Deck 3: Care Transitionsfractured or Flowing

Question 1

The nurse is preparing a patient for transition following administration of chemotherapy. The patient reports nausea and appears to be lethargic. For which type of transition does the nurse prepare this patient?

A) Acute care to post-acute care
B) Ambulatory care to home
C) Acute care directly to home
D) Ambulatory care to acute care

Answer 1

B
Explanation: The patient will be transitioned from ambulatory, where chemotherapy was administered, to the patient's home setting. The patient's manifestations are expected and manageable from home but will require patient and family education about symptom management. Transition from acute care to post-acute care occurs when a patient no longer needs the care provided in the acute setting (hospital). However, the patient often does need ongoing care that can occur in a long-term care setting (skilled nursing site) or in the home with home health care. There is no reason to transfer the patient from ambulatory care to acute care.

Question 2

The physician at an in-patient rehabilitation facility sends a patient to a long-term care facility. The patient is an older adult with dementia and poor recovery from a hip replacement because of a fall. Which transition issue does the nurse see as the greatest risk for this patient?

A) Confusion because of a new, unfamiliar setting
B) Expense increases due to a higher level of care
C) Increased possibility for medication errors
D) Decreased interactions with staff members

Answer 2

A
Explanation: Based on the age and condition of this patient, the greatest risk for this patient is confusion related to being transferred to a new and unfamiliar setting. This manifestation also puts the patient at a higher level of safety risk. Expenses between two sub-acute locations may or may not increase. There may or may not be an increased possibility for medication errors. There may or may not be decreased interactions with staff members. Concern is always focused on the wellbeing and safety of the patient.

Question 3

The Transitions of Care Consensus Conference (TOCCC) tackled the daunting task of creating standards for care transitions. Which standard is part of the TOCCC's efforts?

A) Caregivers must establish a medical home.
B) Family understands their care responsibilities.
C) Staff performs a timely interchange of information.
D) Patients receive a summary of the transition.

Answer 3

C
Explanation: One standard of the TOCCC states that staff must perform a timely interchange of information, which closes a gap during transition. TOCCC also suggests that the patient and caregivers establish a medical home or medical coordinator; however, this action is not a mandate. A TOCCC standard states the patient and\or their family\caregivers need to know who is responsible for patient care at every point of transition; the responsibilities of the family are not the focus of this standard. TOCCC does recognize communication as a standard for transition, but it does not specifically identify the provision of a transition summary to the patient.

Question 4

Administrators in an acute care facility are preparing to improve transition processes into and out of the facility. Which information is most helpful for the administrators to use during the process?

A) Opinions and suggestions from the staff nurses based on experience
B) Satisfaction survey results from patients and family\caregivers
C) Designs of transition procedures from other local facilities
D) Evidence based tools and techniques for care transitions from national organizations, the literature and professional societies

Question 5

An older, classic study lists some common adverse events that occur within the three weeks following discharge. Which is one of these events?

A) Patients exhibit hospital-acquired infections.
B) Patients experience injuries at home after procedures.
C) Patients do not maintain prescribed drug regimens.
D) Patients' symptoms worsen due to compromised home environments.

Question 6

Administrators in an acute care facility receive a report indicating that a high percentage of patients from the facility experience a medication issue within three weeks of being discharged home. Which intervention is most likely to decrease the number of incidences?

A) Arranging for a consultation between the patient and their local pharmacy
B) Requiring that all patients are dispensed drugs in time and dated blister packs
C) Identifying a community resource that can assist the patient with drug administration
D) Ensuring a follow up visit with the primary physician within seven days of discharge for medication reconciliation

Question 7

The nurse is providing care for a frail, older patient from a different culture than the nurse's. The patient's family is opposed to the medical suggestion that the patient be discharged to a skilled-care facility. What does the nurse suspect is the reason for the family's opposition?

A) The family does not believe in paying for expensive care of older relatives.
B) The family does not trust any commercial facility to provide the best care.
C) The family may see the suggestion as questioning their ability to care of the patient.
D) The family's language barrier prevents an understanding about the patient's needs.

Question 8

A new specialty, "the extensivist," has been developed to address the fragmented nature of inpatient to outpatient care coordination. The role is most commonly performed by a social worker or home health care nurse.

Question 9

A patient requires inpatient hospitalization in an acute care hospital for at least two midnights in order to qualify for Medicare coverage for admission to a skilled-nursing facility.

Question 10

INTERACT is a publicly available program that focuses on improving the identification, evaluation, and management of acute changes in the condition of nursing home residents and the use of effective care transition strategies.