The patient is scheduled to go home after having coronary angioplasty. What would be the most effective way to provide discharge teaching to this patient?

a. Provide him with information on health care websites.

b. Provide him with written information on what he has to do.

c. Sit and carefully explain what is required before his follow-up.

d. Use a combination of verbal and written information.

D

While preparing for the patient’s discharge, the nurse uses a discharge planning checklist and notes that the patient is concerned about going home because she has to depend on her family for care. The nurse realizes that successful recovery at home is often based on:

a. the patient’s willingness to go home.

b. the family’s perceived ability to care for the patient.

c. the patient’s ability to live alone.

d. allowing the patient to make her own arrangements.

B

The patient arrives in the emergency department complaining of severe abdominal pain and vomiting, and is severely dehydrated. The physician orders IV fluids for the dehydration and an IV antiemetic for the patient. However, the patient states that she is fearful of needles and adamantly refuses to have an IV started. The nurse explains the importance of and rationale for the ordered treatment, but the patient continues to refuse. What should the nurse do?

a. Summon the nurse technician to hold the arm down while the IV is inserted.

b. Use a numbing medication before inserting the IV.

c. Document the patient’s refusal and notify the physician.

d. Tell the patient that she will be discharged without care unless she complies.

C

An unconscious patient is admitted through the emergency department. How and when is identification of the patient made?

a. Determined only when the patient is able

b. Postponed until family members arrive

c. Given an anonymous name under the “blackout” procedure

d. Determined before treatment is started

B

During admission of a patient, the nurse notes that the patient speaks another language and may have difficulty understanding English. What should the nurse do to facilitate communication?

a. Use hand gestures to explain.

b. Request and wait for an interpreter.

c. Work with the family to gather information.

d. Complete as much of the admission assessment as possible using simple phrases.

B

The patient has been admitted to the emergency department after being beaten and raped. She is agitated and is frightened that her attacker may find her in the hospital and try to kill her. What should the nurse tell her?

a. She is safe in the hospital, and she needs to provide her name.

b. She can be admitted to the hospital without anyone knowing it.

c. Her records will be used as evidence in the trial.

d. Since she has come to the hospital, she has to be examined by the doctor.

B

The patient is admitted to the ICU after having been in a motor vehicle accident. He was intubated in the emergency department and needs to receive two units of packed red blood cells. He is conscious but is indicating that he is in pain by guarding his abdomen. To admit this patient, the nurse first will focus on:

a. examining the patient and treating the pain.

b. orienting the family to the ICU visitation policy.

c. making sure that the consent forms are signed.

d. informing the patient of his HIPAA rights.

A

The nurse is admitting the patient to the medical unit. The patient indicates that he has had several surgeries in the past and has been a diabetic for the past 15 years. He also earlier that morning, but the pain has finally gone since he received a “pain shot” in the emergency department. What does this information prompt the nurse to do next?

a. Provide the patient with an allergy arm band and document his allergies.

b. Postpone routine admission procedures immediately.

c. Ask the patient if he wants a smoking room.

d. Have all family or friends leave the room.

A

At what age is separation anxiety a common problem?

a. School-aged children

b. Preschoolers

c. Middle infancy

d. Newborns

C

The patient is being transferred from the emergency department to another institution for treatment. Which of the following cannot be delegated to nursing assistive personnel (NAP)?

a. Helping the patient get dressed

b. Gathering IV equipment to go with the patient

c. Escorting the patient to the transport area

d. Assessing the patient’s respiratory status before transport

D

When does the plan for patient discharge from a health care facility begin?

a. At admission

b. After a medical diagnosis has been determined

c. When the patient’s physical needs are identified

d. After a home environment assessment is completed

A

The phase of the discharge process where medical attention dominates discharge planning efforts is known as the _____ phase.

a. transitional

b. continuing

c. acute

d. multidisciplinary

C

Once a patient’s discharge has been completed, which activity may be delegated to assistive personnel?

a. Provision of prescriptions to the patient

b. Completion of the discharge summary

c. Gathering of the patient’s personal care items

d. Provision of instructions on community health resources

C

The nurse is providing discharge instruction to an 80-year-old patient and her daughter. The patient lives in a two-story home. When asked if the patient has difficulty climbing stairs, the patient says “No,” but the nurse notices a look of surprise on the daughter’s face. What should the nurse do in this circumstance?

a. Speak with the daughter separately.

b. Cancel the discharge immediately.

c. Order a visiting nurse consult.

d. Notify the physician.

A

The patient has decided that he would like to create an advance directive. The nurse is asked if she would be a witness. What is the best response for the nurse to make to this request?

a. Agree to be a witness.

b. Refuse to be a witness.

c. Contact social work.

d. Contact the physician.

C

The patient is being admitted to the intensive care department with multiple fractures and internal bleeding. Which of the following are considered roles of the nurse in this situation? ( Select all that apply.)

a. Anticipate physical and social deficits to resuming normal activities.

b. Involve the family and significant others in the plan of care.

c. Assist in making health care resources available to the patient.

d. Identify the psychological needs of the patient.

A,B,C,D

Under the Health Insurance Portability and Accountability Act (HIPAA), a patient must: (Select all that apply.)

a. provide his true name before he can be treated.

b. be informed of his privacy rights.

c. have his personal health information used for treatment or payment only.

d. have his personal health information used on a need-to-know basis only.

B,C,D

The patient is admitted to the unit for a cardiac catheterization. Which of the following can be delegated to nursing assistive personnel (NAP)? (Select all that apply.)

a. Obtaining admission vital signs

b. Preparing the patient’s room

c. Gathering and securing personal care items

d. Orienting patient and family to the nursing unit

B,C,D

Which of the following are considered “advance directives”? (Select all that apply.)

a. Living will

b. Power of attorney for health care

c. Notarized handwritten document

d. Nursing progress note

A,B,C

The patient is being transferred from the intensive care unit to the acute care unit. The nurse must ensure that the following activities are completed: (Select all that apply.)

a. providing the receiving nurse with a report before the transfer.

b. determining any equipment needs for the patient during the transfer.

c. providing an updated report after transferring the patient to the receiving unit.

d. making sure a registered nurse accompanies the patient.

A,B,C

Completing and documenting an accurate medication history from the patient is the important first step in the _____________ process.

medication reconciliation

If a patient is having acute physical problems, postpone routine admission procedures until the patient’s immediate needs are met. A ________________ assessment is needed at this point.

focused

When transferring a patient, the nurse must ensure that the patient will receive ____________.

continuity of nursing care

The greatest challenge in effective discharge planning is _______________.

communication

A document that provides a patient’s instructions in terms of future medical care or that designates another person(s) to make medical decisions if the individual loses decision-making capacity is known as an ________________.

advance directive