NURS 6540 FINAL CERTIFICATION
EVALUATION 2026 QUESTIONS WITH
ANSWERS GRADED A+
◉ Informational Continuity. Answer: -Data exchanges
-Information continuity is critical
-Safety net
•Hospital
-interdisciplinary team meetings, huddles, comfort
rounds, progress notes
-handovers, discharge plans, referral contacts,
clinical summaries
•Community
-Appt. reminders, call-back checks, instructions
◉ Transitional Care. Answer: -Transition of Care vs. Transitional
Care
Transitional care:
•Begins in the Hospital
•combines needs of the client & family
•Care coordination & Nurse critical role
,•Respect client autonomy and choice
•clear picture and uncover hidden issues
-Key Elements in Planning for Care Transitions (Table 24-1)
-Communications:
•HIPAA & contact person
•Sending & Receiving Team (Box 24-2)
◉ Discharge Planning. Answer: Goal: provide information for
recovery &/or maintain health status during the immediate post-
hospital period.
•Routine and Complex Discharges
•Nursing Actions:
-Assess under-standing: Confirm medication plan
-Advice of tests/pending results: Review written summary care
instructions
-Schedule follow-up, provider #: Identify responsible caregiver
-Info about home/health care services: Expedite transmission of
summary
◉ ANA Scope and Standards of Practice
Standard 5A: Coordination of Care. Answer: "The RN coordinates
care delivery."
, Some competencies include:
-Communicates with the healthcare consumer, interprofessional
team, and community-based resources to effect safe transitions in
continuity of care.
-Advocates for the delivery of dignified and holistic care by the
interprofessional team.
◉ ANA Scope and Standards of Practice
Standard 16: Resource Utilization. Answer: "The RN utilizes
appropriate resources to plan, provide, and sustain evidence-based
nursing services that are safe, effective, and fiscally responsible."
Some competencies include:
-Assesses healthcare consumer needs and resources available to
achieve desired outcomes.
-Assists the healthcare consumer in identifying and securing
appropriate services to address needs across the healthcare
continuum
◉ Management Continuity. Answer: "A consistent & coherent
approach to the management of a health condition that is responsive
to a patient's changing needs" (Al-Azri, 2008).
-A longitudinal approach
EVALUATION 2026 QUESTIONS WITH
ANSWERS GRADED A+
◉ Informational Continuity. Answer: -Data exchanges
-Information continuity is critical
-Safety net
•Hospital
-interdisciplinary team meetings, huddles, comfort
rounds, progress notes
-handovers, discharge plans, referral contacts,
clinical summaries
•Community
-Appt. reminders, call-back checks, instructions
◉ Transitional Care. Answer: -Transition of Care vs. Transitional
Care
Transitional care:
•Begins in the Hospital
•combines needs of the client & family
•Care coordination & Nurse critical role
,•Respect client autonomy and choice
•clear picture and uncover hidden issues
-Key Elements in Planning for Care Transitions (Table 24-1)
-Communications:
•HIPAA & contact person
•Sending & Receiving Team (Box 24-2)
◉ Discharge Planning. Answer: Goal: provide information for
recovery &/or maintain health status during the immediate post-
hospital period.
•Routine and Complex Discharges
•Nursing Actions:
-Assess under-standing: Confirm medication plan
-Advice of tests/pending results: Review written summary care
instructions
-Schedule follow-up, provider #: Identify responsible caregiver
-Info about home/health care services: Expedite transmission of
summary
◉ ANA Scope and Standards of Practice
Standard 5A: Coordination of Care. Answer: "The RN coordinates
care delivery."
, Some competencies include:
-Communicates with the healthcare consumer, interprofessional
team, and community-based resources to effect safe transitions in
continuity of care.
-Advocates for the delivery of dignified and holistic care by the
interprofessional team.
◉ ANA Scope and Standards of Practice
Standard 16: Resource Utilization. Answer: "The RN utilizes
appropriate resources to plan, provide, and sustain evidence-based
nursing services that are safe, effective, and fiscally responsible."
Some competencies include:
-Assesses healthcare consumer needs and resources available to
achieve desired outcomes.
-Assists the healthcare consumer in identifying and securing
appropriate services to address needs across the healthcare
continuum
◉ Management Continuity. Answer: "A consistent & coherent
approach to the management of a health condition that is responsive
to a patient's changing needs" (Al-Azri, 2008).
-A longitudinal approach
