# The charge nurse reviews an emergency-department record. Which events require immediate follow-up? Highlight the events that may delay screening, stabilization, or an appropriate transfer. > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=568938&lang=en > language: en > subject: Assignment/Delegation/Supervision > category: MOC ## Question The charge nurse reviews an emergency-department record. Which events require immediate follow-up? Highlight the events that may delay screening, stabilization, or an appropriate transfer. Nurses' Notes 0610: The charge nurse audits the sequence of care for a walk-in client reporting severe abdominal pain and faintness. Registration documents that the clerk requires full payment before the medical screening examination can begin. The waiting-room nurse records that the client receives a triage acuity assessment on arrival. At 0625, the qualified clinician begins the examination and identifies an emergency condition needing surgical care. The record shows that continuous blood pressure and cardiac monitoring are started. The facility lacks the required surgical service, and the team begins arranging transfer. At 0640, staff document that the transport team is told to depart before a receiving hospital accepts the client. The physician notes that transfer may be necessary because the required service is unavailable. The medication record shows that ordered intravenous fluid is held until insurance authorization is received. At 0650, the nurse confirms that oxygen is applied for the documented low saturation. The transfer form includes that the physician certifies expected benefits outweigh transfer risks after reviewing the client's current condition. The transport plan states that qualified personnel will continue monitoring during travel. At 0705, the chart reveals that current laboratory and imaging records are not prepared to accompany the client. The client remains pale and hypotensive while the charge nurse stops transport for review. ## Explanation Requiring payment before the medical examination, directing transfer without receiving-facility acceptance, delaying stabilizing care, and omitting records require follow-up. Emergency evaluation and stabilization take priority over financial or administrative steps. ## In-depth explanation Quick answer Highlight payment required before the medical screening examination, departure directed without receiving-facility acceptance, delayed stabilizing treatment, and missing transfer records. These events place emergency access and safe transfer at risk. Why this is correct EMTALA requires an appropriate medical screening examination when emergency care is requested and stabilizing treatment when an emergency medical condition is found. If transfer is necessary before stabilization, risks must be minimized, the receiving facility must accept the client, and pertinent records must accompany the client.[2] Easy analogy or mental picture Picture a bridge with required checkpoints: screen, stabilize, then transfer safely when needed. Payment questions and bed logistics can occur around the bridge, but they cannot remove a checkpoint; the picture organizes the legal sequence and does not replace clinical judgment. Memory hook Screen, stabilize, accept, send records. NCLEX decision rule When a client seeks emergency care, think access before administration; check that screening occurred, stabilizing care was not delayed, and every transfer safeguard is complete before transport. Why the other choices are wrong Insurance details collected after care begins, continuous monitoring, physician risk-benefit certification, and qualified transport support safe care. Routine registration is not the problem unless it delays the examination or treatment.References - [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing - [2]CMS: Emergency Medical Treatment & Labor ActCenters for Medicare & Medicaid Services ## Related questions - [A 67-year-old client with chronic obstructive pulmonary disease attends a routine primary …](https://mymerci.kr/pages/nclex_q.php?qn_id=360522&lang=en) - [A registered nurse on a medical-surgical unit is delegating tasks at the start of shift. 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