Which step of the nursing process is the nurse performing when educating a client about how to do a blood glucose check?
Evaluation
Planning
Implementation
Assessment
The Correct Answer is C
A. Evaluation: Evaluation involves determining whether the client has achieved desired outcomes or goals. Educating the client is an action, not the process of assessing whether the goals have been met.
B. Planning: Planning includes setting measurable goals and determining interventions to achieve them. While education may be part of the plan, the act of teaching occurs later in the process.
C. Implementation: Implementation is the phase of the nursing process where planned interventions are carried out. Teaching the client how to perform a blood glucose check is an active intervention, making this step part of implementation.
D. Assessment: Assessment involves collecting and analyzing client data to identify health status, risks, and needs. Education occurs after assessment, so teaching is not part of this step.
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Related Questions
Correct Answer is D
Explanation
A. A client with a "sprained ankle from playing tennis": A sprained ankle is generally a minor musculoskeletal injury and is not life-threatening. While it requires care for pain and mobility, it is lower priority compared to conditions that may indicate acute or serious illness.
B. A client with "stomach pain after eating oatmeal": Mild stomach discomfort is typically non-urgent unless accompanied by severe or alarming symptoms. This condition is lower priority compared with clients exhibiting potential acute neurological or cardiovascular issues.
C. A client with a "cough and fever for two days": While fever and cough may indicate infection, the short duration without severe distress usually does not require immediate life-saving interventions. This client is important but is less urgent than acute neurological concerns.
D. A client with a "headache and anxiety for an hour": Sudden-onset headache can signal serious conditions such as intracranial hemorrhage or stroke, particularly if accompanied by anxiety or neurological changes. This client requires immediate assessment to rule out life-threatening causes, making it the highest priority.
Correct Answer is A
Explanation
A. Mood: Behavioral assessment during the general survey involves observing the client’s affect, emotional state, and overall behavior. Evaluating mood helps the nurse understand how the client is coping, their level of emotional stability, and any signs of anxiety, depression, or distress. It provides insight into psychological and emotional well-being, which is essential for holistic care planning.
B. Age: Age is a component of the general survey that falls under physical characteristics rather than behavior. It helps establish baseline expectations for growth, development, and age-appropriate functioning, but it does not provide information about the client’s emotional state or behavior.
C. Posture: Posture is part of the physical appearance assessment within the general survey. It provides information about musculoskeletal health, possible pain, or functional limitations but does not reflect the client’s behavioral or emotional status.
D. Gait: Gait assessment evaluates how a client moves, including balance, coordination, and mobility. While it offers important physical and neurological information, it does not give direct insight into the client’s mood, affect, or behavioral patterns.
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