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ACM-RN practice questions

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Question 1Care Management and Coordination

A patient is admitted to a hospital and the nurse case manager begins discharge planning on day one. Which action best reflects the principle of early discharge planning?

  1. Deferring all planning to the post-acute facility's intake team
  2. Waiting until the patient's condition stabilizes before discussing discharge
  3. Estimating the expected length of stay and likely post-acute needs at admission Correct answer.
  4. Completing discharge teaching only on the morning of discharge

Explanation

Early discharge planning begins at admission by anticipating the expected length of stay and probable post-acute needs so that resources and transitions can be arranged in time. Waiting for stabilization or delaying teaching to the day of discharge compresses the timeline and increases readmission risk.

Question 2Care Management and Coordination

Which description best characterizes the case management process?

  1. A one-time eligibility screening performed at hospital admission
  2. A billing function limited to verifying insurance benefits
  3. A supervisory activity restricted to physicians
  4. A time-limited, collaborative process of assessment, planning, facilitation, and advocacy Correct answer.

Explanation

Case management is a collaborative, time-limited process that includes assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet a patient's needs. It is not a single screening event, a billing task, or a physician-only activity.

Question 3Care Management and Coordination

A patient with a chronic illness needs help navigating appointments, transportation, and medication refills. Which nursing role most directly addresses these gaps?

  1. Care coordinator Correct answer.
  2. Staff educator
  3. Infection preventionist
  4. Quality auditor

Explanation

Care coordination focuses on linking patients to needed services, removing logistical barriers, and facilitating communication across providers. The other roles address organizational functions rather than individual patient navigation.

Question 4Care Management and Coordination

Which tool is designed to measure a patient's ability to perform basic self-care activities such as bathing and dressing?

  1. Braden Scale
  2. Glasgow Coma Scale
  3. Morse Fall Scale
  4. Katz Index of Independence in Activities of Daily Living Correct answer.

Explanation

The Katz Index assesses independence in basic activities of daily living such as bathing, dressing, toileting, and feeding. The Braden measures pressure injury risk, the Morse measures fall risk, and the Glasgow Coma Scale measures level of consciousness.

Question 5Care Management and Coordination

A case manager is determining whether a patient meets criteria for skilled nursing facility placement after hospitalization. Which source of information is most authoritative for coverage criteria?

  1. The patient's payer policy and coverage guidelines Correct answer.
  2. The patient's adult child's preference
  3. The hospital's marketing brochure
  4. A neighbor's prior experience with the facility

Explanation

Coverage determinations must be based on the payer's written policy and medical necessity criteria, which define what services are covered and under what conditions. Anecdotes and preferences do not establish eligibility.

Question 6Care Management and Coordination

A patient is being discharged home with a new diagnosis of heart failure. Which action should the case manager prioritize to reduce the risk of readmission?

  1. Scheduling a follow-up appointment within the recommended early post-discharge window Correct answer.
  2. Advising the patient to call only if symptoms worsen
  3. Waiting for the patient to request services after discharge
  4. Providing a list of emergency department addresses

Explanation

Early follow-up after discharge is a core transitional care strategy that allows timely medication reconciliation, symptom review, and reinforcement of teaching. Passive approaches such as waiting for the patient to request help leave gaps unaddressed.

Question 7Care Management and Coordination

Which statement accurately describes patient advocacy within the case manager role?

  1. It means prioritizing institutional cost savings over patient goals
  2. It applies only when the patient lacks decision-making capacity
  3. It involves representing the patient's interests and preferences in care decisions Correct answer.
  4. It requires the nurse to make decisions on the patient's behalf without discussion

Explanation

Advocacy means ensuring the patient's voice, values, and preferences are represented in care planning and that the patient understands options and rights. It is not paternalistic decision-making, cost-driven, or limited to incapacitated patients.

Question 8Care Management and Coordination

Which element is essential when documenting a case management care plan?

  1. A list of staff who have not yet met the patient
  2. Only the diagnoses listed at admission
  3. A narrative of the nurse's personal opinions about the patient
  4. Measurable goals with target timeframes Correct answer.

