The nurse is preparing a teaching plan for a client who is in the implementation step of the teaching plan. Which of the following actions should the nurse take?
Ask the client to demonstrate a skill.
Show the client how to use the incentive spirometer.
Develop a short-term goal for the client.
Assess the client’s pain level.
The Correct Answer is B
Choice A rationale
Asking the client to demonstrate a skill is part of the evaluation step, not the implementation step. The implementation step involves carrying out the teaching plan, not assessing the client’s ability to perform a skill.
Choice B rationale
Showing the client how to use the incentive spirometer is an appropriate action for the implementation step. This step involves providing education and demonstrating skills to the client.
Choice C rationale
Developing a short-term goal for the client is part of the planning step, not the implementation step. The implementation step involves carrying out the teaching plan, not setting goals.
Choice D rationale
Assessing the client’s pain level is part of the assessment step, not the implementation step. The implementation step involves carrying out the teaching plan, not assessing the client’s condition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
The right supervision is one of the five rights of delegation, but it is not the correct answer for this question. The right supervision ensures that the delegated task is performed correctly and safely, with appropriate oversight and support from the delegating nurse.
Choice B rationale
The right person is correct. The right person ensures that the task is delegated to a qualified and competent individual who has the necessary education, training, and experience to perform the task safely and effectively.
Choice C rationale
The right task is one of the five rights of delegation, but it is not the correct answer for this question. The right task ensures that the task being delegated is appropriate for the patient’s condition and within the scope of practice for the person to whom it is being delegated.
Choice D rationale
The right circumstances is one of the five rights of delegation, but it is not the correct answer for this question. The right circumstances ensure that the task is delegated in an appropriate setting and situation, considering the patient’s condition and the availability of resources.
Correct Answer is B
Explanation
Choice A rationale
Contacting the patient’s family for approval before resuscitation is not appropriate when there is a Do Not Resuscitate (DNR) order. A DNR order is a legal document that indicates the patient’s wish not to undergo resuscitation in the event of cardiac or respiratory arrest.
Healthcare providers must respect this order and not seek additional approval from family members.
Choice B rationale
Respecting the order and refraining from initiating resuscitation is the correct action when there is a DNR order. This legal document reflects the patient’s decision to forgo resuscitation efforts, and healthcare providers are obligated to honor this decision to respect the patient’s autonomy and wishes.
Choice C rationale
Ignoring the order and proceeding with resuscitation is a violation of the patient’s rights and wishes. A DNR order must be followed to ensure that the patient’s preferences are respected, and disregarding it can lead to legal and ethical consequences.
Choice D rationale
Implementing the order only if the patient is in the ICU is incorrect. A DNR order applies in all healthcare settings, not just the ICU. Healthcare providers must follow the DNR order regardless of the patient’s location within the healthcare facility.
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