Chapter 13: Admission, Transfer, and Discharge My Nursing Test Banks

Chapter 13: Admission, Transfer, and Discharge

Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition

MULTIPLE CHOICE

1.When admitting a patient to the hospital, the nurse observes that the patient is distracted and tense. What does this behavior suggest as a common reaction to hospitalization?

a. Relief about being cared for
b. Fear of the unknown
c. Feeling of powerlessness
d. Concern about cost

ANS: B

Fear of the unknown may be the most common reaction to hospitalization.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 313

OBJ: 3 | 5 TOP: Admission KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

2.A nurse is admitting a patient to an acute care facility. During the admission procedure, what nursing intervention would best help reduce patient anxiety?

a. Transport the patient by wheelchair.
b. Inform the physician that the patient is admitted.
c. Greet the patient by name.
d. Collect financial information during the interview.

ANS: C

Greeting the patient by name is one of the most important aspects of admission.

PTS: 1 DIF: Cognitive Level: Application REF: Page 316

OBJ: 1 | 4 | 5 TOP: Admission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

3.What essential part of the admission procedure is performed by the RN?

a. Securing the patients valuables
b. Confirming the type of insurance coverage
c. Obtaining a health history
d. Familiarizing the patient with the room

ANS: C

Admission assessment is performed by the RN.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 318

OBJ: 5 | 6 TOP: Admission KEY: Nursing Process Step: Assessment

MSC:NCLEX: Safe, Effective Care Environment

4.When should discharge planning begin?

a. The day before discharge
b. On the first day postoperatively
c. Shortly after admission
d. When the doctor orders it

ANS: C

Discharge planning begins shortly after admission.

PTS: 1 DIF: Cognitive Level: Knowledge REF: Page 323

OBJ: 5 | 8 TOP: Discharge KEY: Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

5.Where can a nurse refer the family of a patient to find a source of financial aid to meet medical expenses?

a. A local bank
b. A clinical nurse specialist
c. The hospital administration
d. Social services

ANS: D

Often a patient will require services of various disciplines within the hospital. Social services can assist with meeting medical financial obligations.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 326 Health Promotion

OBJ:8TOP:Social services

KEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

6.When a patient demands to be discharged without a physicians order and is leaving the unit with his belongings, what should the nurse ask the patient to sign?

a. A form exercising the patients rights
b. A discharge against medical advice form
c. An informed consent
d. An advanced directive

ANS: B

If a doctor cannot convince the patient to stay, the patient should sign an against medical advice form.

PTS: 1 DIF: Cognitive Level: Application REF: Page 327, Box 13-6

OBJ: 10 TOP: Discharge KEY: Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

7.The nurse must be sensitive to an older adult patient experiencing separation anxiety when admitted to the hospital. When a child experiences separation anxiety they will usually cry. What will an older adult often demonstrate when experiencing separation anxiety?

a. Withdrawal
b. Anger
c. Depression
d. Regression

ANS: C

The older adult may demonstrate depression as a result of separation anxiety entering the hospital.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 314

OBJ: 3 TOP: Admission KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

8.Upon admission, the nurse notes that a patient without family members present has a billfold filled with cash. Where can the nurse suggest the money be placed?

a. In a sealed envelope in the bedside table
b. In the care of hospital security
c. Locked in the narcotic cupboard
d. In the hospital safe

ANS: D

Valuables should be locked in the hospital safe.

PTS: 1 DIF: Cognitive Level: Application REF: Page 316

OBJ:6TOP:Care of valuables

KEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

9.If a patient has an order for an interagency transfer where does the nurse explain that the patient will be moved?

a. A double room to a private room
b. One unit of the hospital to another
c. One room of the unit to another
d. One facility to another

ANS: D

The interagency transfer moves a patient from one health care agency to another.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 322

OBJ: 7 TOP: Transfer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

10.Before the actual discharge occurs, what must the nurse ensure ?

a. The patient is well enough to go home.
b. The patient has not been overly medicated.
c. The patient understands the discharge instructions.
d. The patient has adequate transportation.

ANS: C

It is essential that the patient be fully aware of the discharge instructions before being discharged.

PTS:1DIF:Cognitive Level: Application

REF: Pages 323, 325-326, 328 Skill 13-3 OBJ: 5 | 9

TOPischargeKEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

11.A patient who is alert and oriented is threatening to leave the hospital against medical advice (AMA). What action should the nurse take?

a. Forcibly detain and restrain the patient.
b. Administer a sedative hypnotic medication.
c. Prevent patient from leaving until an AMA form is signed.
d. Notify the physician that the patient is threatening to leave AMA.