Explanation

A care plan must contain measurable, time-bound goals so that progress can be evaluated objectively. Personal opinions, static admission data, and staff tracking lists do not constitute a plan of care.

Question 9Care Management and Coordination

A patient with diabetes is repeatedly readmitted with hyperglycemia. The case manager notes the patient cannot afford insulin and skips doses. Which action best applies the case management principle of addressing barriers to care?

  1. Recommending the patient try harder to follow the regimen
  2. Connecting the patient with medication assistance programs and pharmacy resources Correct answer.
  3. Scheduling the next routine visit in six months
  4. Documenting nonadherence and closing the case

Explanation

Case management identifies and removes barriers to adherence; cost-related nonadherence calls for resource linkage such as assistance programs, social work referral, or lower-cost alternatives. Labeling the patient nonadherent ignores the modifiable financial barrier.

Question 10Care Management and Coordination

During an interdisciplinary team meeting, two specialists recommend conflicting treatment plans. Which approach best reflects effective care coordination?

  1. Facilitating a discussion to reconcile recommendations around the patient's stated goals Correct answer.
  2. Implementing both plans simultaneously without discussion
  3. Choosing the plan from the specialist who documented first
  4. Asking the patient to decide which specialist is correct

Explanation

Care coordination resolves conflict by bringing the team together to align recommendations with the patient's goals and preferences, using evidence and shared decision-making. Arbitrary selection or simultaneous conflicting orders risks harm.

Question 11Care Management and Coordination

A case manager uses a validated screening tool to identify patients at high risk for readmission. What is the primary purpose of risk stratification?

  1. To target intensive resources toward patients most likely to benefit Correct answer.
  2. To determine which patients should be denied services
  3. To rank patients by their insurance type
  4. To replace clinical judgment with an algorithm

Explanation

Risk stratification identifies patients at elevated risk so that limited case management resources can be concentrated where they will have the greatest impact. It informs, but does not replace, clinical judgment and is not a basis for denying care.

Question 12Care Management and Coordination

A patient is being discharged to home with home health services. Which action ensures a safe handoff to the home health agency?

  1. Sending a complete referral with diagnoses, medications, functional status, and goals Correct answer.
  2. Telling the patient to contact the agency when ready
  3. Relying on the patient to relay instructions to the agency
  4. Providing only the discharge summary without medication details

Explanation

A safe handoff requires a complete, timely referral containing diagnoses, medication reconciliation, functional status, and goals so the receiving agency can plan care. Incomplete referrals and reliance on the patient create information gaps.

Question 13Care Management and Coordination

Which situation best demonstrates appropriate use of motivational interviewing by a case manager?

  1. Listing the consequences of nonadherence in detail
  2. Telling the patient exactly what to do to avoid readmission
  3. Setting goals for the patient without discussion
  4. Exploring the patient's reasons for change and reflecting them back Correct answer.

Explanation

Motivational interviewing elicits and strengthens the patient's own motivation by exploring ambivalence and reflecting the patient's reasons for change. Directing, warning, and imposing goals are directive approaches that tend to increase resistance.

Question 14Care Management and Coordination

A case manager is reviewing a patient's medication list and notices duplicate therapy from two prescribers. Which action is most appropriate?

  1. Documenting the duplication without further action
  2. Contacting the prescribers to reconcile the medications before the next dose Correct answer.
  3. Removing one medication independently
  4. Waiting for the patient to report side effects

Explanation

Medication reconciliation requires verifying the list with prescribers and resolving discrepancies to prevent adverse drug events. Independent removal exceeds the nurse's scope, and passive monitoring allows harm to occur.

Question 15Care Management and Coordination

Which outcome measure best evaluates the effectiveness of a care coordination program for chronically ill patients?

  1. Total pages in the patient education booklet
  2. Number of providers on the organizational chart
  3. Rate of unplanned hospital readmissions within 30 days Correct answer.
  4. Number of staff meetings held per month

Explanation

Outcome measures reflect patient results, and 30-day unplanned readmission is a recognized indicator of care coordination effectiveness. Structural or process counts such as meetings or booklet length do not measure patient outcomes.

