# Review the discharge-readiness timeline for a client with a new colostomy and determine how the nurse should preserve continuity of care. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=395215&lang=en > language: en > subject: Continuity of Care > category: MOC ## Question Review the discharge-readiness timeline for a client with a new colostomy and determine how the nurse should preserve continuity of care. | Time | Data | | --- | --- | | Postoperative day 1 | Client watches pouch emptying but declines hands-on practice, saying, 'I will learn tomorrow.' | | Postoperative day 3 | Client needs step-by-step prompting and cannot maintain the skin seal. The client lives alone. Home-health referral is submitted but not accepted. | | Discharge morning | Vital signs are stable and discharge is ordered. Supply delivery, transportation to the ostomy clinic, and the first home-health visit remain unconfirmed. | Q1. How should the nurse interpret the overall trend? The client is fully ready because vital signs are stable Written instructions are sufficient for a client who lives alone All transition needs can be deferred to the first clinic visit Discharge readiness remains incomplete despite medical stability Q2. What should the nurse do before discharge proceeds? Tell the client to ask an unavailable family member for help Coordinate the client, ostomy nurse, case manager, provider, supplies, home health, and follow-up while continuing skill practice Remove the pouch so the client will be motivated to learn at home Cancel all referrals because the client is physiologically stable Q3. Which update best demonstrates a safer transition plan? The client signs the instruction sheet without explaining the plan The referral remains pending, but a brochure is placed in the bag The client completes return demonstration, supplies and services are confirmed, and follow-up and warning-sign plans are taught back The client agrees to search online if problems occur ## Explanation Discharge readiness includes the client's ability to manage the plan and the availability of needed resources, not only stable vital signs. The client cannot yet perform pouch care, the home-health referral is pending, and supplies and transportation are unconfirmed. The nurse should involve the client as a full partner; coordinate with the wound or ostomy nurse, case manager, provider, pharmacy, and home-health team; use return demonstration and teach-back; and confirm supplies, medication understanding, warning signs, appointments, transportation, and contact information before discharge. Giving written instructions alone does not resolve the transition gap. ## In-depth explanation Trend to recognize The client is physiologically stable but the home-care plan is not executable. Skill, supplies, referral, and transportation gaps make the transition unsafe. Continuity response Coordinate the people, skills, supplies, and follow-up before the client leaves; discharge planning is a process, not a final packet. Readiness evidence Return demonstration, teach-back, confirmed supplies and referrals, scheduled follow-up, and a clear contact plan provide stronger evidence than a signed instruction sheet. Why the alternatives fail Medical stability does not erase functional barriers. Telling a client who lives alone to ask family assumes unavailable support. Sending the client home while referrals are merely pending transfers system risk to the client. Source 1AHRQ IDEAL Discharge Planning 22026 NCLEX-RN Test Plan ## Clinical scenario Transition planning A 68-year-old client lives alone and is preparing for discharge after creation of a colostomy. The client is medically stable, but self-care ability and home resources change during the stay. ## Related questions - [A nurse is transferring an older adult from a hospital to a long-term care facility. 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