Chapter 20: Admission, Transfer, and Discharge PDF

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FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

Chapter 20: Admission, Transfer, and Discharge Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The nurse recognizes that a client develops an impression of the nurse during which process? 1. Teaching 2. Discharge 3. Admission 4. Implementation

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2. Which behavior does the LPN/LVN expect the admitting nurse to demonstrate during the admission process? 1. Smiling and speaking kindly 2. Exhibiting tense body language and frowning 3. Informing the client that the unit is shorthanded 4. Avoiding eye contact and speaking in a clipped manner

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3. A nurse is admitting a client to a hospital unit. Which does the LPN/LVN recognize that the nurse should do to demonstrate respect for the client? 1. Maintain direct eye contact with the client. 2. Address the client by the correct title and last name. 3. Use a voice of authority to promote a sense of client security. 4. Ask permission to use a term of endearment with the client.

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4. A client is being directly admitted to the hospital from the physician’s office. Which component of the admission process should the nurse expect? 1. The admitting physician will write orders within 8 hours after admission. 2. If available, a hospitalist will assume all responsibility for client orders. 3. The physician’s nurse will provide client information to the hospital nurse. 4. The physician’s office staff will give the client instructions for admission.

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5. Which reaction by the hospitalized client should the nurse consider to be most realistic? 1. Loss of control about procedures and medical treatment 2. Anxiety related to the cost and ability to pay for care 3. Fear that family members will see sickness as a weakness 4. Concern about the comfort and safety of the environment

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6. The nurse correctly recognizes that separation anxiety is particularly common in children and which additional population? 1. Adolescents 2. Young adults 3. Middle-aged individuals 4. Older adults

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7. The nurse is caring for an older adult client who is experiencing anxiety related to a new diagnosis of cancer. Which action by the nurse is most helpful in alleviating the client’s anxiety? 1. Informing the client that cancer is curable 2. Asking the client to repeat the physician’s diagnosis 3. Ascertaining which family member can stay with the client 4. Providing the client with reading materials about the diagnosis

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FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

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8. A nurse is providing care to a client newly diagnosed with AIDS. Which behavior by the nurse demonstrates a caring demeanor toward the client? 1. Protecting the client’s diagnosis from visitors and staff members 2. Discussing the client’s diagnosis in the presence of a roommate for support 3. Avoiding any discussion with the client about the new diagnosis 4. Asking the client the means by which the condition was acquired

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9. The LPN/LVN is assisting the nurse during the admission process of a new client. Which task focused on client safety will the LPN/LVN perform? 1. Obtaining initial set of vital signs from the client. 2. Assessing the client for the need of fall prevention. 3. Asking the client about a history of choking on fluids. 4. Orienting the client about location and use of the call light.

____ 10. The LPN/LVN needs to reinforce teaching for a client who speaks a limited amount of English. Which action will the RN suggest to the LPN/LVN to best assure that the client understands the information presented? 1. Prompt the client to summarize the teaching. 2. Ask the client questions about the information. 3. Have an interpreter translate for the client and nurse. 4. Provide printed material in the client’s language. ____ 11. A client tells the LPN/LVN, “I am going home. I am not getting better, and I cannot afford to stay here.” After informing the RN, which action will the LPN/LVN anticipate happening first? 1. The RN will present the client with Against Medical Advice forms and explain that the client must sign out. 2. The RN will attempt to explain why it is not in the client’s best interest to leave without physician permission. 3. The RN will contact the attending physician about the client’s wishes and attempt to get a discharge order. 4. The RN will inform the client’s family that they will be responsible for the client’s bill if the client leaves. ____ 12. The LPN/LVN is asked by the RN to sign the client’s personal inventory sheet as a witness. Which inventory description will the LPN/LVN question? 1. Cash in the amount of $157.25 2. Eyeglasses with corrective lenses 3. Gold ring with single large diamond 4. Dentures with inscribed identity number ____ 13. The RN asks the LPN/LVN to orient a client arriving for admission to the unit. Which client orientation will the LPN/LVN directly connect to a safety need? 1. The client’s stated age is 75 years. 2. The client had open-heart surgery 1 year ago. 3. The client is traveling alone for business. 4. The client reports vomiting for 24 hours. ____ 14. When conducting an admission assessment, the nurse correctly recognizes which information as objective data? 1. A client’s family history 2. A client’s statement of pain 3. A client’s description of anxiety 4. A client’s fruity-smelling breath Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