Question 16Care Management and Coordination

A patient with limited English proficiency is being discharged with complex instructions. Which action best supports safe self-management?

  1. Providing written materials in English only
  2. Arranging a qualified medical interpreter for discharge teaching and confirming understanding Correct answer.
  3. Relying on a family member to interpret all instructions
  4. Using gestures to convey the instructions

Explanation

Use of qualified medical interpreters and teach-back confirms comprehension and supports safe self-management. Untrained family interpreters, English-only materials, and gestures risk miscommunication of critical instructions.

Question 17Care Management and Coordination

A case manager is prioritizing a caseload. Which patient should be seen first?

  1. A patient who missed a wellness visit last year
  2. A patient asking for a copy of immunization records
  3. A patient with a new ostomy and no identified caregiver support Correct answer.
  4. A patient requesting a routine refill of a stable medication

Explanation

Prioritization is based on acuity, complexity, and risk; a new ostomy with no caregiver support presents immediate safety and self-care concerns. Routine refills and record requests are low-acuity administrative needs.

Question 18Care Management and Coordination

Which action reflects appropriate use of teach-back during care coordination?

  1. Asking the patient to sign a form acknowledging teaching
  2. Asking the patient whether the instructions were clear
  3. Providing written instructions and assuming they were read
  4. Asking the patient to explain in their own words how they will take the medication Correct answer.

Explanation

Teach-back verifies understanding by having the patient restate the information in their own words, revealing gaps that can be corrected. Yes/no questions and signatures do not demonstrate comprehension.

Question 19Care Management and Coordination

A patient is enrolled in a managed care plan that requires prior authorization for a post-acute rehabilitation stay. Which action should the case manager take first?

  1. Submit the clinical documentation required for authorization before the planned transfer Correct answer.
  2. Cancel the rehabilitation plan entirely
  3. Advise the patient to pay out of pocket for the stay
  4. Arrange the transfer and obtain authorization afterward

Explanation

When a payer requires prior authorization, the case manager submits supporting clinical documentation before the service to secure approval and avoid denial. Proceeding first and authorizing later risks nonpayment and disrupted care.

Question 20Care Management and Coordination

A case manager is reviewing a patient's advance directive. Which statement best describes the nurse's role in this process?

  1. Ensuring the directive is documented, accessible, and honored in care decisions Correct answer.
  2. Overriding the directive if family members disagree
  3. Deciding which treatments the patient should refuse
  4. Filing the directive without informing the care team

Explanation

The nurse's role is to ensure advance directives are documented in the record, available to the care team, and incorporated into care decisions consistent with the patient's wishes. The nurse does not choose treatments for the patient or override valid directives based on family preference.

Question 21Care Management and Coordination

A patient with multiple chronic conditions sees four specialists who order overlapping tests. Which case management strategy best addresses this fragmentation?

  1. Coordinating a shared care plan and communicating with all providers to reduce duplication Correct answer.
  2. Limiting the patient to one specialist regardless of need
  3. Instructing the patient to coordinate among the specialists
  4. Referring the patient to a fifth specialist for oversight

Explanation

Fragmentation is reduced through a shared, communicated care plan and provider-to-provider coordination that identifies and eliminates duplicate services. Adding providers or shifting coordination to the patient worsens fragmentation.

Question 22Care Management and Coordination

A patient with end-stage disease wants to enroll in hospice, but a family member insists on continued curative treatment. Which action best reflects ethical case management?

  1. Enrolling the patient without discussing the disagreement
  2. Following the family member's wishes to avoid conflict
  3. Exploring the patient's goals and facilitating a family meeting that respects patient autonomy Correct answer.
  4. Deferring the decision indefinitely until the family agrees

Explanation

Ethical practice centers on the patient's autonomy and goals while using facilitated communication to address family concerns. Deferring to family preference over a capacitated patient's wishes, acting without discussion, or indefinite delay violates autonomy and delays appropriate care.

Question 23Care Management and Coordination

A case manager reviewing readmission data finds that patients discharged on Fridays have higher readmission rates than those discharged earlier in the week. Which interpretation is most appropriate?

