CNL Care Transitions & Discharge Planning 2 — Questions and Answers
Question 1: During medication reconciliation at discharge, the CNL discovers a patient was prescribed two anticoagulants — one new and one pre-admission. The FIRST action should be:
- Fill both prescriptions and let the patient decide which to take
- Clarify the discrepancy with the prescribing physician before discharge (Correct answer)
- Document the discrepancy and discharge the patient
- Instruct the patient to take the lower dose of the two
Correct answer: Clarify the discrepancy with the prescribing physician before discharge
Medication discrepancies must be clarified with the prescribing physician before discharge to prevent potentially life-threatening duplication errors.
Question 2: The BOOST (Better Outcomes by Optimizing Safe Transitions) tool is primarily used to:
- Calculate hospital billing for discharge services
- Identify patients at high risk for readmission so targeted interventions can be applied (Correct answer)
- Train nursing staff on documentation requirements
- Audit compliance with Joint Commission standards
Correct answer: Identify patients at high risk for readmission so targeted interventions can be applied
Project BOOST uses validated risk assessment tools to identify patients at high risk for 30-day readmission so that focused discharge interventions can be applied.
Question 3: Which element is considered a CORE component of an effective transition of care record (transition of care summary)?
- Patient's dietary preferences and hobbies
- Reconciled medication list, active problem list, and pending test results (Correct answer)
- Insurance billing codes for the hospitalization
- Nursing staff assignments during the hospital stay
Correct answer: Reconciled medication list, active problem list, and pending test results
A complete transition of care summary must include a reconciled medication list, active problems, and pending results to ensure safe handoffs between providers.
Question 4: A CNL is implementing a bundle to reduce heart failure readmissions. Which intervention has the HIGHEST evidence for reducing 30-day readmissions in this population?
- Restricting patient visitors during the last 24 hours before discharge
- Patient self-monitoring of daily weight with a clear action plan for weight gain (Correct answer)
- Providing printed pamphlets about heart failure at admission
- Scheduling a follow-up appointment within 90 days of discharge
Correct answer: Patient self-monitoring of daily weight with a clear action plan for weight gain
Daily weight self-monitoring with a clear action plan (when to call, when to go to ER) is among the highest-evidence interventions for reducing heart failure readmissions.
Question 5: When using the 'teach-back' method during discharge education, the nurse's CORRECT approach is to ask:
- 'Do you understand everything we went over today?'
- 'Can you explain to me in your own words how to take this medication?' (Correct answer)
- 'Is there anything you didn't understand?'
- 'Are you comfortable going home today?'
Correct answer: 'Can you explain to me in your own words how to take this medication?'
Teach-back requires the patient to demonstrate understanding by explaining or demonstrating in their own words, rather than answering a yes/no comprehension question.
Question 6: Which team member is MOST important to include in discharge planning for a patient with complex social needs such as homelessness or food insecurity?
- The hospital chaplain
- The social worker or case manager (Correct answer)
- The pharmacy technician
- The radiology technologist
Correct answer: The social worker or case manager
Social workers and case managers have expertise in connecting patients with community resources to address social determinants of health that affect post-discharge outcomes.
Question 7: A CNL is evaluating a newly implemented discharge planning protocol. Which metric BEST measures the protocol's effectiveness at improving care transitions?
- Average number of discharge teaching sessions per patient
- 30-day all-cause readmission rate (Correct answer)
- Number of discharge summaries completed on time
- Patient satisfaction scores for hospital food
Correct answer: 30-day all-cause readmission rate
The 30-day all-cause readmission rate directly measures whether the discharge planning protocol is achieving the outcome of keeping patients safely at home after discharge.
CNL Care Transitions & Discharge Planning 2
During medication reconciliation at discharge, the CNL discovers a patient was prescribed two anticoagulants — one new and one pre-admission.
The FIRST action should be: