Chapter 23: Admitting, Transferring, and Discharging Patients My Nursing Test Banks

Chapter 23: Admitting, Transferring, and Discharging Patients

Test Bank

MULTIPLE CHOICE

1. The nurse is aware that patients who are admitted to the hospital as a routine admission under a managed care plan must:

a.

have Medicare.

b.

be pre-approved.

c.

be able to pay the deductible.

d.

be admitted several days prior to the procedure.

ANS: B

Managed care insurance programs require that all routine admissions be pre-approved. Often the patient is required to come to the hospital several days prior to the admission to complete paperwork or lab procedures.

DIF: Cognitive Level: Comprehension REF: p. 392 OBJ: Theory #1

TOP: Managed Care KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

2. 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:

a.

arrive 2 hours before the scheduled procedure.

b.

wear comfortable clothing.

c.

read printed materials about the procedure.

d.

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. 392 OBJ: Theory #1

TOP: Outpatient Admission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

3. 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:

a.

patient.

b.

admissions department of the health facility.

c.

patient, physician, and the admissions department.

d.

office of the admitting physician.

ANS: D

The office of the admitting physician is the usual agent to get prior approval for a hospitalization. The admissions department confirms that all pre-admission requirements are met.

DIF: Cognitive Level: Knowledge REF: p. 392 OBJ: Theory #1

TOP: Admission Procedures KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

4. The nurse orienting a new patient to the unit would include:

a.

expected cost of the room per day.

b.

location of call bell and how to use it.

c.

calling the patient by their first name for less formality.

d.

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. 392 OBJ: Clinical Practice #1

TOP: Admission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

5. A patient admitted to the hospital through the emergency department has jewelry and a large amount of money. The most efficient intervention about these valuables would be:

a.

send them home with a family member.

b.

put them away quickly in the patients closet.

c.

lock them in the narcotics cabinet on the nursing unit.

d.

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. 393 OBJ: Clinical Practice #1

TOP: Admission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

6. 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 physicians medication order sheet. The nurses best initial action is to:

a.

send the medications home with a family member.

b.

seal the medications in an envelope and lock it in the medicine cart.

c.

administer the medications with the ordered medications.

d.

notify the physician about the medications the patient has been taking.

ANS: D

It is important to notify the physician of any medications the patient has been taking at home that are not included in the present orders.

DIF: Cognitive Level: Application REF: p. 393 OBJ: Clinical Practice #1

TOP: Admission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: safety and infection control

7. New orders have been written by the attending physician for a patient admitted to a skilled nursing facility. After transcription, the orders will be verified by the:

a.

unit secretary.

b.

administrative RN.

c.

LPN/LVN in charge.

d.

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. 393 OBJ: Clinical Practice #1

TOP: Orders in Skilled Nursing Facility KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

8. When the nurse discovers that the patients consent form for an invasive procedure is incorrect, the nurse should:

a.

cross out the incorrect information and write error, and then write in the correct information.

b.

destroy the incorrect form and write a new one correctly.

c.

cross out the entire form, but leave it in the chart as a permanent record.

d.

notify the physician of the error and clarify what the physician 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. 393 OBJ: Clinical Practice #1

TOP: Consent Forms KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

9. A patients condition warrants a transfer from Intensive Care to a regular nursing unit in the same hospital. Before assisting with the patients move, the nurse notes that the transfer has been authorized by the:

a.

patient.

b.

charge nurse.

c.

physician.

d.

family.

ANS: C

In general, transfers from one nursing area to another require a specific order by the attending physician. The charge nurse of the receiving unit should be notified as well as the patient and family.

DIF: Cognitive Level: Application REF: p. 395 OBJ: Clinical Practice #3

TOP: Transfer KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

10. A newly admitted patient has his own walker that he wishes to use during this hospital stay. The responsibility of the nurse to this piece of durable equipment is to:

a.

write the patients name on a wide piece of tape and affix it to the walker.

b.

list the walker as part of the patients personal belongings and place the list in his chart.

c.

tell the patient that personal walkers cannot be used in the hospital for safety reasons.

d.

write a note in the nursing care plan that the patient has his own walker.

ANS: A

All equipment brought to the hospital by the patient should be clearly labeled, usually with a wide piece of tape on which the patients name is written in large letters.