  1. Readmission rates are unrelated to discharge timing and require no review
  2. Weekend gaps in follow-up and home services may contribute and warrant targeted transition planning Correct answer.
  3. The finding proves Friday discharges are unsafe and should be banned
  4. The data are meaningless because day of week cannot matter

Explanation

Elevated readmissions after Friday discharge suggest system factors such as reduced weekend availability of follow-up and home services, which can be addressed with targeted transitional planning. A single pattern does not prove causation or justify an outright ban.

Question 24Care Management and Coordination

A high-risk patient is eligible for both a transitional care program and a chronic disease management program with overlapping services. Which approach best allocates resources?

  1. Enrolling the patient in both programs with separate care managers
  2. Choosing the program with the larger budget
  3. Declining both programs to conserve resources
  4. Integrating the two programs into a single coordinated plan to avoid duplication Correct answer.

Explanation

When programs overlap, integrating services under a single coordinated plan avoids duplication, conflicting instructions, and patient burden while preserving needed components. Parallel enrollment with separate managers fragments care.

Question 25Care Management and Coordination

A case manager is evaluating whether a patient is ready for discharge. Which combination of findings most strongly indicates readiness?

  1. Patient verbalizes desire to go home
  2. Stable clinical status, demonstrated self-care with teach-back, and confirmed follow-up and support Correct answer.
  3. Normal vital signs alone
  4. Family requests discharge

Explanation

Discharge readiness requires clinical stability plus demonstrated ability to manage self-care and confirmed post-discharge resources and follow-up. Vital signs alone, a desire to leave, or family request do not establish safe readiness.

Question 26Care Management and Coordination

Which activity is the clearest example of care coordination rather than case management?

  1. Completing a comprehensive assessment of a patient's functional status at intake
  2. Negotiating a discounted rate with a home infusion vendor on the patient's behalf
  3. Arranging a shared appointment so a cardiologist and nephrologist can see the same patient on one day Correct answer.
  4. Authorizing a request for a post-acute rehabilitation stay under the plan benefit

Explanation

Care coordination deliberately organizes activities among participants so that care is delivered in a timely, efficient way without duplication. Bringing two specialists together for one visit is a coordination activity. Assessment, benefit authorization, and vendor negotiation are case management functions tied to a single patient's management.

Question 27Care Management and Coordination

A patient is being transferred from an acute hospital to a skilled nursing facility. Which information is most essential for the case manager to transmit to the receiving facility?

  1. The patient's insurance group number and copayment amount
  2. The patient's preferred daily routine and food preferences
  3. The hospital's internal case management staffing schedule
  4. The patient's current medication list, diagnoses, and pending test results Correct answer.

Explanation

A safe handoff requires transferring the clinical information the receiving team needs to continue care: current medications, active diagnoses, and any pending results that could change management. Preferences and administrative details are useful but secondary to clinical safety.

Question 28Care Management and Coordination

A case manager is explaining the purpose of the case management process to a new patient. Which description is most accurate?

  1. It replaces the patient's primary care provider as the coordinator of medical decisions
  2. It guarantees that the patient will receive every service the patient requests
  3. It is a collaborative process of assessment, planning, facilitation, and advocacy to meet health needs Correct answer.
  4. It is a billing function used to determine which services the insurer will pay for

Explanation

Case management is a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individual's health needs. It does not guarantee services, replace the treating clinician, or serve primarily as a billing function.

Question 29Care Management and Coordination

A patient with limited health literacy is being set up with a new home oxygen regimen. Which case manager action best supports adherence?

  1. Scheduling a follow-up call and using teach-back to confirm the patient can describe safe oxygen use Correct answer.
  2. Providing a printed manufacturer's manual and asking the patient to call with questions
  3. Sending the prescription to the durable medical equipment supplier and closing the referral
  4. Documenting that the patient verbalized understanding during a brief hallway conversation

Explanation

Teach-back confirms that the patient can restate instructions in their own words, which surfaces gaps in understanding before discharge. Pairing it with a follow-up call adds a safety net. Handing over a manual or closing a referral does not verify the patient's comprehension.

Question 30Care Management and Coordination

A case manager is deciding how to allocate limited resources across a caseload. Which principle should guide the allocation?

