Discharge and Continuity of Care

1. Mr. Desrosiers, 76, is being discharged after treatment for diverticulitis. He brings two different pill bottles and a list from his outpatient clinic; the inpatient team changed his antihypertensive dose. The LPN notices discrepancies between the lists and the new prescription. The patient says, “My son manages my pills — he’ll sort it out.” What is the LPN’s most appropriate immediate action before discharge? *

Trust the son to reconcile medication at home

Proceed with discharge and ask the patient to bring all bottles to his family doctor

Arrange a pharmacist-led medication reconciliation and counseling prior to discharge

Give the patient the new prescription and advise him to stop the old meds

2. Mrs. LeBlanc, 83, with mild dementia is scheduled for discharge. Her apartment building stairs are steep and the elevator is often out of service. She insists on going home and appears competent in brief assessments, but family admits they cannot provide daily support. Which is the LPN’s best step to ensure safe continuity of care? *

Honor her wish and discharge with written instructions only

Discharge and ask her daughter to check in weekly

Escalate to the interprofessional team to arrange a home-safety assessment and home-care services before discharge

Advise the patient to move to a lower-floor apartment later

3. Mr. Moreau, 69, is started on a DOAC for new atrial fibrillation and will be discharged in 24 hours. He lives alone and has mild hearing loss. The LPN provides verbal teaching but the patient nods and signs the form without questions. What action best ensures understanding and safety prior to discharge? *

Provide the manufacturer pamphlet and advise follow-up with family doctor

Use teach-back with simplified language, large-print instructions, and arrange a nurse or pharmacist follow-up call within 48 hours

Assume comprehension because he signed the form

Ask the patient’s neighbour to remind him about medication

4. Due to bed shortages, a medically stable but socially vulnerable patient is being considered for early discharge. He has uncontrolled diabetes, limited literacy, no phone, and uncertain housing. The team assumes community resources will fill gaps after discharge. Which is the LPN’s ethically sound response? *

Facilitate discharge and document the plan as “community follow-up”

Discharge and hand the patient a list of community numbers

Tell the patient to present to the ED if problems arise

Raise safety concerns with the team and request a delay until essential supports (housing/phone/medication access) are arranged

5. An 86-year-old man refuses home nursing visits due to privacy concerns, despite needing wound care and medication supervision. He appears competent and insists on going home. What is the nurse’s correct course of action? *

Honor the refusal and discharge without further documentation

Coerce acceptance because it is clinically indicated

Ensure he understands risks via teach-back, document informed refusal, offer alternatives (e.g., clinic-based wound clinic, scheduled home safety check), and notify the team

Discharge and arrange home care covertly

6. A frail patient is medically ready for discharge, but the daughter wants home-based care and the son insists on long-term care placement due to caregiver burden. The patient is passive and undecided. What should the LPN prioritize? *

Allow the team to decide without family input

Follow the daughter’s wishes to keep the patient at home

Place the patient according to the son’s request to relieve family burden

Facilitate a capacity assessment and a patient-centered meeting including SW, family, and patient preferences to reach an informed plan

7. A patient with heart failure is discharged, but the discharge summary lacks recent diuretic dose changes and the follow-up appointment date. The LPN suspects the primary care provider will be unable to adjust care based on missing information. What is the LPN’s best corrective action before the patient leaves? *

Ask the patient to remind the physician at the next visit

Fax all inpatient notes without highlighting changes

Ignore it; documentation is the physician’s responsibility

Contact the discharging physician to clarify and ensure the discharge summary includes medication changes and scheduled follow-up

8. A patient with a complex leg wound will be homeless upon discharge. He needs regular dressing changes, antibiotics, and follow-up visits. Which plan best secures continuity of care? *

Arrange an outreach nursing service or shelter-based clinic for wound care and coordinate case management for housing supports

Discharge with a supply of dressings and instructions to come to the ED if problems arise

Refer to volunteer groups to check on him occasionally

Ask him to return daily to clinic for dressing changes on his owns

9. A patient with low-risk heart failure is being considered for early discharge with a remote monitoring device (BP/weight telemonitoring). He is technologically inexperienced and has intermittent Wi-Fi. The team sees remote monitoring as an acceptable substitute for in-person follow-up. What is the LPN’s most appropriate action before discharge? *

Enroll him without training because the device is standard

Tell him to ask a family member to manage the device later

Refuse remote monitoring and insist on inpatient stay

Provide device training, verify connectivity, arrange in-person alternatives if monitoring is not feasible, and document a backup plan