A client is scheduled for discharge with a medication that requires refrigeration and regular follow-up. The client then reveals living in a car and having no refrigerator. Which action should the nurse take first?
1Provide a small cooler, continue the discharge, and arrange no additional follow-up
2Pause the discharge and coordinate a feasible plan with the client and care team✓ Correct answer
3Tell the client to skip doses whenever safe refrigeration is unavailable
4Document expected nonadherence and ask the client to sign the discharge papers
Explanation
The new housing information makes the discharge plan unsafe and potentially unworkable. Pause discharge and involve the client, case management, pharmacy, prescriber, and community resources to arrange feasible medication storage, access, and follow-up.
Quick answer Pause the discharge and coordinate a realistic plan with the client and interdisciplinary team. A plan that depends on unavailable refrigeration is not a safe transition plan.
Why this is correct Discharge planning must fit the client's actual environment, resources, and preferences. Case management, pharmacy, the prescriber, and community partners may identify a different formulation, storage solution, care setting, medication access program, or follow-up arrangement.
Easy analogy or mental picture A discharge plan is a bridge from hospital care to daily life. If a required support is missing, the bridge has a gap; the analogy does not mean discharge must always be cancelled, but the gap must be addressed before crossing.
Memory hook If the home plan cannot work in the client's real setting, stop and redesign the transition with the team.
NCLEX decision rule When a new social or environmental barrier makes essential treatment infeasible, do not simply repeat instructions. Reassess discharge readiness, engage the client, and coordinate clinical and community resources before proceeding.
Why the other choices are wrong A cooler without a sustainable storage and supply plan may fail quickly. Skipping doses is unsafe, and labeling the client nonadherent shifts responsibility away from an unworkable plan instead of correcting the barrier.
References
[1]
NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing
[2]
CMS: Care CoordinationCenters for Medicare & Medicaid Services