The nurse is preparing a teaching plan for a client who is learning the planning step in the teaching plan. Which of the following actions should the nurse take?
Ask the client to demonstrate emptying of the colostomy bag.
Describe which supplies would be needed.
Determine the client’s readiness to learn.
Identify the client’s learning needs.
The Correct Answer is C
Choice A rationale
Asking the client to demonstrate emptying of the colostomy bag is an action that would be part of the implementation or evaluation phase, not the planning phase.
Choice B rationale
Describing which supplies would be needed is also part of the implementation phase. The planning phase focuses on assessing the client’s needs and readiness to learn.
Choice C rationale
Determining the client’s readiness to learn is a crucial step in the planning phase. It ensures that the client is prepared and willing to engage in the learning process, which is essential for effective education.
Choice D rationale
Identifying the client’s learning needs is part of the assessment phase, which precedes the planning phase. The planning phase involves using the information gathered during the assessment to develop a teaching plan.
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Naxlex Comprehensive Predictor Exams
Related Questions
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.
Correct Answer is B
Explanation
Choice A rationale
Reporting unusual lung sounds requires assessment skills that are beyond the scope of practice for an unlicensed assistive personnel (UAP). UAPs are not trained to interpret or evaluate clinical data, which is essential for identifying unusual lung sounds. This task should be performed by a licensed nurse who can accurately assess and respond to the findings.
Choice B rationale
Providing assistance with morning care is within the scope of practice for UAPs. This task involves helping the patient with activities of daily living such as bathing, dressing, and grooming, which do not require clinical judgment or assessment skills. It is a routine task that UAPs are trained to perform safely and effectively.
Choice C rationale
Teaching the patient about a heart-healthy diet involves providing education and requires a thorough understanding of the patient’s medical condition and dietary needs. This task should be performed by a licensed nurse or dietitian who has the knowledge and skills to provide accurate and comprehensive education.
Choice D rationale
Checking the client’s blood pressure medication involves administering medication, which is outside the scope of practice for UAPs. Medication administration requires knowledge of pharmacology, the ability to assess the patient’s response to the medication, and the ability to recognize and respond to potential side effects. This task should be performed by a licensed nurse.
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