DIF: Cognitive Level: Application REF: p. 395 OBJ: Theory #3

TOP: Admission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

11. The nurse helping to organize the transfer of an elderly patient from the acute care facility to an extended care facility will be sure to:

a.

check drawers and shelves for personal items.

b.

give unused medications to the patient.

c.

ask the business office to send stored valuables to the receiving facility.

d.

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 REF: p. 395 OBJ: Clinical Practice #3

TOP: Transfer KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

12. As a member of the health care team, the LPN/LVN understands that discharge planning for the hospitalized patient begins:

a.

the day before discharge.

b.

at the time of admission.

c.

immediately following diagnostic procedures or surgery.

d.

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. 395 OBJ: Theory #5

TOP: Discharge KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

13. 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:

a.

making an entry in the physician progress notes.

b.

writing a note to the charge nurse.

c.

having the patient sign for them as per policy.

d.

asking the unit secretary to place a note in the chart.

ANS: C

Retrieve any valuables stored in the hospital safe before discharge and have the patient sign according to policy and procedure.

DIF: Cognitive Level: Application REF: p. 395 OBJ: Theory #5

TOP: Discharge KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

14. A patient has a hospital discharge order for later that day. The LPN/LVN understands that part of the discharge process to be performed by the registered nurse is:

a.

packing the patients personal belongings.

b.

writing the discharge instructions.

c.

assisting the patient to get dressed.

d.

accompanying the patient to the hospital 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. 396 OBJ: Theory #5

TOP: Discharge KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

15. A patient who has questions about the availability of home health services after hospital discharge should be referred to the:

a.

physician.

b.

registered nurse.

c.

occupational therapist.

d.

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 REF: p. 396 OBJ: Clinical Practice #5

TOP: Discharge KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

16. A hospitalized patient tells the nurse that he intends to leave the hospital, against medical advice. The nurses initial action(s) should be to:

a.

listen to the patient, answer questions, and offer to have the supervisor or physician speak with the patient.

b.

advise the patient that this may mean that insurance would not pay for this hospitalization.

c.

obtain a written explanation of the reasons from the patient and have the patient sign at the bottom of the sheet.

d.

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 physician 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. 396 OBJ: Theory #5

TOP: Discharge Against Medical Advice (AMA)

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

17. 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:

a.

ask the family the name of their mortician.

b.

offer to call the spiritual advisor (e.g., priest, minister, or rabbi).

c.

encourage the family to perform their rituals.

d.

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. 397 OBJ: Clinical Practice #6

TOP: Death of a Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

18. For the nurse to provide support to families of patients who have died, it is most important to:

a.

have an understanding that all people deal with death in due time.

b.

read a number of articles about death and dying.

c.

have a personal experience of a similar nature.

d.

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. 397 OBJ: Clinical Practice #6

TOP: Death of a Patient KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: psychosocial adaptation

19. A nurse who was present at the time of the death of a patient should document:

a.

time of death.

b.

time at which life signs ceased.

c.

notification of the mortuary.

d.

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. 397 OBJ: Theory #6

TOP: Pronouncement of Death KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

20. A young patient has died in the emergency department after suffering severe trauma. The nurse understands that this patients family may take comfort from the opportunity to:

a.

allow donation of the patients organs.

b.

view all of the injuries to the patients body.

c.

plan the funeral before leaving the hospital.

d.

donate the patients 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. 397 OBJ: Clinical Practice #6

TOP: Organ Donation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

21. A blind, elderly patient is admitted to the hospital for dehydration and weakness. The nurse can make the admission process less stressful by:

a.

sending all personal belongings home with family members.

b.

performing the initial assessment in a non-hurried manner.

c.

providing a printed orientation handout regarding hospital policy.

d.

performing a quick assessment before orienting the patient to the unit.

ANS: B

Elderly patients need time and support in adjusting to a hospital 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. 393, Elder Care

OBJ: Clinical Practice #3 TOP: Admission

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: coping and adaptation

22. It is determined that a patient is brain dead after suffering a massive cerebral bleed. The physician has just talked to the family about removing the patient from life support. The nurse would anticipate:

a.

calling the coroners office.

b.

calling the insurance company.

c.

contacting the organ donation team.

d.

asking about an autopsy.

ANS: C

Requests for organ donation are usually done by a physician or a nurse trained for making such requests.

