In the I-PASS handoff format, the receiving nurse's 'synthesis' step consists of:

Restating key points and actions to confirm understanding

Listing the tasks that must be done during the shift

Rating the overall severity of the client's illness

Describing the plan for problems that might occur

While on the phone with the lab, the nurse is given a value of 6.8 mEq/L for a client's serum K+. Which step comes first?

Write down the value and read it back to the caller

Notify the provider before writing down the value

Ask the lab to send the result to the provider directly

Repeat the blood draw to check that it is accurate

The oncoming nurse receives handoff on four clients. Which statement from the off-going nurse needs clarification before she leaves?

'His insulin drip was changed; I'm not sure what rate the new order says.'

'She walked in the hall twice today with the physical therapist.'

'She refused her bath this morning and wants one later this evening.'

'His wife is bringing his glasses and his hearing aids after lunch.'

A new order reads 'Ondansetron 4 mg every 6 hours as needed for nausea.' What should the nurse do before giving the first dose?

Contact the prescriber to clarify the route

Ask the pharmacist to choose the route

Give it IV, as nausea makes swallowing hard

Give it orally, as that is the usual route

Handoff, orders, referrals and discharge

48 NCLEX-RN practice questions on Handoff, orders, referrals and discharge, part of Management of Care. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
In the I-PASS handoff format, the receiving nurse's 'synthesis' step consists of:
1. AListing the tasks that must be done during the shift
2. BRating the overall severity of the client's illness
3. CRestating key points and actions to confirm understanding
4. DDescribing the plan for problems that might occur
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Answer: C · Restating key points and actions to confirm understanding
I-PASS stands for Illness severity, Patient summary, Action list, Situation awareness and contingency planning, and Synthesis by receiver. In synthesis, the receiver summarises what was heard, asks questions and restates the key actions, closing the communication loop. This step catches misunderstandings before the off-going nurse leaves. This item tests recognising cues about structured handoff.
- A: The action list is given by the sender.
- B: Illness severity is the first element, given by the sender.
- D: Contingency planning is part of situation awareness.
Question 2 · Medium
While on the phone with the lab, the nurse is given a value of 6.8 mEq/L for a client's serum K+. Which step comes first?
1. AWrite down the value and read it back to the caller
2. BNotify the provider before writing down the value
3. CAsk the lab to send the result to the provider directly
4. DRepeat the blood draw to check that it is accurate
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Answer: A · Write down the value and read it back to the caller
Critical results received by phone are written down and read back to confirm accuracy, a Joint Commission requirement. The nurse then notifies the provider promptly and assesses the client, including cardiac monitoring. Calling the provider with an unconfirmed number risks passing on an error. This item tests taking action on a critical result.
- B: Confirming the value comes before acting on it.
- C: The nurse who receives the result is responsible for reporting it.
- D: Re-drawing delays treatment of a possibly dangerous value.
Question 3 · Medium
After a stroke, a client coughs and clears his throat each time he drinks water. Which team member should the nurse ask the provider to consult?
1. ASpeech-language pathologist
2. BRespiratory therapist
3. COccupational therapist
4. DRegistered dietitian
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Answer: A · Speech-language pathologist
Coughing with drinking is a sign of dysphagia and aspiration risk. A speech-language pathologist performs swallowing evaluation and recommends safe diet textures and techniques. The nurse keeps the client NPO until the swallow is assessed. This item tests recognising cues and generating solutions through referral.
- B: A respiratory therapist manages breathing and airway therapy, not swallowing.
- C: Occupational therapy helps with activities of daily living, such as adapted utensils, but does not evaluate swallowing.
- D: A dietitian adjusts nutrition after the safe texture is decided.
Question 4 · Hard
The oncoming nurse receives handoff on four clients. Which statement from the off-going nurse needs clarification before she leaves?
1. A'She walked in the hall twice today with the physical therapist.'
2. B'His insulin drip was changed; I'm not sure what rate the new order says.'
3. C'She refused her bath this morning and wants one later this evening.'
4. D'His wife is bringing his glasses and his hearing aids after lunch.'
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Answer: B · 'His insulin drip was changed; I'm not sure what rate the new order says.'