____ 15. When performing a client assessment, the nurse will correctly recognize which assessment finding as subjective data? 1. A client’s vital signs 2. A client’s unsteady gait 3. A client’s foul-smelling wound 4. A client’s statement of discomfort ____ 16. A client is being discharged from the hospital unit to home. Which task is most appropriate for the RN to assign to the LPN/LVN? 1. Obtaining and charting a final set of vital signs 2. Assisting the client to gather personal belongings 3. Taking the client out of the hospital by wheelchair 4. Providing instructions about activities and medications ____ 17. The nurse correctly recognizes that discharge planning should be initiated at which point in a client’s hospital stay? 1. During the admission process 2. Before the client is admitted to the hospital 3. Immediately before discharging the client 4. The day after the client’s hospital admission ____ 18. During the admission procedure, the nurse learns that a new client is from a culture that requires men to keep their head covered at all times by wearing a turban. The client’s roommate in the double room is recovering from detoxification and has episodes of using racial slurs. Which action by the nurse is best? 1. Make a note on the client’s record that a curtain should be kept drawn between the two roommates at all times. 2. Assume that the client will be fine, because the client’s culture prides themselves on their strength. 3. Describe and explain the situation and ask if the client is comfortable being in the same room with the roommate. 4. Arrange to have the client assigned to a different room, without the probability of a verbally offensive roommate. Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 19. During the admission process, which actions will the nurse take to make the client feel comfortable and welcome? Select all that apply. 1. Maintain an attitude of authority. 2. Introduce self and shake the client’s hand. 3. Make eye contact and speak directly to the client. 4. Share the nurse’s credentials with the client. 5. Inform the client that the unit is understaffed. ____ 20. The nurse is aware that admission to the hospital setting can be stressful for clients. Which conditions does the nurse recognize as causes of stress? Select all that apply. 1. Fear related to unknown diagnostic or treatment procedures 2. Anxiety about interruption of daily routines and responsibilities 3. Loss of control of activities and schedules in the hospital setting 4. Concern about maintaining nutritional needs with hospital food 5. Uncertainty about how the nurses will react to the client’s feelings Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

____ 21. An LPN/LVN is caring for a pediatric client who appears anxious. Which actions should the LPN/LVN take to help decrease the client’s anxiety? Select all that apply. 1. Encourage the client to ask questions. 2. Send home toys so they do not get lost. 3. Refrain from using medical terminology. 4. Encourage the parent to stay with the client. 5. Provide an explanation of the client’s diagnosis. ____ 22. The nurse is preparing for the discharge of a client from the hospital to an extended care facility. Which information is most important for the nurse to include for the new facility? Select all that apply. 1. A list of the medications ordered for the client at the time of transfer 2. The discharge summary of the client’s conditions, diseases, and test results 3. A description of the client’s condition and vital signs at the time of discharge 4. Instructions regarding the client’s diet, activity, and follow up appointments 5. Names of the family members who will be visiting the client after transfer ____ 23. A physician writes an order to teach a client about nitroglycerin. A nurse correctly educates the client that nitroglycerin (Select all that apply.): 1. Should be swallowed. 2. Is administered sublingually. 3. Is used in the treatment of angina. 4. Should be protected from light and moisture. 5. Should be placed under the tongue prior to chest pain. ____ 24. The LPN/LVN listens to the RN provide discharge teaching to a client about newly prescribed nitroglycerine. Which action is within the LPN/LVN’s scope of practice? Select all that apply. 1. Reinforces the client teaching provided by the RN 2. Listens to the client tell a spouse how the medication is taken 3. Validates for the RN that the client took the medication correctly 4. Tells the RN the client does not know the purpose of the medication 5. Provides the client with a clear bottle for home storage of the medication ____ 25. A client hospitalized with pneumonia is deteriorating. The nurse obtains an order from the physician for a transfer to the facility’s intensive care unit. Which part of the transfer process is exclusive to this transfer when compared to the transfer process to another facility? Select all that apply. 1. The client’s complete medical record is transferred with the client. 2. A summary is completed on the client’s condition at the time of transfer. 3. Reasons for the transfer are explained to the client and the client’s family. 4. The client is discharged from the original unit and admitted to the new unit. 5. Any prescribed medications dispensed from the pharmacy will be transferred. ____ 26. The nurse is preparing a client for discharge from the hospital to home. Which situation will prompt the nurse to reconcile the client’s medication orders? Select all that apply. 1. The client has two physicians writing medication orders. 2. All previous home medications have been discontinued. 3. Medication orders have been checked for dosage ranges. 4. Medication orders for home are different than hospital orders. 5. Two medications for home have the same classification and action.

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FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

Chapter 20: Admission, Transfer, and Discharge Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 4. Explain the importance of making the patient feel welcome during the admission process. Page: 374 Heading: Admission Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Communication Difficulty: Easy Feedback 1 This is incorrect. The client will already have developed an initial impression of the nurse by the time the nurse provides any teaching. 2 This is incorrect. The client’s impression of the nurse will be fully determined by the time of discharge. 3 This is correct. The nurse has the opportunity, ability, and responsibility to make admission less stressful for clients. It is during the admission process that the nurse will make a first impression on the client, one that can either improve the client’s stay or cause a negative experience. Admission is the time to begin establishing rapport and a trusting relationship with the client. 4 This is incorrect. During the implementation of interventions, the client will continue to form an impression of the nurse, but the client’s impression begins to form as soon as the client is admitted and begins to interact with the nurse. PTS: 1 CON: Communication 2. ANS: 1 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 3. Describe therapeutic nursing interventions that will demonstrate respect and compassion for common reactions to admission. Page: 374 Heading: Admission Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Communication Difficulty: Easy Feedback 1 This is correct. The admitting nurse will smile and speak kindly and respectfully to the client in order to present a caring demeanor. It is important for the nurse to demonstrate respect and compassion for common client reactions to the admission process. 2 This is incorrect. The admitting nurse should make a conscious effort to avoid letting any negativity—such as being behind schedule—show in speech, facial expression, or body language. 3 This is incorrect. The admitting nurse should make a conscious effort to avoid Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

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complaining about being short-staffed. The focus should be on the client, client needs, and client concerns. This is incorrect. The admitting nurse who avoids eye contact with the client conveys an impression of being impersonal and uncaring. The nurse who uses clipped speech with the client can appear to be in a hurry.