DIF: Cognitive Level: Comprehension REF: p. 397 OBJ: Clinical Practice #6

TOP: Organ Donation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity

23. The nurse recognizes that an autopsy must be performed when the patient:

a.

is over 52.

b.

died of unknown causes.

c.

has requested it on admission.

d.

has died in an industrial accident.

ANS: B

Autopsies are required when a patient has died of unknown causes. A family may request an autopsy, but the request must be signed by the next of kin.

DIF: Cognitive Level: Knowledge REF: p. 397 OBJ: Theory #2

TOP: Autopsy KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

24. The nurse is performing an initial assessment on a patient with respiratory difficulty. The nurse would anticipate documenting signs and symptoms such as:

a.

alteration in sensation.

b.

use of accessory muscles.

c.

regular respiratory pattern.

d.

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 REF: p. 394, Table 23-1

OBJ: Clinical Practice #2 TOP: Assessment

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: physiological adaptation

25. 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 nurses best response?

a.

Are you sure that your weight has not changed?

b.

I will write down your stated weight.

c.

It is important to get a more recent weight.

d.

Dont 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. 394, Table 23-1

OBJ: Clinical Practice #2 TOP: Assessment

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: basic care and comfort

26. The nurse reminds a patient that if enrolled in a managed care program, some procedures will not be approved for payment, such as:

a.

cosmetic surgery to repair a scar from an accident.

b.

breast augmentation.

c.

emergency admission for shortness of breath.

d.

post-mastectomy breast implants.

ANS: B

Elective cosmetic surgeries are not covered by managed care companies.

DIF: Cognitive Level: Comprehension REF: p. 392 OBJ: Theory #1

TOP: Non-payment for Procedures KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

27. When the orders have been verified, the nurse:

a.

draws a line below the orders and signs his or her name and the date.

b.

signs his or her name in red immediately below the physicians signature.

c.

writes: transcribed by A Nurse at 0900.

d.

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. 294, Skill 19-1

OBJ: Clinical Practice #2 TOP: Documentation

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

COMPLETION

28. 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 physician.

DIF: Cognitive Level: Knowledge REF: p. 297 OBJ: Theory #6

TOP: Post Mortem KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

MULTIPLE RESPONSE

29. The nurse is orienting an elderly patient newly admitted to the nursing unit. Which are appropriate interventions to apply to alleviate the patients anxiety? (Select all that apply.)

a.

Call the patient by his first name.

b.

Instruct the patient on the use of the call light.

c.

Encourage the patient to ask questions regarding admission.

d.

Allow extra time for the patient to process any new information.

e.

Lock all patient valuables in the facilitys 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: pp. 392-393 OBJ: Theory #3

TOP: Health Education KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

30. 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 patients chart? (Select all that apply.)

a.

Results of the autopsy

b.

Who pronounced the patient

c.

Official time of death

d.

Time vital signs ceased

e.

Why the patient died

ANS: B, C, D

Death must be accurately noted in the medical record and should include who pronounced the patients death, the time vital signs ceased, and the official time of death.

DIF: Cognitive Level: Application REF: p. 397 OBJ: Clinical Practice #6

TOP: Pronouncement of Death KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity

31. The nurse appreciates that a routine hospital admission differs from an emergency admission in that a routine admission: (Select all that apply.)

a.

is scheduled in advance.

b.

is not stressful.

c.

is completely covered by insurance.

d.

has a predictable outcome.

e.

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 familys routine. All hospital admissions can be stressful and potentially have unpredictable outcomes. Insurance may not completely cover the expense.

DIF: Cognitive Level: Comprehension REF: p. 391 OBJ: Theory #1

TOP: Routine Admissions KEY: Nursing Process Step: Planning

MSC: NCLEX: Safe Effective Care Environment: coordinated care

32. The nurse explains that the Admitting Department of the acute care facility has a number of significant duties, which include: (Select all that apply.)

a.

arranging for pre-admission lab work and radiographs.

b.

notifying the patients spiritual counselor of the admission.

c.

confirming that all admission criteria are met.

d.

arranging for special diets.

e.

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 pre-admission 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 patients insurance.

DIF: Cognitive Level: Comprehension REF: p. 392 OBJ: Theory #2

TOP: Admitting Department KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe Effective Care Environment: coordinated care

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