An uncertain rate on a high-alert infusion is a direct safety risk, and the off-going nurse may know what was ordered and when it changed. The two nurses should check the order and the pump together before she leaves. The other statements are routine and need no urgent clarification. This item tests prioritising hypotheses in handoff.
- A: Ambulation progress is routine information.
- C: A bath preference can be handled later without risk.
- D: Bringing personal items is not a safety concern.
Question 5 · Medium
A new order reads 'Ondansetron 4 mg every 6 hours as needed for nausea.' What should the nurse do before giving the first dose?
1. AAsk the pharmacist to choose the route
2. BContact the prescriber to clarify the route
3. CGive it IV, as nausea makes swallowing hard
4. DGive it orally, as that is the usual route
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Answer: B · Contact the prescriber to clarify the route
A complete medication order includes the client, drug, dose, route, frequency and the prescriber's signature, and this order lacks a route. The nurse does not guess; she contacts the prescriber to clarify. Ondansetron can be given orally, as an orally disintegrating tablet, IV or IM, so the route changes the plan. This item tests recognising cues in an incomplete order.
- A: The pharmacist cannot complete a missing element of a prescription.
- C: Picking IV is still guessing at the missing route.
- D: Choosing a route is prescribing; the nurse may not assume it.
Question 6 · Medium
A client needs IV antibiotics for 4 more weeks after discharge and can manage at home with family help. Which referral is most appropriate?
1. AHome health agency for skilled nursing visits
2. BLong-term care facility for placement
3. CHospice program for supportive care
4. DOutpatient physical therapy service
Answer and explanation in LearnFree account
Question 7 · Easy
A main advantage of giving shift handoff at the client's bedside is that it:
1. AKeeps the client's information private from family visitors
2. BMeans the oncoming nurse need not do a first assessment
3. CLets the client take part and both nurses see the client
4. DTakes less time than a report given at the nurses' station
Answer and explanation in LearnFree account
Question 8 · Medium
At an interprofessional care conference about a client's discharge, the nurse's most important contribution is to:
1. AReview the insurance coverage for each proposed service
2. BReport the client's own goals and how he is responding to care
3. CDecide which services the client will receive after he leaves
4. DApprove the therapy plans written by the other disciplines
Answer and explanation in LearnFree account
Question 9 · Hard
A 68-year-old with heart failure has had three admissions in 4 months. He is going home today. Which discharge action is most likely to prevent another early readmission?
1. AAdvise him to go to the emergency department for any weight gain
2. BGive him a printed packet that lists heart failure symptoms
3. CSchedule a provider visit within 7 days of discharge
4. DAsk his daughter to keep a diary of everything he eats
Answer and explanation in LearnFree account
Question 10 · Medium
During a routine day shift, a provider standing at the nurses' station tells the nurse, 'Start her on lisinopril 10 mg daily.' What is the best response?
1. AAsk another nurse to listen to the order as a witness
2. BAsk the provider to enter the order electronically
3. CWrite down the order, read it back and give the drug now
4. DGive the drug and ask the provider to sign it tomorrow
Answer and explanation in LearnFree account
Question 11 · Easy
Asking a client to explain, in her own words, how she will change her dressing at home is the teaching method called:
1. ARole-playing
2. BClosed questioning
3. CReturn demonstration
4. DTeach-back
Answer and explanation in LearnFree account
Question 12 · Hard
The provider has written a discharge order for a client after a fall. In the afternoon, the physical therapist documents, 'Unsafe to walk without help; needs a walker and supervision on stairs.' The client lives alone in a second-floor apartment. What should the nurse do?
1. ADischarge the client as ordered and suggest he use a walker
2. BAsk the client to sign a waiver that accepts the risk of falls
3. CCancel the discharge order and keep him in hospital tonight
4. DInform the provider of the therapy findings and ask for a team review
Answer and explanation in LearnFree account
Question 13 · Easy
The main purpose of reading back a telephone order to the prescriber is to:
1. AMeet the rule that a second nurse must hear every order
2. BConfirm the order was heard and recorded correctly
3. CGive the prescriber time to change the order if needed
4. DRecord the exact time the order was given in the chart
Answer and explanation in LearnFree account
Question 14 · Hard
A 70-year-old who lives alone is to be discharged in 2 hours with a new insulin pen. He has macular degeneration and needed three attempts to read the dose window during teaching. What is the nurse's best action?
1. AGive him a written handout on insulin in large print
2. BAsk a neighbor to give him his insulin at home every day
3. CDelay discharge until he can read the dose window by himself