  1. Distributing resources equally so that every patient receives the same number of contacts
  2. Prioritizing patients who are most likely to give favorable satisfaction scores
  3. Directing resources to patients with the greatest clinical need and potential to benefit Correct answer.
  4. Serving patients in the order their referrals were received

Explanation

Resource allocation in case management is guided by need and the potential for benefit, which supports both quality and stewardship. Equal distribution or first-come ordering ignores differences in acuity and may waste resources on patients with little to gain.

Question 31Care Management and Coordination

A case manager is building a care plan with a patient who has chronic obstructive pulmonary disease and depression. Which goal statement best meets the criteria for a measurable care plan goal?

  1. Patient will feel better about managing the condition
  2. Patient will walk two blocks without stopping by the end of eight weeks Correct answer.
  3. Patient will improve overall health and well-being
  4. Patient will be more compliant with the medication regimen

Explanation

A measurable goal specifies an observable behavior, a criterion, and a timeframe. Walking two blocks without stopping within eight weeks meets all three. Statements about feeling better or improving well-being cannot be objectively measured.

Question 32Care Management and Coordination

A patient's insurer denies coverage for a needed home health aide. Which action should the case manager take first?

  1. Review the denial and submit an appeal with supporting clinical documentation Correct answer.
  2. Refer the patient to a different insurer
  3. Discharge the patient from case management services
  4. Tell the patient to pay out of pocket while the appeal is pending

Explanation

The case manager advocates for the patient by reviewing the denial, confirming the clinical criteria, and submitting an appeal with documentation that supports medical necessity. Advising the patient to self-pay or disenrolling the patient abandons the advocacy role.

Question 33Care Management and Coordination

A case manager is completing a utilization review for a patient who has been in an acute hospital for four days. Which finding best supports continued inpatient stay?

  1. The patient lives alone and has no transportation
  2. The patient's family has requested a longer stay
  3. The patient's insurance benefit includes thirty inpatient days
  4. The patient's intravenous antibiotics will continue for three more days Correct answer.

Explanation

Continued inpatient stay is justified by ongoing need for acute-level services that cannot be delivered in a lower level of care. Intravenous antibiotics requiring inpatient monitoring meet that standard. Social circumstances, family preference, and benefit limits do not by themselves establish medical necessity.

Question 34Care Management and Coordination

A case manager is coordinating care for a patient with early-stage dementia who lives with a spouse. Which action best supports the patient's autonomy while maintaining safety?

  1. Refer the patient immediately to a long-term care facility
  2. Involve the patient in decisions about daily routines and supports while assessing for safety risks Correct answer.
  3. Take over all decision-making to prevent errors
  4. Avoid discussing the diagnosis with the patient to reduce distress

Explanation

Autonomy is preserved by involving the patient in decisions to the extent the patient is capable, while assessing for risks that require support. Removing decision-making or avoiding the diagnosis undermines the patient's remaining capacity and trust.

Question 35Care Management and Coordination

A case manager for a patient with multiple chronic conditions wants to measure whether care coordination has improved continuity. Which indicator is most direct?

  1. Total number of diagnoses coded for the patient
  2. Average length of the case manager's documentation entries
  3. Percentage of patients with a documented follow-up visit within seven days of discharge Correct answer.
  4. Number of case management telephone calls placed per month

Explanation

Continuity of care is most directly reflected in whether patients actually connect with follow-up providers after discharge. A timely follow-up visit rate captures that connection. Call volume, diagnosis counts, and documentation length are process or administrative measures.

Question 36Care Management and Coordination

A patient with a new ostomy is anxious about self-care at home. Which case manager action best applies a patient-centered approach?

  1. Telling the patient that anxiety is normal and will resolve without intervention
  2. Scheduling a follow-up appointment in three months
  3. Providing a list of supply vendors and closing the case
  4. Arranging a peer visit from a trained ostomy volunteer and a home health nurse for hands-on teaching Correct answer.

Explanation

A patient-centered approach addresses the patient's stated concern with concrete supports matched to the need. Peer support and hands-on teaching build confidence and skill. Dismissing anxiety or delaying follow-up leaves the patient without the resources to manage self-care.

