Coordination of Care

Question 1

A nurse is preparing to discharge a client who was hospitalized for heart failure. Which action best supports continuity of care?

Accepted Answer

Arrange follow-up appointments, communicate with the home health agency, and use teach-back to confirm understanding

Answer

Effective care coordination at discharge includes arranging post-discharge follow-up, communicating the care plan to receiving providers, and verifying client understanding through teach-back. This reduces readmission rates and ensures seamless transitions.

Question 2

A nurse is caring for a client who needs a wound consult, physical therapy evaluation, and dietary assessment. What is the nurse's most effective approach?

Accepted Answer

Initiate an interdisciplinary care conference to coordinate simultaneous planning

Answer

An interdisciplinary care conference brings together all team members (wound care, PT, dietitian, physician, nursing) to coordinate an integrated care plan. This prevents fragmented care, reduces duplicated effort, and ensures goals are client-centered.

Question 3

A nurse is handing off care using the SBAR communication tool. Which element is included under the 'Recommendation' component?

Accepted Answer

What the nurse believes needs to happen and the requested action

Answer

In SBAR (Situation, Background, Assessment, Recommendation), the Recommendation component contains what the nurse is requesting — such as a medication order, diagnostic test, or transfer. It is the action-oriented conclusion of the communication.

Question 4

A case manager is coordinating discharge for an elderly client who lives alone and has limited mobility after a hip replacement. The priority referral is to:

Accepted Answer

Home health services including physical therapy and skilled nursing visits

Answer

A client with limited mobility who lives alone after hip replacement requires home health services to ensure safe recovery. Home physical therapy improves mobility and fall prevention, while skilled nursing visits monitor wound healing and medication adherence.

Question 5

During a care transition, the nurse realizes that a client's medication list from the transferring facility omits a daily blood thinner. What is the nurse's priority action?

Accepted Answer

Perform medication reconciliation by contacting the transferring provider to verify the complete list

Answer

Medication reconciliation at transitions of care is a critical safety process. The nurse must verify the complete and accurate medication list with the previous provider before administering anything. Administering unverified medications can cause serious harm.

NCLEX Practice Test

NCLEX Practice Test

Coordination of Care