Discharge teaching is where readmissions are won or lost. These questions cover assessing health literacy rather than assuming it, teach-back as verification instead of a formality, medication reconciliation, coordinating follow-up and home services, and the red flags a patient must be able to recognise at home.
Question 1
A 72-year-old patient with end-stage COPD is discharged home under the care of their spouse, who reports exhaustion and resentment about sleep disruption. The spouse states, "I can't keep doing this alone." The patient requires continuous oxygen and assistance with ADLs. Which intervention addresses both caregiver burden and patient safety?
- A) A) Arrange twice-weekly home health aide visits for personal care assistance
- B) B) Refer for inpatient hospice admission to manage complex symptom control
- C) C) Coordinate a 5-day respite stay at a Medicare-certified facility next month✓
- D) D) Schedule weekly telehealth counseling for the caregiver starting immediately
Show rationale
Respite care provides temporary relief, directly addressing exhaustion and resentment while ensuring safe patient care during the break. Option A addresses ADLs but not sleep disruption or emotional burden. Option B is inappropriate as the patient remains at home without acute symptom escalation. Option D supports emotional health but ignores immediate safety risks from caregiver fatigue. The NCP Guidelines prioritize respite for caregivers expressing inability to cope, especially with high-care-needs patients. Medicare certification ensures coverage for eligible patients.
Question 2
A Spanish-speaking farmworker with limited health literacy is hospitalized for pesticide exposure. The occupational health nurse discovers inconsistent safety gear use due to fear of employer retaliation. What is the nurse's priority collaborative action?
- A) A) Provide Spanish educational materials on personal protective equipment
- B) B) Report the employer to OSHA without patient consent
- C) C) Consult hospital social work to address fear and legal protections✓
- D) D) Schedule a translator for discharge medication instructions
Show rationale
Social workers navigate legal/employment concerns (discriminating cue: fear of retaliation) while maintaining confidentiality. Option A overlooks systemic barriers; education alone won't address retaliation. Option B violates autonomy by reporting without consent. Option D focuses on language but ignores the primary safety threat. Social work collaboration (C) addresses both vulnerability cues (language barrier + occupational risk) through advocacy and resource linkage per AMSN care coordination standards.
Question 3
A manager must reduce overtime costs. Data show 70% of overtime occurs when discharge paperwork delays bed turnover. The EHR discharge module is underutilized, and social work consults average 48-hour response times. Which intervention offers sustainable cost control?
- A) A) Hire additional social workers to expedite discharge planning
- B) B) Mandate nursing overtime for unfinished discharges before shift end
- C) C) Train RNs on EHR discharge tools and standardize morning team huddles✓
- D) D) Outsource discharge documentation to a remote scribe service
Show rationale
Option C addresses the root cause (paperwork delays) using existing resources, reducing overtime by improving efficiency. Hiring staff (A) increases fixed costs. Mandating overtime (B) contradicts cost-reduction goals. Outsourcing (D) adds expenses and risks care fragmentation. The cues (EHR underuse, social work delays) justify process improvement: team huddles proactively identify barriers, while EHR training streamlines documentation. This aligns with ANA’s emphasis on workflow redesign over staffing changes for financial stewardship.
Question 4
A newly diagnosed hypertensive patient with low health literacy avoids medications, stating, "Herbs kept my ancestors healthy." Which culturally responsive resource should the nurse initiate first?
- A) A) Sharing educational videos about hypertension complications in their native language
- B) B) Coordinating a visit with a traditional healer who collaborates with local clinics✓
- C) C) Referring to a pharmacist for simplified medication education using pictograms
- D) D) Providing contacts for a hypertension peer support group at a community center
Show rationale
Collaborating with a traditional healer respects cultural beliefs ("herbs/ancestors") while integrating biomedical care, building trust for treatment acceptance. Videos (A) and pictograms (C) educate but don't address cultural resistance. Peer groups (D) lack authority in health belief reconciliation. National CLAS Standards emphasize leveraging cultural health practices to improve adherence in chronic disease management.
Question 5
A 78-year-old patient with hypertension, osteoarthritis, and two falls in the past month takes lisinopril, hydrochlorothiazide, and scheduled ibuprofen. During medication reconciliation, which drug requires immediate reevaluation due to polypharmacy risks?
- A) A) Continue hydrochlorothiazide due to stable blood pressure control
- B) B) Discontinue lisinopril to reduce orthostatic hypotension risk
- C) C) Substitute acetaminophen for ibuprofen to mitigate fall hazards✓
- D) D) Maintain ibuprofen for effective osteoarthritis pain management
Show rationale
NSAIDs like ibuprofen increase fall risk in older adults by causing dizziness/orthostasis and exacerbating hypertension. Beers Criteria strongly discourage scheduled NSAIDs in fall-prone seniors. Option C addresses this by recommending safer acetaminophen. Hydrochlorothiazide (A) may contribute to falls but is less risky than NSAIDs in this context. Lisinopril (B) shouldn't be discontinued without antihypertensive replacement. Continuing ibuprofen (D) ignores fall risk despite pain control. The cues (falls, osteoarthritis, hypertension) make NSAID deprescribing urgent per geriatric guidelines.
