C HAPTER 23: A DMITTING , T RANSFERRING ,
AND D ISCHARGING P ATIENTS
Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th
Edition
MULTIPLE CHOICE
1. A patient who has questions about the availabilit y of home health services
after hospital discharge should be referred to the:
a. primary care provider.
b. registered nurse.
c. occupational therapist.
d. medical social worker (MSW).
ANS: D
An MSW can provide information a bout long-term planning, financial
assistance, and communit y services available after discharge.
DIF: Cognitive Level: Application REF: p. 404 OBJ:
Clinical Practice #5 TOP: Discharge KEY: Nursing
Process Step: Planning MSC: NCLEX: Safe, Effecti ve
Care Environment: Coordinated Care
2. A hospitalized patient tells the nurse that he intends to leave the acute
care facilit y, against medical advice. The nurse’s initial action(s) should
be to:
, a. listen to the patient, answer questions, and offer to have t he
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 shee t.
d. call both the supervisor and a famil y 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
primary care provider 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. 404 OBJ:
Theory #5 TOP: Discharge Against Medical Advice (AMA)
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Psychosocial Integrit y: Coping and Adaptation
3. A patient is near death and the famil y is upset and disorganized. The most
helpful intervention for the patient and the famil y would be for the nurse
to:
a. ask the famil y the name of their mortician.
b. offer to call the spiritual advisor (eg, priest, minister, or rabbi).
c. encourage the famil y to pe rform their rituals.
d. encourage the famil y 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. 404 OBJ:
Clinical Practice #6 TOP: Death of a Patient KEY: Nursing
Process Step: Implementation MSC: NCLEX:
Psychosocial Integrity: Coping and Adaptation
4. 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. 404
OBJ: Clinical Practice #6 TOP: Death of a Patient
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Psychosoci al Integrit y: Psychosocial Adaptation
AND D ISCHARGING P ATIENTS
Williams: deWit's Fundamental Concepts and Skills for Nursing, 5th
Edition
MULTIPLE CHOICE
1. A patient who has questions about the availabilit y of home health services
after hospital discharge should be referred to the:
a. primary care provider.
b. registered nurse.
c. occupational therapist.
d. medical social worker (MSW).
ANS: D
An MSW can provide information a bout long-term planning, financial
assistance, and communit y services available after discharge.
DIF: Cognitive Level: Application REF: p. 404 OBJ:
Clinical Practice #5 TOP: Discharge KEY: Nursing
Process Step: Planning MSC: NCLEX: Safe, Effecti ve
Care Environment: Coordinated Care
2. A hospitalized patient tells the nurse that he intends to leave the acute
care facilit y, against medical advice. The nurse’s initial action(s) should
be to:
, a. listen to the patient, answer questions, and offer to have t he
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 shee t.
d. call both the supervisor and a famil y 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
primary care provider 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. 404 OBJ:
Theory #5 TOP: Discharge Against Medical Advice (AMA)
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Psychosocial Integrit y: Coping and Adaptation
3. A patient is near death and the famil y is upset and disorganized. The most
helpful intervention for the patient and the famil y would be for the nurse
to:
a. ask the famil y the name of their mortician.
b. offer to call the spiritual advisor (eg, priest, minister, or rabbi).
c. encourage the famil y to pe rform their rituals.
d. encourage the famil y 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. 404 OBJ:
Clinical Practice #6 TOP: Death of a Patient KEY: Nursing
Process Step: Implementation MSC: NCLEX:
Psychosocial Integrity: Coping and Adaptation
4. 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. 404
OBJ: Clinical Practice #6 TOP: Death of a Patient
KEY: Nursing Process Step: Implementation MSC:
NCLEX: Psychosoci al Integrit y: Psychosocial Adaptation
