# A 72-year-old female is being discharged 5 days after an ischemic stroke. She has right hemiparesis and dysphagia, lives alone in a two-story home, and uses a cane for ambulation. The physician has approved discharge. Which action should the nurse take first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=372682&lang=en  
> language: en  
> subject: Collaboration with Multidisciplinary Team  
> category: MOC

## Question

A 72-year-old female is being discharged 5 days after an ischemic stroke. She has right hemiparesis and dysphagia, lives alone in a two-story home, and uses a cane for ambulation. The physician has approved discharge. Which action should the nurse take first?

## Option

1. Initiate a referral to social work for home safety evaluation and community resource coordination. **✔ Correct answer**
2. Discharge the client immediately because physician approval is sufficient for safe discharge.
3. Encourage the client to practice all activities of daily living independently before discharge to build strength.
4. Instruct the family to rearrange furniture on the first floor before the client arrives home.

**Correct answer: 1**

## Explanation

Discharge planning for a post-stroke client with hemiparesis, dysphagia, and a two-story home requires comprehensive coordination. Social work referral ensures professional home safety assessment, adaptive equipment arrangements, meal services, and community support — reflecting the nurse's coordination of care role under MOC. Physician approval alone does not substitute for nursing discharge coordination. Instructing family without professional assessment is insufficient. Promoting independence is appropriate but not the first priority when safety barriers exist.

## In-depth explanation

Clinical Judgment
The nurse's first action is coordination, not independence promotion or premature discharge. Right hemiparesis + dysphagia + living alone in a two-story home = multiple unresolved safety barriers. Social work bridges the gap between medical clearance and safe community re-entry.

Memory Tip
SAFE HOME = Social work first: assess → coordinate → educate → discharge.

KR vs US
In Korea, discharge coordination often defaults to family. NCLEX emphasizes the nurse's proactive role in formal social work referral regardless of family availability.

## Clinical scenario

Clinical Practice Guide
AHA/ASA 2021 Stroke Guidelines: discharge planning should begin within 24–48 h of admission; occupational therapy evaluates home safety; social work coordinates community services for stroke survivors.

Caution
NCLEX often uses "physician approved discharge" as a distractor — medical clearance does not replace nursing coordination of the discharge plan.

## Key concepts

- **Hemiparesis** — Weakness or partial paralysis on one side of the body. Post-stroke right hemiparesis affects right-sided motor function. NCLEX tip: assess fall risk, ADL capacity, and home safety before discharge.
- **Dysphagia** — Difficulty swallowing, a common post-stroke complication affecting 50% of stroke survivors. Risk: aspiration pneumonia. NCLEX tip: NPO until swallow screen; speech therapy referral is a nursing responsibility.
- **Discharge Planning** — A systematic process beginning at admission to ensure the client can safely transition from acute care to the community. Includes: home safety assessment, equipment needs, caregiver support, community services, and follow-up appointments.

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