintain records of patient satisfaction with services received

f. Assess the strengths and limitations of the patient and family

b, d, f.

b. Evaluate the effectiveness of the current nursing care plan

d. Make referrals to appropriate facilities

f. Assess the strengths and limitations of the patient and family

The primary roles of the discharge planner as patients move from acute to home care are evaluating the nursing plan for effectiveness of care, making referrals for patients, and assessing the strengths of patients and their families. The staff typically performs an admission health assessment and assists with patient transfers from the OR. In most facilities, maintaining records of patient satisfaction is the role of the public relations manager or office manager.

A discharge nurse is evaluating patients and their families to determine the need referrals to other facilities after hospitalization. Which patients will the nurse recommend for these services? Select all that apply.

a. Older adult diagnosed with dementia in the hospital

b. Adult diagnosed with Parkinson disease

c. Adult woman receiving chemotherapy for breast cancer

d. Adolescent being discharged with a cast on his leg

e. New mother who delivered a healthy infant via a cesarean birth

f. Adult man diagnosed with end-stage cancer

a, b, f.

a. Older adult diagnosed with dementia in the hospital

b. Adult diagnosed with Parkinson disease

f. Adult man diagnosed with end-stage cancer

The patients who are most likely to need a formal discharge plan or referral to another facility are those who are emotionally or mentally unstable (e.g., those with dementia), those who have recently diagnosed chronic disease (e.g., Parkinson disease), and those who have a terminal illness (e.g., end-stage cancer). Other candidates include patients who do not understand the treatment plan, are socially isolated, have had major surgery or illness, need a complex home care regimen, or lack financial services or referral sources.

A home health nurse is scheduled to visit a patient recently discharged from the hospital with a new colostomy. During the entry phase of the home visit, what actions will the nurse perform? Select all that apply.

a. Collect information about the patient’s diagnosis, surgery, and treatments

b. Call the patient to make initial contact and schedule a visit

c. Develop rapport with the patient and their family

d. Assess the patient to identify their needs

e. Assess the physical environment of the home

f. Evaluate safety issues including the neighborhood in which the patient lives

c, d, e.

c. Develop rapport with the patient and their family

d. Assess the patient to identify their needs

e. Assess the physical environment of the home

In the entry phase of the home visit, the nurse develops rapport with the patient and family, makes assessments, determines nursing diagnoses, establishes desired outcomes, plans and implements prescribed care, and provides teaching. In the pre-entry phase of the home visit, the nurse collects information about the patient’s diagnoses, surgical experience, socioeconomic status, and treatment orders. In the pre-entry phase, the nurse also gathers supplies needed, makes an initial phone contact with the patient to arrange for a visit, and assesses the patient’s neighborhood for safety issues.

A nurse and AP are planning to receive a patient who sustained a traumatic head injury in a motor vehicle accident. Which activity can the nurse safely delegate to the AP?

a. Collecting information for a health history

b. Performing a physical assessment

c. Contacting the health care provider for medical orders

d. Preparing the bed and collecting needed supplies

d. Preparing the bed and collecting needed supplies

The nurse may delegate preparation of the bed and collection of needed supplies to assistive personnel but performs the other activities listed.

A home care nurse is observing the patient’s family member perform a wound irrigation and dressing change for a postoperative wound dehiscence containing purulent drainage. In which situation will the nurse provide additional education?

a. The family member places the old dressing in a separate bag at the bedside.

b. The patient takes an analgesic a half-hour prior to the dressing change.

c. The family member states they washed their hands an hour ago.

d. The patient returns to bed during the dressing change.

c. The family member states they washed their hands an hour ago.

The nurse teaches the patient and family to effectively wash their hands before and after having direct contact with the patient, before performing invasive procedures, when handling dressing or touching open wounds, and when administering medications or feeding the patient. All other options are correct.

A patient is being transferred from the intensive care unit (ICU) to a medical-surgical unit. What is the responsibility of the ICU nurse during the transfer of care?

a. Providing a verbal report to the nurse on the new unit

b. Giving a detailed written report to the unit secretary

c. Delegating the responsibility for providing information

d. Making a copy of the patient’s medical record

a. Providing a verbal report to the nurse on the new unit

The transferring (ICU) nurse gives a verbal report on the patient’s condition and nursing care needs to the receiving nurse. This information should not be given to a unit secretary, nor can this be delegated to others. The medical record is transferred with the patient; a copy is not made for transfers within the agency.

