# An adult with heart failure is medically ready for discharge. For each proposed action, select the best care-management classification.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=393409&lang=en  
> language: en  
> subject: Case Management  
> category: MOC

## Question

An adult with heart failure is medically ready for discharge. For each proposed action, select the best care-management classification.

|  | Coordinate resource or follow-up support | Provide and verify discharge teaching | Requires revision |
| --- | --- | --- | --- |
| Ask case management or social work to address transportation, coverage, medication assistance, and available community services before discharge |  |  |  |
| Reconcile an affordable medication plan with the provider and pharmacist and communicate the final list and follow-up responsibilities |  |  |  |
| Use plain language and teach-back for daily weights, medications, worsening symptoms, and who to call |  |  |  |
| Ask the client to explain the plan and demonstrate how weight will be monitored at home |  |  |  |
| Document noncompliance and discharge without addressing the stated transportation and medication-cost barriers |  |  |  |
| Assume a family member will provide transportation and medication support without confirming consent, willingness, or capacity |  |  |  |

## Explanation

Care management identifies and addresses barriers that can make an otherwise medically appropriate discharge unsafe. Case management or social work can help with transportation, coverage, medication assistance, equipment, and community services. The clinical team and pharmacist reconcile an affordable medication plan, communicate it to follow-up clinicians, and clarify who will manage pending needs. Nursing education uses plain language, teach-back, and client-specific warning signs. Labeling the client as noncompliant, relying on family without consent or capacity assessment, or postponing known barriers until after discharge does not create a safe transition.

## In-depth explanation

Correct Answer
Coordinate transportation, medication access, follow-up, and community support; provide and verify individualized teaching; and revise plans that blame the client or defer known barriers.

Why It Fits
Medical stability alone does not make a transition safe. The plan must fit the client's resources, understanding, preferences, and ability to obtain treatment and follow-up.

Clinical Picture
Transportation, affordability, and uncertainty about weight gain are actionable discharge cues. Different team members address different gaps, with one coordinated plan communicated across settings.

Memory Link
Find the barrier, assign the resource, teach the plan, close the loop.

NCLEX Rule
Case management connects assessed needs to specific services and follow-up. It is not a generic referral made after the client has already failed.

Why the Alternatives Fail
Calling the client noncompliant ignores access barriers. Assuming family availability can create an unsafe plan. Delaying transportation or medication access work until after discharge makes preventable gaps more likely.

Source
1AHRQ Re-Engineered Discharge Tool 3
2AHRQ PSNet Discharge Planning and Transitions of Care
32026 NCLEX-RN Test Plan

## Clinical scenario

The client has missed visits because of transportation problems, reports difficulty paying for medications, and is unsure how to respond to rapid weight gain. The nurse includes the client in planning and addresses clinical, logistical, and learning barriers before the transition.

## Key concepts

- **Case management** — A coordinated process that links assessed clinical and social needs with services, resources, and follow-up across settings.
- **Medication access** — The practical ability to obtain and continue an indicated medication, including affordability, coverage, transportation, and regimen feasibility.
- **Closed-loop transition** — A care transition in which the receiving team and client receive, understand, and can act on the current plan and follow-up responsibilities.

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