# Place the nursing actions in order when transferring a deteriorating client from a medical unit to the intensive care unit.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=396350&lang=en  
> language: en  
> subject: Continuity of Care  
> category: MOC

## Question

Place the nursing actions in order when transferring a deteriorating client from a medical unit to the intensive care unit.

Ask the receiving RN to synthesize the key concerns, clarify questions, and explicitly accept responsibility

Reassess airway, breathing, circulation, vital signs, and transport readiness while confirming the destination and required transport support

Send the reconciled records with the client, complete the transfer documentation, and communicate any change that occurs before departure

Reconcile current medications, allergies, lines, oxygen, time-critical therapies, recent results, and unresolved tasks

Give a structured handoff that includes illness severity, recent changes, treatments, pending results, and contingency plans

## Explanation

Reassess stability and transport needs first. Next reconcile the high-risk information and equipment that must accompany the client. Deliver the structured handoff, require receiver synthesis and explicit acceptance, then complete the record transfer and update the receiving team if the client's condition changes before departure.

## In-depth explanation

Correct sequence
Reassess and prepare transport → reconcile critical information → give the structured handoff → confirm receiver synthesis and acceptance → transfer records and document.

Why this is correct
A handoff transfers information, authority, and responsibility. A one-way report is incomplete when the receiver has not clarified uncertainty or acknowledged responsibility. The sending RN also must communicate any material change before the client physically leaves.

NCLEX decision rule
Stabilize urgent threats first, then close the loop. Never assume that an electronic note alone transferred accountability.References
1AHRQ TeamSTEPPS: Handoff
2NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Transfer of responsibility
A client with worsening work of breathing has received immediate stabilization and an ICU bed is ready. The sending RN remains accountable until the receiving clinician clearly accepts the handoff. Use the facility's structured handoff process.

## Key concepts

- **Closed-Loop Handoff** — A transfer in which the receiver clarifies, synthesizes, and acknowledges responsibility rather than passively receiving information.
- **Contingency Plan** — An explicit plan describing what change to watch for and what action to take if it occurs.
- **Transfer of Accountability** — The explicit change in who is responsible for ongoing decisions and follow-through during a care transition.

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