A nurse is reviewing the discharge plan with a patient who had major abdominal surgery. Which statement by the nurse is most appropriate?

a. “I’ll bet you will be so glad to be home and sleep in your own bed.”

b. “Tell me about your understanding of your recovery needs after discharge.”

c. “Be sure to take your pain medications and change your dressing.”

d. “You will just be fine! Please stop worrying.”

b. “Tell me about your understanding of your recovery needs after discharge.”

The purpose of discharge planning is to ensure for continuity of care for the patient and family needs. The nurse uses open-ended assessment questions to begin a planning session. Essential components of discharge planning include assessing the strengths and limitations of the patient, the family or support person, and the environment; implementing and coordinating the care plan; considering individual, family, and community resources; and evaluating the effectiveness of care. Answers a and c are examples of communication or interventions, which may be included after an assessment. The statement “You will just be fine! Please stop worrying.” is a cliché and is avoided.

A nurse is caring for a patient who has been hospitalized for dehydration secondary to a urinary tract infection. The patient states, “I’m leaving. There are too many germs here, and I’ll probably get sicker than when I came in.” As this patient has capacity for decision making, which response is most consistent with the nurse’s legal accountability?

a. “Only the primary health care provider can authorize your discharge from a hospital.”

b. “Let me gather your belongings and prepare the discharge paperwork.”

c. “I will inform the health care provider that you want to leave and request a psychiatric consult.”

d. “Your choice carries risks for complications, so I must ask you to sign a release form.”

d. “Your choice carries risks for complications, so I must ask you to sign a release form.”

The patient is legally free to leave the hospital against medical advice (AMA); however, patients who leave AMA must sign a form releasing the health care provider and hospital from legal responsibility for their health status. This signed form becomes part of the medical record.

A nurse is considering moving from the hospital setting to home health care. In speaking with other professionals, what qualities does the nurse find they should possess to be successful? Select all that apply.

a. Making accurate assessments

b. Researching new treatments for chronic diseases

c. Communicating effectively

d. Delegating tasks appropriately

e. Performing clinical skills effectively

f. Making independent decisions

a, c, e, f.

a. Making accurate assessments

c. Communicating effectively

e. Performing clinical skills effectively

f. Making independent decisions

Nurses working in the community must have the knowledge and skills to make accurate assessments, work independently, communicate effectively, and perform clinical skills accurately. Community-based nurses may be researchers and occasionally delegate care, but these are not key qualities for this type of nursing.

A nurse asks the AP to prepare the hospital room for a new ambulatory patient. Which aspect of the room will the nurse ask the AP to correct?

a. The bed linens are folded back.

b. A hospital gown is on the bed.

c. Equipment for taking vital signs is in the room.

d. The bed is in the highest position.

d. The bed is in the highest position.

A properly prepared hospital room includes a bed in the lowest position for an ambulatory patient, an open bed with top linens folded back, routine and special equipment and supplies assembled, and the physical environment of the room adjusted.

A nurse on a medical-surgical unit is teaching a patient’s family about hospice care. How does the nurse best explain the focus of this care?

a. Hospice care focuses on symptom and pain relief.

b. Nutrition is provided orally or by tube to maintain intake.

c. Surgical procedures are performed when medically necessary.

d. Services are provided until the patient’s death.

a. Hospice care focuses on symptom and pain relief.

Hospice services include pain management, physician and nurse practitioner services, spiritual support, respite services, and bereavement counseling.

A visiting nurse is performing the initial assessment and plan for a patient who receives Medicare and was recently discharged from the acute care hospital. Before implementing the plan of care, what follow-up is required by the nurse?

a. Validating the patient's consent for care

b. Obtaining the health care provider's signature and approval

c. Determining how the patient will pay for services

d. Ensuring that a family member or friend can assist with implementation

b. Obtaining the health care provider’s signature and approval

The nurse assesses the patient eligible for home services and presents the plan to the health care provider for approval. This approval the plan allows for provision of care and reimbursement of services.

When transferring a patient from the operating room to the medical-surgical unit, a nurse uses the SBAR format for handoff communication. Place the components of the SBAR communication (Situation, Background, Assessment, and Recommendations) in their proper order.

a. This 20-year-old patient presented to the ER with right lower quadrant pain, fever, and an elevated WBC count.

b. The patient is postlaparoscopic appendectomy.

c. The patient may need pain medication in 30 minutes.

d. The patient is sleepy, but responsive; five small bandages on the abdomen are clean and dry.

b, a, c, d. The SBAR communication for this patient should be: The patient is post laparoscopic appendectomy. This 20-year-old patient presented to the ER with right lower quadrant pain, fever, and an elevated WBC count. The patient may need pain medication in 30 minutes. The patient is sleepy, but responsive; there are five small bandages on the abdomen that are clean and dry.