# A nurse is preparing discharge plans for several patients on the medical-surgical unit. Which patients should the nurse refer to social work as part of safe discharge planning? Select all that apply. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=372763&lang=en > language: en > subject: Collaboration with Multidisciplinary Team > category: MOC ## Question A nurse is preparing discharge plans for several patients on the medical-surgical unit. Which patients should the nurse refer to social work as part of safe discharge planning? Select all that apply. 1 A 45-year-old patient with end-stage liver disease and active alcohol use disorder who has been declined by two outpatient transplant programs and lacks transportation to follow-up. 2 A 72-year-old patient who lives alone, will need home oxygen, and reports difficulty paying for utilities and medications. 3 A 16-year-old patient admitted for sepsis after a delayed presentation; the parent appears intoxicated and bruising not consistent with the medical history is noted. 4 A 58-year-old patient with stable hypertension being discharged home with the same medications, mobility, and home environment as on admission. 5 A 34-year-old woman who discloses partner violence at home and asks the nurse for help finding a safe place to stay. ## Explanation Social work referrals are integral to safe discharge planning whenever a patient's social, financial, safety, or community-resource needs threaten the medical plan or safety. Choices 1, 2, 3, and 5 each describe a clear unmet psychosocial or safety need: (1) a 45-year-old patient with end-stage liver disease, active alcohol use disorder, and transportation barriers to follow-up; (2) a 72-year-old patient who lives alone, requires home oxygen, and reports difficulty paying for utilities and medications; (3) a 16-year-old patient with possible child maltreatment (parent appears intoxicated and bruising inconsistent with history), which is also a mandatory reporting situation where social work supports the nurse and the patient/family; (5) a 34-year-old woman disclosing intimate partner violence and asking for help finding a safe place to stay. Choice 4 is incorrect — a patient discharged home with unchanged medications, mobility, and environment, and without new resource needs, does not require routine social work referral. Discharge planning still includes clear medication and follow-up instructions, but referral is targeted, not routine. ## In-depth explanation Social work involvement is integral to discharge planning whenever a psychosocial, financial, safety, or community-resource gap threatens the safe execution of the medical plan. The nurse identifies indications, makes the referral, and coordinates the resulting plan with the multidisciplinary team. High-yield referral indications include intimate partner violence (with the patient's safety and autonomy guiding what action is taken), suspected child or elder maltreatment (which is also a mandatory reporting situation), substance use disorder with access or transportation barriers, housing insecurity or homelessness, financial hardship interfering with medications or basic needs, complex post-discharge needs such as new home oxygen or wound care without resources, and end-of-life or hospice planning. Routine discharge of a stable patient with unchanged medications, mobility, and home environment does not require social work; nurses still provide medication reconciliation and follow-up teaching but referral is targeted to identified needs. ## Clinical scenario A nurse is preparing **discharge plans** for several patients on the medical-surgical unit and considers **which patients require a social work referral** as part of safe discharge planning. ## Key concepts - **When to Refer to Social Work** — High-yield indications: intimate partner violence; suspected child or elder maltreatment; housing insecurity or homelessness; substance use disorder; financial hardship preventing medication or basic needs; complex post-discharge needs (new home oxygen, wound care, infusion) without resources; transition to hospice or palliative care; mental health crisis without follow-up; transportation barriers. - **Discharge Planning Framework** — Begins at admission. Nurse identifies anticipated post-discharge needs, coordinates with social work, case management, pharmacy, and rehab/PT/OT as needed. Discharge teaching includes medication reconciliation, follow-up, red flags, and home equipment. Targeted referrals are made for specific gaps; routine referral is not the standard. - **Mandatory Reporting Coexists with Referral** — Suspected child maltreatment, elder maltreatment, intimate partner violence (in some states), and certain communicable diseases require mandatory reporting to the appropriate agency (CPS/APS, public health). Social work supports the nurse with the report and the patient/family with services; reporting is not deferred for the social work consult. ## Related questions - [A nurse is taking a verbal medication order during a code blue from the resident physician…](https://mymerci.kr/pages/nclex_q.php?qn_id=368265&lang=en) - [A 78-year-old woman with stage IV lung adenocarcinoma and multiple bone metastases reports…](https://mymerci.kr/pages/nclex_q.php?qn_id=372704&lang=en) - [A client with a traumatic brain injury is preparing for inpatient rehabilitation. For each…](https://mymerci.kr/pages/nclex_q.php?qn_id=393416&lang=en) - [Drag each hospitalized-client need to the interprofessional team member who should be cons…](https://mymerci.kr/pages/nclex_q.php?qn_id=393514&lang=en) - [A client is being discharged after hospitalization for heart failure. 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The nurse compares t…](https://mymerci.kr/pages/nclex_q.php?qn_id=568889&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=372763&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=372763&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=372763&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=372763&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=372763&lang=vi) --- More free questions: [NCLEX-RN Practice](https://mymerci.kr/pages/nclex_bank.php?lang=en) _For study reference only. Always follow current clinical guidelines and your institution’s protocols._