Question 6
An 82-year-old with COPD on home oxygen, osteoporosis, and recurrent falls is discharged to assisted living. Which care coordination priority reduces readmission risk?
- A) A) Verify the facility's fall prevention protocols✓
- B) B) Review inhaler technique with nursing staff
- C) C) Confirm emergency oxygen backup systems
- D) D) Assess dietary calcium intake documentation
Show rationale
Fall prevention is critical given osteoporosis and history of falls, which could cause catastrophic injury in COPD patients. Option B addresses routine disease management but not the immediate safety threat. Option C is important but less urgent than fall risks. Option D focuses on long-term bone health over acute safety. National Transitions of Care Coalition prioritizes environmental safety coordination for high-fall-risk patients.
Question 7
A 68-year-old patient with type 2 diabetes, macular degeneration, and limited smartphone proficiency is discharged after foot ulcer treatment. The nurse must provide education on wound care and glucose monitoring. Which technology-based approach best accommodates this patient's needs?
- A) A) Sending daily text reminders with written wound care instructions
- B) B) Providing a tablet app featuring video tutorials with audio descriptions✓
- C) C) Scheduling live video calls with visual demonstration of procedures
- D) D) Emailing illustrated PDF guides with enlarged font diagrams
Show rationale
Audio descriptions accommodate macular degeneration by eliminating reliance on visual cues, while tablet interfaces are more intuitive for limited tech proficiency than multi-step video calls. Text reminders (A) lack audio support and visual aids for complex wound care. Video calls (C) require real-time tech navigation skills and adequate vision for demonstrations. PDFs (D) depend entirely on visual acuity despite font enlargement, failing macular degeneration needs. The app allows self-paced review with dual sensory input, aligning with ADA accessibility standards for sensory deficits.
Question 8
A Spanish-speaking patient with heart failure and low literacy learns fluid restriction. After demonstration using measuring cups, teach-back reveals confusion between "8 ounces" and "cups." Which intervention ensures comprehension?
- A) A) Repeat the demonstration using metric measurements exclusively
- B) B) Show visual aids comparing ounces to common household items✓
- C) C) Teach family members to monitor daily intake instead
- D) D) Provide a bilingual pamphlet with conversion charts
Show rationale
Visual comparisons bridge literacy gaps using familiar objects, aligning with low-literacy principles. Switching to metric (A) introduces new concepts. Family monitoring (C) reduces patient autonomy. Pamphlets (D) don't confirm real-time understanding. AMSN protocols prioritize modified teach-back with culturally relevant visuals for health literacy barriers.
Question 9
A 65-year-old with severe COPD (FEV1 48%) and osteoporosis is discharged after vertebral fracture. Which exercise should be included in their individualized rehabilitation plan?
- A) A) High-intensity interval training on a stationary bicycle
- B) B) Weight-bearing walks for 20 minutes three times daily
- C) C) Seated dumbbell exercises with controlled breathing✓
- D) D) Aquatic therapy in chest-deep water three times weekly
Show rationale
Seated exercises minimize fall risk from osteoporosis while controlled breathing accommodates COPD (ATS/ERS guidelines). Weight-bearing walks (B) benefit bones but may cause dyspnea in severe COPD. Aquatic therapy (D) risks water immersion pressure compromising respiration. High-intensity cycling (A) exceeds aerobic capacity. Cues (COPD severity, vertebral fracture) necessitate low-impact, positionally safe strengthening that addresses both conditions.
Question 10
A nurse is preparing to educate a 78-year-old Vietnamese patient with newly diagnosed heart failure and limited health literacy. The patient's daughter states, "My father respects authority figures but won't ask questions." Which approach best assesses his communication preferences?
- A) A) Provide detailed written materials in Vietnamese for independent review
- B) B) Ask the daughter to privately explain his preferred learning style
- C) C) Use teach-back method after concise explanations with visual aids✓
- D) D) Schedule a family conference with an interpreter present
Show rationale
The teach-back method with visual aids respects the patient's potential deference to authority by having the nurse lead, while accommodating limited health literacy through simplified explanations. Written materials (A) ignore his reported reluctance to engage independently. Asking the daughter (B) bypasses patient autonomy. While an interpreter is appropriate, a family conference (D) may overwhelm him and doesn't specifically address learning preferences. CMSRN standards emphasize assessing comprehension through active methods like teach-back for low-literacy patients.
