A nurse is teaching a male adolescent recently diagnosed with type 1 diabetes mellitus (DM) about self-injecting insulin.
Which approach is best for the nurse to use to evaluate the effectiveness of the teaching?

Observe him as he demonstrates the self-injection technique to another diabetic adolescent.

Ask the adolescent to describe his level of comfort with injecting himself with insulin.

Review his glycosylated hemoglobin level 3 months after the teaching session.

Have the adolescent list the procedural steps for safe insulin administration.

Answer and Explanation

The Correct Answer is A

Choice A rationale

Demonstrating the self-injection technique is a practical way for the nurse to evaluate the adolescent's ability to perform the procedure correctly. This hands-on approach allows the nurse to observe technique accuracy and provide corrective feedback if needed. It also helps build the adolescent’s confidence in self-administering insulin, which is crucial for managing type 1 diabetes mellitus independently. Furthermore, demonstrating skills to peers can reinforce learning as it involves active engagement and peer teaching, which have been shown to enhance knowledge retention and skill proficiency.

Choice B rationale

Asking the adolescent to describe his level of comfort with injecting himself provides subjective feedback rather than an objective measure of his ability to perform the procedure correctly. Comfort level does not necessarily correlate with competency in technique. However, assessing comfort can be part of a comprehensive evaluation but should not be the sole method. Comfort levels might influence adherence to the injection regimen, but they do not directly indicate whether the injection is being done correctly.

Choice C rationale

Reviewing glycosylated hemoglobin (HbA1c) levels can provide information about long-term blood glucose control but does not directly evaluate the adolescent's insulin injection technique. HbA1c reflects average blood glucose levels over the past 2-3 months and is influenced by multiple factors, including diet, physical activity, and overall diabetes management. While important for monitoring diabetes control, it is not a specific measure of the effectiveness of teaching self-injection techniques.

Choice D rationale

Having the adolescent list the procedural steps for safe insulin administration tests his recall of the steps but does not ensure that he can perform the injection correctly. Verbalizing steps is important for cognitive understanding but does not equate to the physical ability to execute the procedure. This approach may reveal gaps in knowledge but does not provide a comprehensive assessment of the actual injection technique.

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Correct Answer is C

Explanation

Choice A rationale

Measuring and discarding residual gastric contents before feeding is generally avoided in infants because it can disrupt gastrointestinal function and increase the risk of aspiration. Instead, monitoring for signs of intolerance or high residuals through clinical observation is preferred.

Choice B rationale

Using the syringe plunger to push formula at a rate of 5 mL per minute is inappropriate because it can create excessive pressure, leading to discomfort, aspiration, or injury to the gastrointestinal tract. Gravity feeding or using an appropriate pump at a controlled rate is safer.

Choice C rationale

Holding the infant with head and shoulders slightly elevated during feeding is recommended. This position helps to prevent aspiration by ensuring that the formula flows smoothly through the esophagus and into the stomach, reducing the risk of regurgitation.

Choice D rationale

Microwaving refrigerated formula to room temperature is unsafe because microwaving can create hot spots in the formula, posing a burn risk to the infant. It is safer to warm the formula by placing the bottle in warm water and ensuring an even temperature.

A. EMR safeguards prohibit access to medical records for personnel not involved in direct care of the client. B. The daughter's permission needs to be obtained before the information can be shared by the nurse. C. Encourage the friend to share her concerns with her daughter and other family members. D. Review of the EMR violates client confidentiality and is not permitted legally or ethically. E. EMR tracking alerts the hospital information systems of the nurse's attempts to access the record.

Correct Answer is ["A","B","D","E"]

Explanation

Choice A rationale

EMR safeguards are designed to protect patient privacy and ensure that only authorized personnel involved in the direct care of the client have access to their medical records. Access controls and audit trails are implemented to prevent unauthorized access and maintain confidentiality. These safeguards comply with healthcare regulations and standards, ensuring that patient information is secure and only accessed when necessary for medical care purposes.

Choice B rationale

Patient confidentiality and privacy are fundamental principles in healthcare. Before any information can be shared by the nurse, the patient's permission must be obtained. This consent ensures that the patient's rights and autonomy are respected, and their personal health information is not disclosed without their explicit approval. Sharing medical information without consent can lead to legal and ethical violations.

Choice C rationale

Encouraging the friend to share her concerns with her daughter and other family members promotes open communication and supports the patient's involvement in their care decisions. However, this choice does not directly address the nurse's responsibility to maintain patient confidentiality and adhere to legal and ethical guidelines regarding access to medical records. While it is a supportive action, it does not replace the need to obtain the patient's consent.

Choice D rationale

Reviewing the EMR without the patient's consent violates client confidentiality and is both legally and ethically prohibited. Healthcare providers must adhere to strict confidentiality standards to protect patient information and maintain trust. Unauthorized access to medical records can result in legal consequences and breaches of professional ethical standards.

Choice E rationale

EMR tracking systems monitor and log access to patient records, ensuring that any attempts to access information are recorded and can be audited. These tracking mechanisms alert the hospital information systems of unauthorized access attempts, providing an additional layer of security and accountability. This helps prevent unauthorized access and ensures that patient confidentiality is maintained.

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A nurse is teaching a male adolescent recently diagnosed with type 1 diabetes mellitus (DM) about self-injecting insulin. Which approach is best for the nurse to use to evaluate the effectiveness of the teaching?

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A nurse is teaching a male adolescent recently diagnosed with type 1 diabetes mellitus (DM) about self-injecting insulin.
Which approach is best for the nurse to use to evaluate the effectiveness of the teaching?