Question 37Care Management and Coordination

A case manager learns that a patient is being discharged with a new diagnosis of diabetes and has no glucometer. Which action best demonstrates advocacy?

  1. Documenting the lack of equipment in the discharge summary
  2. Advising the patient to monitor symptoms instead of glucose
  3. Instructing the patient to purchase a glucometer after the first paycheck
  4. Contacting the provider and payer to obtain a glucometer before discharge Correct answer.

Explanation

Advocacy means acting to secure the resources a patient needs to carry out the plan of care. Contacting the provider and payer to obtain the device before discharge addresses the gap directly. Documentation alone or delaying acquisition leaves the patient unable to perform the prescribed monitoring.

Question 38Care Management and Coordination

A case manager is coordinating care for a patient who is homeless and has a chronic wound requiring dressing changes. Which arrangement best reflects an appropriate level of care?

  1. Daily emergency department visits for dressing changes
  2. Weekly home health visits with no plan for the intervening days
  3. Inpatient admission until housing is secured
  4. A wound care clinic visit with a plan for shelter-based nursing support Correct answer.

Explanation

The appropriate level of care meets the clinical need in the least restrictive setting. A wound clinic combined with shelter-based nursing support provides consistent dressing changes without unnecessary acute care. Daily emergency visits or inpatient admission over-utilize acute resources, and weekly visits leave gaps.

Question 39Care Management and Coordination

A case manager is reviewing a population of patients with heart failure and finds that readmissions cluster among patients who missed their first post-discharge appointment. Which interpretation is most appropriate?

  1. The finding proves that follow-up appointments prevent readmission
  2. The data should be discarded because it is observational
  3. Readmission rates are unrelated to outpatient access
  4. Missed follow-up is a marker identifying patients who need intensified outreach Correct answer.

Explanation

Observational data can identify markers of risk and targets for intervention, but it cannot by itself prove causation. Missed follow-up identifies a group that may benefit from outreach. Concluding that appointments prevent readmission overstates what the data show.

Question 40Care Management and Coordination

A case manager is coordinating care for a patient who is eligible for both Medicare and Medicaid. Which action best addresses the coordination challenges of dual eligibility?

  1. Referring the patient to a financial planner for benefit decisions
  2. Advising the patient to drop one program to simplify coordination
  3. Identifying a single point of contact to align benefits and avoid duplicated services Correct answer.
  4. Enrolling the patient in both programs separately and letting each manage its own services

Explanation

Dual-eligible patients often face fragmented benefits across two programs. Designating a single point of contact to align benefits and prevent duplication improves coordination. Letting each program operate separately perpetuates fragmentation, and dropping coverage reduces access.

Question 41Patient Advocacy and Education

A patient with limited English proficiency is being asked to sign a surgical consent form. Which action best supports the patient's right to informed consent?

  1. Have a bilingual family member translate the form at the bedside
  2. Provide a written translation and skip the verbal discussion
  3. Ask the patient to sign and explain the details afterward
  4. Use a trained medical interpreter to interpret the consent discussion Correct answer.

Explanation

Informed consent requires that the patient understand the information, so interpretation must be accurate and complete. Trained medical interpreters reduce errors and protect confidentiality better than ad hoc interpreters such as family members. The discussion must occur before signature, not after.

Question 42Patient Advocacy and Education

Which statement best describes the nurse's role as a patient advocate?

  1. Deciding for the patient when the care team disagrees about treatment
  2. Acting to protect the patient's rights, values, and preferences within the health care system Correct answer.
  3. Following the physician's orders without questioning them
  4. Persuading the patient to accept the team's recommended plan

Explanation

Advocacy means representing and protecting the patient's interests, rights, and choices, including when those differ from team preferences. The nurse supports autonomous decision-making rather than overriding it.

Question 43Patient Advocacy and Education

An adult patient with decision-making capacity refuses a prescribed blood transfusion. What is the most appropriate nursing action?