PTS: 1 CON: Communication 3. ANS: 2 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 3. Describe therapeutic nursing interventions that will demonstrate respect and compassion for common reactions to admission. Page: 377 Heading: Admission Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Communication Difficulty: Moderate Feedback 1 This is incorrect. The nurse should make brief and intermittent eye contact during the admission process; constant direct eye contact can cause client feelings of discomfort. The use of eye contact is influenced by cultural practices and beliefs. 2 This is correct. The nurse should address the client by the appropriate title (Mr., Mrs., etc.) and the client’s last name. The nurse should avoid using the client’s first name unless specifically asked to do so by the client. 3 This is incorrect. The nurse should be cautious about using a voice of authority during the admission process. The action may not demonstrate respect or compassion towards the client. 4 This is incorrect. The nurse should avoid asking permission or using terms of endearment when addressing the client. Use of these terms may be considered condescending or patronizing. PTS: 1 CON: Communication 4. ANS: 4 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 6. Discuss components of the admitting procedure. Page: 379 Heading: Admission Integrated Processes: Communication and Documentation Client Need: Safe and Effective Care Environment: Coordinated Care Cognitive Level: Analysis [Analyzing] Concept: Communication Difficulty: Moderate Feedback 1 This is incorrect. For a direct admit, the admitting physician will write orders sooner than 8 hours after admission. A client is commonly made a direct admit because of a condition or diagnosis that needs immediate attention. 2 This is incorrect. In some hospitals, hospitalists are part of the facility staff. It is more likely the admitting physician will speak to the hospitalist about the client. Orders can then be initiated with input from both physicians. Copyright © 2019 F. A. Davis Company

FUNDAMENTALS OF NURSING CARE 3RD EDITION BURTON TEST BANK

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This is incorrect. Nurse-to-nurse communication takes place when a client is transferred from one facility to another, and not during the admission process. Identification of the transferring nurse should be documented. This is correct. The office staff for the admitting physician can be responsible for providing the client with instructions about the admission. Instruction would include information about the facility, unit, and time frames.

PTS: 1 CON: Communication 5. ANS: 2 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 2. Identify four common patient reactions to admission. Page: 376 Heading: Admission: Reactions to Admission Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Analysis [Analyzing] Concept: Culture Difficulty: Difficult Feedback 1 This is incorrect. Some clients may feel a loss of control about procedures and medical treatment. However, if the client is reminded of the client’s rights related to health care, this concern should not be the most realistic reaction. 2 This is correct. A very realistic reaction by a hospitalized client is often related to the cost of health care and the client’s ability to pay. This reaction is especially true for the client without coverage from a third-party payer, such as insurance. 3 This is incorrect. Clients may or may not be fearful of how others will perceive the client’s sickness. Therefore, this reaction is not the most realistic. 4 This is incorrect. Clients do sometimes become concerned about comfort and safety in the hospital environment; however, this is not the most common or realistic reaction given the other options. PTS: 1 CON: Culture 6. ANS: 4 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 2. Identify four common patient reactions to admission. Page: 375, 376 Heading: Admission: Reactions to Admission Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Comprehension [Understanding] Concept: Culture Difficulty: Easy Feedback 1 This is incorrect. Separation anxiety is less common among adolescents than among young children, who usually trust and are dependent on and accustomed to having their needs met by their parents or guardians. The younger the child, the more dependent on the parent or guardian the child will be. 2 This is incorrect. Most young adults have matured to the point that separation anxiety is not generally an issue. 3 This is incorrect. Middle-aged adults usually do not experience much separation Copyright © 2019 F. A. Davis Company

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anxiety. This is correct. Separation anxiety is particularly common in older adults. The older adult may have been married to a spouse for a long period of time, sometimes rarely or never having been separated from the spouse. If the older adult is dependent on a spouse, child, or other designated caregiver, separation from those persons can cause severe anxiety and loneliness.

PTS: 1 CON: Culture 7. ANS: 3 Chapter: Chapter 20, Admission, Transfer, and Discharge Objective: 3. Describe therapeutic nursing interventions that will demonstrate respect and compassion for common reactions to admission. Page: 376 Heading: Admission: Reactions to Admission Integrated Processes: Caring Client Need: Psychosocial Integrity Cognitive Level: Application [Applying] Concept: Stress Difficulty: Moderate Feedback 1 This is incorrect. Informing the client that cancer is curable is an example of providing the client wi...