# A rural emergency department identifies an unstable client with a suspected ruptured cerebral aneurysm. The hospital has no neurosurgical service. While transfer is being arranged, the insurer says authorization is pending. Which action should the nurse support?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=498273&lang=en  
> language: en  
> subject: Client Rights  
> category: MOC

## Question

A rural emergency department identifies an unstable client with a suspected ruptured cerebral aneurysm. The hospital has no neurosurgical service. While transfer is being arranged, the insurer says authorization is pending. Which action should the nurse support?

## Option

1. Pause further treatment while the insurer reviews transfer authorization
2. Ask the family to drive the client to a hospital with neurosurgery
3. Transfer the client before a receiving hospital accepts the case
4. Continue stabilizing care while arranging transfer to another hospital **✔ Correct answer**

**Correct answer: 4**

## Explanation

EMTALA requires available stabilizing treatment for an emergency medical condition and an appropriate transfer when the hospital lacks the capability to stabilize the client. Insurance authorization must not delay emergency stabilization or an appropriate transfer.

## In-depth explanation

Quick answer
Continue the stabilizing care the hospital can provide while an appropriate transfer is arranged. Pending insurance authorization does not take priority over emergency treatment.

Why this is correct
The client has an emergency condition that the current hospital cannot definitively manage. The team should reduce immediate risk within its capability and coordinate transfer to a facility with the required service rather than delaying care for payment review.

Easy analogy or mental picture
This is like keeping a damaged boat afloat while arranging a tow to a repair dock. The temporary support does not repair the hull, and the analogy does not replace the formal acceptance, records, and transport requirements of an appropriate medical transfer.

Memory hook
Emergency condition means stabilize within capability, then transfer appropriately; payment review comes later.

NCLEX decision rule
When an NCLEX item combines an emergency condition, a capability gap, and insurance delay, choose ongoing stabilization plus an appropriate transfer. Do not let authorization delay emergency care or substitute private transportation for a medically coordinated transfer.

Why the other choices are wrong
Pausing treatment gives payment review unsafe priority. Family transport lacks the safeguards of a coordinated transfer, and sending the client before acceptance can interrupt continuity and emergency care.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]CMS: Emergency Medical Treatment and Labor ActCenters for Medicare & Medicaid Services

## Related questions

- [A 45-year-old male is alert and oriented ×4 and is actively bleeding from a gastrointestin…](https://mymerci.kr/pages/nclex_q.php?qn_id=372683&lang=en)
- [A 70-year-old Vietnamese-speaking woman is admitted for syncope evaluation. Her 18-year-ol…](https://mymerci.kr/pages/nclex_q.php?qn_id=372701&lang=en)
- [A 56-year-old patient scheduled for an elective hip replacement tomorrow tells the nurse, …](https://mymerci.kr/pages/nclex_q.php?qn_id=372748&lang=en)
- [A nurse is giving a handoff report for a client whose blood pressure is falling and urine …](https://mymerci.kr/pages/nclex_q.php?qn_id=397242&lang=en)
- [A nurse receives a telephone prescription to administer potassium chloride by IV push for …](https://mymerci.kr/pages/nclex_q.php?qn_id=397302&lang=en)
- [A client being evaluated for intermittent chest pain says, "I need to leave now." The clie…](https://mymerci.kr/pages/nclex_q.php?qn_id=497624&lang=en)
- [A nurse realizes that an assessment completed earlier in the shift was not documented. Whi…](https://mymerci.kr/pages/nclex_q.php?qn_id=497913&lang=en)
- [A medical unit wants to reduce client falls using the Plan-Do-Study-Act approach. Which ac…](https://mymerci.kr/pages/nclex_q.php?qn_id=498087&lang=en)

## Read in another language

- [en](https://mymerci.kr/pages/nclex_q.php?qn_id=498273&lang=en)
- [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=498273&lang=ko)
- [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=498273&lang=ja)
- [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=498273&lang=zh-tw)
- [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=498273&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._