4. DArrange home health visits to support insulin use and safety
Answer and explanation in LearnFree account
Question 15 · Medium
A 76-year-old who lives alone had a hip repair and cannot yet bear weight. She needs physical therapy twice daily. Which discharge setting should the nurse expect the team to arrange?
1. AShort-term stay in a rehabilitation facility
2. BAdmission to a hospice inpatient unit
3. CDischarge home with outpatient therapy visits
4. DTransfer to an assisted-living apartment
Answer and explanation in LearnFree account
Question 16 · Hard
A client is being discharged 2 days after a drug-eluting coronary stent. His home list includes aspirin and atorvastatin. The discharge medication list includes aspirin and atorvastatin but no clopidogrel, which he has received daily in hospital. What should the nurse do?
1. ADischarge him with the list as written by the provider
2. BTeach him that aspirin alone will protect the new stent
3. CContact the provider to clarify whether clopidogrel was left out
4. DTell him to keep taking clopidogrel from his hospital supply
Answer and explanation in LearnFree account
Question 17 · Medium
For a client admitted for a planned hip replacement, discharge planning should begin:
1. AAt admission or before the surgery
2. BWhen the provider writes the discharge order
3. COn the first day after the surgery
4. DAfter the client can walk the length of the hall
Answer and explanation in LearnFree account
Question 18 · Medium
A client is receiving a continuous heparin infusion. After the client's transfer to a new service, a second provider orders enoxaparin 1 mg/kg subcutaneously every 12 hours. What should the nurse do?
1. AHold the enoxaparin and clarify with the provider
2. BGive both, as they work by different mechanisms
3. CStop the heparin and start the enoxaparin instead
4. DGive the enoxaparin and watch for signs of bleeding
Answer and explanation in LearnFree account
Question 19 · Medium
A client with a new ileostomy is anxious about managing the pouch at home. Which referral best meets this need?
1. AWound, ostomy and continence nurse
2. BRegistered dietitian
3. CPhysical therapist
4. DClinical social worker
Answer and explanation in LearnFree account
Question 20 · Medium
On admission, a client brings a bag of his home medications. What should the nurse do with them?
1. AGive them to the pharmacy to use for the client's hospital doses
2. BDiscard them, since all hospital doses come from the pharmacy
3. CList them for reconciliation, then send home or store them
4. DKeep them at the bedside so the client can take his usual doses
Answer and explanation in LearnFree account
Question 21 · Medium
A client's potassium this morning is 2.9 mEq/L (reference 3.5-5.0 mEq/L). The provider has ordered furosemide 40 mg IV now. What should the nurse do?
1. AGive the dose and recheck the potassium in 6 hours
2. BGive half the dose and note the low potassium
3. CHold the dose and report the potassium
4. DGive the dose with a high-potassium meal tray
Answer and explanation in LearnFree account
Question 22 · Hard
Day 1 after a colectomy, at 1400: BP 88/50 mm Hg (was 124/78 at 0800), pulse 118/min, urine output 60 mL over the last 4 hours, abdominal dressing dry. The nurse calls the surgeon using SBAR. Which statement is the 'Recommendation'?
1. A'Please come see him now; do you want a fluid bolus and a CBC?'
2. B'I'm worried he may be bleeding internally and in shock.'
3. C'His pressure is 88/50, and his pulse has risen to 118.'
4. D'He had an open colectomy yesterday for colon cancer.'
Answer and explanation in LearnFree account
Question 23 · Hard
A provider orders hydromorphone 10 mg IV every 2 hours for an opioid-naive adult after surgery. The nurse calls to question the dose, and the provider insists that it be given. What should the nurse do next?
1. AAsk another nurse to give the dose, since the nurse disagrees
2. BGive the dose because the provider has confirmed the order
3. CWithhold the dose and notify the charge nurse or nursing supervisor
4. DGive a smaller dose that the nurse judges to be safer for the client
Answer and explanation in LearnFree account
Question 24 · Medium
During shift handoff, the off-going nurse says that a client 'had some chest pain earlier.' What should the oncoming nurse do?
1. AAccept the report, since the pain has already resolved
2. BAsk when it occurred, what was done and how he is now
3. CNote it and check on the client after report is finished
4. DRequest a 12-lead ECG as soon as handoff is complete
Answer and explanation in LearnFree account
Question 25 · Hard
A client is to go home today, 3 days after an open appendectomy. Findings at 1000: temperature 101.8°F (38.8°C), pulse 104/min, incision red with a small amount of cloudy drainage, pain 3/10 with oral analgesic, tolerating a regular diet. Which finding should the nurse report to the provider before discharge?
1. AThe use of oral rather than IV pain medicine
2. BThe tolerance of a regular diet without nausea
3. CThe pain rating of 3/10 on oral analgesics
4. DThe fever with cloudy drainage from the incision
Answer and explanation in LearnFree account