ANS: D

When a patient threatens to leave AMA, the physician should be notified immediately. If the physician fails to convince the patient to remain in the facility, the physician will ask the patient to sign an AMA form releasing the facility from legal responsibility for any medical problems the patient may experience after discharge. If the physician is not available, the nurse should discuss the discharge form with the patient and obtain the patients signature. If the patient refuses to sign the AMA form, the patient should not be detained. This violates the patients legal rights. After the patient leaves, the nurse should document the incident thoroughly in the nurses notes and notify the physician. A rational adult patient who will not sign the AMA form cannot be forcibly detained.

PTS: 1 DIF: Cognitive Level: Application REF: Page 327, Box 13-6

OBJ:10TOP:Against medical advice

KEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

12.How can the nurse demonstrate cultural sensitivity to a Haitian American patient?

a. By providing a well-lit  room 24 hours a day
b. By writing out all instructions given to the patient
c. By allowing the patient to keep leaves in her room
d. By asking the physician to provide all directions to the patient

ANS: C

Many Haitians believe that leaves have a special significance in healing. Leaves may be found in the clothes and on various parts of the body. Leaves are thought to have mystical power related to regaining or keeping health.

PTS:1DIF:Cognitive Level: Application

REF: Page 315, Cultural Considerations OBJ: 4 TOP: Cultural awareness

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychological Integrity

13.A nurse is caring for a Haitian American patient. How might the nurse demonstrate cultural sensitivity?

a. Discarding any leaves the patient may have brought with them
b. Assigning the patient to a room with any Haitian American patient
c. Instructing the patient to ride in a wheelchair when discharged
d. Allowing the patient to walk out of the hospital when discharged

ANS: D

Some Haitian Americans associate wheelchairs with being sick. Therefore, on discharge, the patient who is allowed to walk out of the hospital will be more likely to feel that care has been effective. A poor patient with a Haitian background and a wealthy patient with a Haitian background, although from the same country, may find the same room assignment together in the hospital very distasteful.

PTS:1DIF:Cognitive Level: Application

REF: Page 315, Cultural Considerations OBJ: 4 TOP: Cultural awareness

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychological Integrity

MULTIPLE RESPONSE

14.How can the nurse help reduce the stress of a hospital admission? (Select all that apply.)

a. Show the patient how bedside equipment works.
b. Explain the need to establish a clear source of reimbursement.
c. Give simple explanation of policies.
d. Involve the patient in the plan of care.
e. Keep family interventions to a minimum.

ANS: A, C, D

An empathic reception reduces anxiety of admission; for instance, demonstrating how bedside equipment works, explaining hospital policies, and involving the patient in the plan of care from the start all help to reduce the stress of a hospital admission. Securing financial information is not a role of the nurse, and family interventions are frequently helpful in reducing stress.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 314-318

OBJ:4 | 5TOP:Stress reduction

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

15.The nurse adheres to the discharge standards set by The Joint Commission (TJC), which include that patients will receive instruction regarding which aspect(s) of care? (Select all that apply.)

a. Medications
b. Rehabilitation techniques
c. Referral to community agencies
d. Medical equipment to be used
e. Obtaining health insurance

ANS: A, B, C, D

The Joint Commission (TJC) standards require that a patient have information pertinent to medication, rehabilitation instructions, referral to community agencies, instruction in using any medical equipment, family care responsibility, diet, and how to obtain further treatment if necessary.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 324

OBJ:9TOP:TJC standards for discharge

KEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

COMPLETION

16.The nurse completes thorough documentation before, during, and after a transfer to ensure _______ of _______.

ANS:

continuity, care

Clear documentation before, during, and after a transfer ensures that the patients condition is being monitored and maintains the continuity of care.

PTS: 1 DIF: Cognitive Level: Comprehension REF: Page 322

OBJ:5 | 7TOPocumentation

KEY:Nursing Process Step: Implementation

MSC:NCLEX: Safe, Effective Care Environment

17.Some _____________________patients consider sundown Friday to sundown Saturday to be the Sabbath, which is a time of rest.

ANS:

Orthodox Jewish

Some Orthodox Jewish patients consider sundown Friday to sundown Saturday to be the Sabbath, which is a time of rest. These patients may avoid the use of any electronic equipment, so the nurse should find alternatives to the use of this equipment if possible.

PTS:1DIF:Cognitive Level: Knowledge

REF: Page 315, Cultural Considerations OBJ: 3 TOP: Orthodox Jewish culture

KEY:Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

18.Because of the stress caused by hospitalization, the nurse assesses a newly admitted older adult patient for ________________.

ANS:

disorientation

In a normally alert and oriented older adult, medical conditions that necessitate hospitalization often result in some level of disorientation.

PTS:1DIF:Cognitive Level: Application

REF: Page 314, Life Span Considerations OBJ: 3 | 5

TOP: Disorientation in older adults KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity

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