# A client with new mobility and medication needs is preparing to return home. Complete the collaborative discharge plan. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=563777&lang=en > language: en > subject: Collaboration with Multidisciplinary Team > category: MOC ## Question A client with new mobility and medication needs is preparing to return home. Complete the collaborative discharge plan. The nurse should first ::선택::ask the client about goals, supports, home barriers, and preferred partners in planningschedule discharge before discussing the home environmentexclude the client until the professionals agreegive every unresolved task to the client. The team should then ::선택::write separate recommendations without assigning responsibilitycreate one shared plan with nursing, pharmacy, therapy, social work, and the prescriber, including owners and timelinescancel all referrals because several disciplines are involvedassume the first electronic note is the final plan, while medication safety requires ::선택::giving only the medication nameasking the client to search online after dischargereconciling the regimen and teaching purpose, dose, interactions, bleeding signs, and who to callwithholding the medication list from the client. Before discharge, the nurse must ::선택::accept a signature as proof of readinessleave transportation and equipment confirmation for the next clinicrepeat all teaching rapidly on the way outconfirm equipment, services, transport, appointments, contact pathways, and understanding by teach-back. ## Explanation Safe discharge is a coordinated process rather than a collection of separate referrals. The nurse should include the client and chosen support person as partners, convene the appropriate disciplines, reconcile medications, evaluate the home and mobility barriers, and confirm services, equipment, transportation, and follow-up ownership. Teaching should cover home function, medications, warning signs, results, and appointments in plain language with teach-back. The plan is not ready until responsibilities and contingencies are closed loop and the client can explain what to do. ## In-depth explanation Correct Answer The nurse should coordinate a shared, client-centered discharge plan with explicit ownership and verification. Why It Fits Mobility, medication, home access, education, and transportation risks cross several disciplines and remain unresolved. Clinical Picture Care coordination bridges information and responsibility gaps during transitions and includes the patient and family as partners. Memory Link A referral is not a plan until the service, owner, timing, and patient understanding are confirmed. NCLEX Rule Align the team around the client's goals, assign responsibilities, reconcile information, and verify both service availability and teach-back before discharge. Why the Alternatives Fail Handing the client several phone numbers, assuming another discipline completed the work, or delaying education until departure leaves critical gaps. Sources 1AHRQ IDEAL Discharge Planning 2AHRQ Care Coordination Measures Atlas 3NCSBN 2026 NCLEX-RN Test Plan ## Clinical scenario Discharge planning conference An older adult recovering from a stroke lives alone in a second-floor apartment without an elevator. The client now uses a walker, has a new anticoagulant prescription, cannot name bleeding warning signs, and has no confirmed transportation for follow-up. Several disciplines entered separate notes, but no shared plan or accountable follow-up owner is documented. ## Key concepts - **Care coordination** — Team-based organization of information, services, and responsibility to meet a client's needs across settings. - **Teach-back** — Asking a client to explain instructions in their own words to verify that teaching was effective. - **Closed-loop ownership** — Explicit confirmation of who will complete a task, by when, and how completion or failure will be communicated. ## Related questions - [A nurse is taking a verbal medication order during a code blue from the resident physician…](https://mymerci.kr/pages/nclex_q.php?qn_id=368265&lang=en) - [A 78-year-old woman with stage IV lung adenocarcinoma and multiple bone metastases reports…](https://mymerci.kr/pages/nclex_q.php?qn_id=372704&lang=en) - [A nurse is preparing discharge plans for several patients on the medical-surgical unit. 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The nurse compares t…](https://mymerci.kr/pages/nclex_q.php?qn_id=568889&lang=en) ## Read in another language - [en](https://mymerci.kr/pages/nclex_q.php?qn_id=563777&lang=en) - [ko](https://mymerci.kr/pages/nclex_q.php?qn_id=563777&lang=ko) - [ja](https://mymerci.kr/pages/nclex_q.php?qn_id=563777&lang=ja) - [zh-TW](https://mymerci.kr/pages/nclex_q.php?qn_id=563777&lang=zh-tw) - [vi](https://mymerci.kr/pages/nclex_q.php?qn_id=563777&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._