The RN has completed an assessment on a client. What should the nurse do next?

Choice A reason: The client will be able to return to work is not a SMART goal. SMART stands for Specific, Measurable, Achievable, Relevant, and Time-bound. This goal is not specific, as it does not state what kind of work the client will do, or how the client's back pain will affect their work performance. It is also not measurable, as it does not state how the client's work ability will be assessed. It may not be achievable, as the client's work-related injury may prevent them from returning to their previous occupation. It may not be relevant, as the client may have other priorities or preferences than work. It is also not time-bound, as it does not state when the client will return to work.

Choice B reason: The client will verbalize diminished pain at the conclusion of physical therapy is not a SMART goal. This goal is not specific, as it does not state how much pain the client will experience, or what level of pain is acceptable for the client. It is also not measurable, as it relies on the client's subjective report of pain, which may vary depending on the client's mood, expectations, or coping skills. It may not be achievable, as the client's chronic back pain may not be fully resolved by physical therapy. It may not be relevant, as the client may have other outcomes or indicators of improvement than pain. It is also not time-bound, as it does not state how long the physical therapy will last, or when the client will verbalize their pain level.

Choice C reason: The client will be able to perform self-care is not a SMART goal. This goal is not specific, as it does not state what aspects of self-care the client will perform, or how the client's back pain will affect their self-care abilities. It is also not measurable, as it does not state how the client's self-care performance will be evaluated. It may not be achievable, as the client's chronic back pain may limit their range of motion, strength, or endurance for self-care tasks. It may not be relevant, as the client may have other goals or needs than self-care. It is also not time-bound, as it does not state when the client will achieve this goal.

Choice D reason: The client will engage in desired activities without the pain level increasing above a pain scale level of 3 out of 10 within one month is a SMART goal. This goal is specific, as it states what activities the client wants to do, and how the client's pain level will be monitored. It is measurable, as it uses a numeric pain scale that can be easily recorded and compared. It is achievable, as it sets a realistic and attainable pain threshold that allows the client to enjoy their activities. It is relevant, as it reflects the client's personal interests and values, and enhances their quality of life. It is time-bound, as it states a clear and reasonable deadline for achieving this goal.

Choice A reason: A teacher who notices a mole change but doesn't have time to see a dermatologist is not in a state of wellness. A mole change could indicate skin cancer, which is a serious health problem that requires prompt medical attention. Ignoring or delaying the diagnosis and treatment of skin cancer could compromise the teacher's physical and emotional well-being.

Choice B reason: A fitness trainer who is struggling to cope with the death of her mother is not in a state of wellness. The death of a loved one is a major life stressor that can affect the fitness trainer's mental and emotional health. Grieving is a normal and healthy process, but it can also interfere with the fitness trainer's daily functioning and quality of life. The fitness trainer may need professional help or support from family and friends to cope with the loss.

Choice C reason: A hospice client who is comfortable and at peace with dying is in a state of wellness. Wellness is not only the absence of disease, but also the presence of positive health behaviors and attitudes. A hospice client who is comfortable and at peace with dying has accepted the reality of their condition and has made peace with themselves and others. The hospice client may also receive palliative care, which aims to relieve pain and suffering and improve the quality of life for terminally ill patients and their families.

Choice D reason: A type 1 diabetic who gives himself extra insulin so he can eat cookies is not in a state of wellness. A type 1 diabetic who gives himself extra insulin so he can eat cookies is engaging in unhealthy and risky behavior that could harm his physical health. Extra insulin could cause hypoglycemia, which is a condition where the blood sugar level drops too low and can lead to seizures, coma, or death. Eating cookies could also increase the blood sugar level and contribute to complications such as nerve damage, kidney damage, or cardiovascular disease. A type 1 diabetic who wants to eat cookies should follow a balanced diet and monitor his blood sugar level regularly.