  1. Ask the family to sign a consent overriding the refusal
  2. Administer the transfusion because it is life-sustaining
  3. Obtain a court order before stopping the transfusion
  4. Respect the refusal and document the discussion and patient's reasons Correct answer.

Explanation

A competent adult has the right to refuse any treatment, even life-sustaining therapy. The nurse should ensure the patient is informed, document the refusal, and continue to provide other care.

Question 44Patient Advocacy and Education

A patient asks the nurse to explain a newly prescribed medication. Which teaching approach best promotes learning?

  1. Give the patient the pharmacy printout and ask them to read it later
  2. Use detailed pathophysiology to ensure the patient understands the mechanism
  3. Assess the patient's current knowledge and health literacy before teaching Correct answer.
  4. Provide all instructions in a single session to save time

Explanation

Effective patient education begins with an assessment of baseline knowledge, readiness, and health literacy so teaching can be tailored. Chunking information and confirming understanding improve retention.

Question 45Patient Advocacy and Education

Which action best confirms that a patient has understood discharge teaching about wound care?

  1. Ask the patient to sign the discharge instruction sheet
  2. Give the patient a brochure and note that teaching was provided
  3. Ask the patient if they have any questions before leaving
  4. Ask the patient to demonstrate the dressing change and explain it back Correct answer.

Explanation

Teach-back and return demonstration verify that the patient can apply the information, which is the goal of education. Signature or brochure distribution documents delivery, not comprehension.

Question 46Patient Advocacy and Education

A patient with a terminal illness asks about hospice care. Which statement reflects an accurate understanding by the nurse?

  1. Hospice focuses on comfort and quality of life when curative treatment is no longer pursued Correct answer.
  2. Hospice requires the patient to stop all medications
  3. Hospice care can only be provided in an inpatient facility
  4. Hospice is chosen only in the last 24 hours of life

Explanation

Hospice emphasizes comfort, symptom management, and quality of life for patients with a terminal prognosis, typically when curative treatment is no longer the goal. It can be delivered in the home, and comfort-focused medications continue.

Question 47Patient Advocacy and Education

A patient reports that a staff member was rude and dismissive during morning care. What is the nurse's best initial advocacy action?

  1. Ignore the report because rudeness is not a clinical issue
  2. Listen to the patient's concern, document it, and address it through appropriate channels Correct answer.
  3. Advise the patient to file a complaint with the state licensing board
  4. Tell the patient that staff are busy and to be more understanding

Explanation

Advocacy includes taking patient concerns seriously, documenting them, and using the organization's processes to resolve them. The nurse validates the concern and acts within the system.

Question 48Patient Advocacy and Education

Which situation requires the nurse to report to adult protective services?

  1. An older adult with unexplained bruising and a caregiver who gives inconsistent explanations Correct answer.
  2. An older adult who chooses to live alone despite mild arthritis
  3. An older adult who refuses a recommended influenza vaccine
  4. An older adult who prefers to spend savings on a family vacation

Explanation

Unexplained injuries with inconsistent explanations raise suspicion of abuse and require reporting per mandatory reporting laws. Lifestyle choices made by a competent adult are not reportable.

Question 49Patient Advocacy and Education

A patient's advance directive names a daughter as health care agent. The patient is now unconscious and the daughter requests a treatment the team opposes. What is the nurse's best action?

  1. Follow the team's preferred plan because clinicians know best
  2. Ask another family member to decide instead
  3. Wait until the patient regains consciousness to decide
  4. Support the agent's role and facilitate communication between the agent and the team Correct answer.

Explanation

A health care agent has legal authority to make decisions consistent with the patient's known wishes. The nurse advocates by facilitating discussion and mediating conflict rather than overriding the agent.

Question 50Patient Advocacy and Education

Which statement about the Patient Self-Determination Act is accurate?

  1. It mandates that all patients complete a living will on admission
  2. It allows hospitals to refuse care to patients without an advance directive
  3. It requires health care organizations to inform patients of their right to make advance directives Correct answer.
  4. It gives nurses legal authority to sign advance directives for patients

Explanation

The Patient Self-Determination Act requires facilities receiving Medicare/Medicaid funds to inform patients of their rights regarding advance directives. It does not require patients to complete them.