A nurse is developing pain management goals to a post-operative client. Which of the following steps of the nursing process is the nurse performing?
Planning
Assessment
Implementation
Evaluation
The Correct Answer is A
A. Planning: Developing goals is part of the planning phase, where the nurse sets objectives and outcomes for the patient’s care.
B. Assessment: Assessment involves collecting data about the patient’s condition.
C. Implementation: Implementation involves putting the care plan into action.
D. Evaluation: Evaluation involves determining whether the patient has met the goals and outcomes set during the planning phase.
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Related Questions
Correct Answer is B
Explanation
A. Assess the client's pain level: Assessing the client's pain level is part of the assessment step, not the evaluation step.
B. Ask the client to demonstrate use of the incentive spirometer: Asking the client to demonstrate use of the incentive spirometer is a way to evaluate whether the client has understood and can perform the skill.
C. Develop a short-term goal for the client: Developing a short-term goal is part of the planning step, not the evaluation step.
D. Provide instructions on how to use the incentive spirometer: Providing instructions is part of the implementation step, not the evaluation step.
Correct Answer is B
Explanation
A. "There are no provider's prescriptions available." This statement is about the current situation or background, not a recommendation.
B. "The client should be seen by a neurologist." The Recommendation (R) step involves suggesting actions or solutions, such as recommending that the client be seen by a neurologist.
C. "The client is disoriented. Pupils are slow to respond to light." This statement belongs in the Assessment (A) step as it describes the nurse’s clinical findings.
D. "The client was found unconscious on the floor in her home." This statement provides background information (B) about the client’s situation.
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