# Review the transfer timeline and identify the unresolved accountability risk before the client leaves the unit.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=546512&lang=en  
> language: en  
> subject: Continuity of Care  
> category: MOC

## Question

Review the transfer timeline and identify the unresolved accountability risk before the client leaves the unit.

| Time | Data |
| --- | --- |
| 1100 | Hemoglobin is 8.4 g/dL after treatment. A repeat CBC is ordered for 1330 because the client had melena overnight. |
| 1300 | The transfer summary says 'repeat CBC pending,' but it does not name who will review the result or what change requires escalation. |
| 1315 | The receiving nurse asks who owns the 1330 result. The sending nurse cannot identify an accountable clinician; transport is scheduled for 1320. |

Q1. What safety problem is revealed?

An accountability gap for a time-sensitive pending result
An unnecessary delay caused by asking questions
A need to remove the pending result from the handoff

Q2. What should occur before transfer?

Ask the family to look for the result
Transfer now and assume the facility will discover the order
Name and confirm the result owner, review time, threshold, and escalation plan

Q3. Which statement best closes the loop?

The result is in the chart if anyone wants it
You will review the 1330 CBC, call for the stated hemoglobin or bleeding threshold, and tell me now if you cannot accept that responsibility
Someone usually checks laboratory results after transport

## Explanation

A handoff transfers information together with accountability and responsibility. A note that a complete blood count is pending is not enough when no clinician has accepted responsibility for reviewing the result and acting on recurrent bleeding. The nurses should identify the accountable clinician, state when the result is expected, communicate the response and escalation thresholds, and confirm acceptance with check-back. If safe ownership cannot be established, the transfer should pause while the gap is escalated. Silently assuming that someone will see the result creates a preventable loss of follow-up.

## In-depth explanation

Correct Answer
The unresolved trend is a transfer-of-accountability gap for a time-sensitive pending laboratory result.

Why It Fits
The transfer time approaches while the repeat hemoglobin has no named owner, review time, or escalation plan.

Clinical Picture
The receiving nurse's check-back reveals the ambiguity before the client physically leaves the sending unit.

Memory Link
Pending means named owner, time, threshold, and check-back.

NCLEX Rule
A handoff is not complete until responsibility is communicated, accepted, and confirmed.

Why the Alternatives Fail
Relying on an unsigned note, asking the family to monitor the result, or transferring first and assigning ownership later does not close the safety gap.

Sources
1AHRQ TeamSTEPPS Communication Module
2AHRQ TeamSTEPPS Check-Back Tool
3NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Transfer to a rehabilitation facility
An older adult was treated for an upper gastrointestinal bleed. The hemoglobin stabilized after transfusion, and a repeat complete blood count is scheduled shortly after the planned transfer. The sending and receiving nurses review the handoff.

## Key concepts

- **Handoff** — A transfer of information, authority, accountability, and responsibility during a transition in care.
- **Check-back** — Closed-loop confirmation in which the receiver repeats key information and the sender verifies understanding.
- **Pending result** — A test result not yet available that still requires a named reviewer, expected time, and response plan.

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