23 more Handoff, orders, referrals and discharge questions

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Study Management of Care

Handoff, orders, referrals and discharge

In the I-PASS handoff format, the receiving nurse's 'synthesis' step consists of:

While on the phone with the lab, the nurse is given a value of 6.8 mEq/L for a client's serum K+. Which step comes first?

After a stroke, a client coughs and clears his throat each time he drinks water. Which team member should the nurse ask the provider to consult?

The oncoming nurse receives handoff on four clients. Which statement from the off-going nurse needs clarification before she leaves?

A new order reads 'Ondansetron 4 mg every 6 hours as needed for nausea.' What should the nurse do before giving the first dose?

A client needs IV antibiotics for 4 more weeks after discharge and can manage at home with family help. Which referral is most appropriate?

A main advantage of giving shift handoff at the client's bedside is that it:

At an interprofessional care conference about a client's discharge, the nurse's most important contribution is to:

A 68-year-old with heart failure has had three admissions in 4 months. He is going home today. Which discharge action is most likely to prevent another early readmission?

During a routine day shift, a provider standing at the nurses' station tells the nurse, 'Start her on lisinopril 10 mg daily.' What is the best response?

Asking a client to explain, in her own words, how she will change her dressing at home is the teaching method called:

The provider has written a discharge order for a client after a fall. In the afternoon, the physical therapist documents, 'Unsafe to walk without help; needs a walker and supervision on stairs.' The client lives alone in a second-floor apartment. What should the nurse do?

The main purpose of reading back a telephone order to the prescriber is to:

A 70-year-old who lives alone is to be discharged in 2 hours with a new insulin pen. He has macular degeneration and needed three attempts to read the dose window during teaching. What is the nurse's best action?

A 76-year-old who lives alone had a hip repair and cannot yet bear weight. She needs physical therapy twice daily. Which discharge setting should the nurse expect the team to arrange?

A client is being discharged 2 days after a drug-eluting coronary stent. His home list includes aspirin and atorvastatin. The discharge medication list includes aspirin and atorvastatin but no clopidogrel, which he has received daily in hospital. What should the nurse do?

For a client admitted for a planned hip replacement, discharge planning should begin:

A client is receiving a continuous heparin infusion. After the client's transfer to a new service, a second provider orders enoxaparin 1 mg/kg subcutaneously every 12 hours. What should the nurse do?

A client with a new ileostomy is anxious about managing the pouch at home. Which referral best meets this need?

On admission, a client brings a bag of his home medications. What should the nurse do with them?

A client's potassium this morning is 2.9 mEq/L (reference 3.5-5.0 mEq/L). The provider has ordered furosemide 40 mg IV now. What should the nurse do?

Day 1 after a colectomy, at 1400: BP 88/50 mm Hg (was 124/78 at 0800), pulse 118/min, urine output 60 mL over the last 4 hours, abdominal dressing dry. The nurse calls the surgeon using SBAR. Which statement is the 'Recommendation'?

A provider orders hydromorphone 10 mg IV every 2 hours for an opioid-naive adult after surgery. The nurse calls to question the dose, and the provider insists that it be given. What should the nurse do next?

During shift handoff, the off-going nurse says that a client 'had some chest pain earlier.' What should the oncoming nurse do?