Author Question: During teaching, the nurse makes sure the client understands how to activate the safety mechanism on ... (Read 162 times)

DelorasTo · **on:** Jul 23, 2018

During teaching, the nurse makes sure the client understands how to activate the safety mechanism on the syringe to prevent needlestick injuries when self-administering insulin. Which guideline of implementing interventions is the nurse using?

1. Adapt activities to the individual client.
2. Encourage clients to participate actively in implementing nursing interventions.
3. Base nursing interventions on scientific knowledge, research, and standards of care.
4. Implement safe care.

Question 2

Upon entering a room, a client and spouse are found crying. The nurse decides to sit with both of them, offering presence and listening to their fears instead of providing the planned education. What action did the nurse perform?

1. Implementing nursing intervention
2. Determining the nurse's need for assistance
3. Supervising delegated care
4. Reassessing the client

Tabitha_2016 · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

Correct Answer: 4
Rationale 1: Adapting activities would involve understanding the client's beliefs, values, age, health status, and environment as factors that can affect the success of a nursing action.
Rationale 2: Encouraging clients to participate enhances their sense of independence and control.
Rationale 3: The nurse must be aware of the scientific rationale for, as well as possible side effects or complications of, all interventions so that implementation centers on specific knowledge and care standards.
Rationale 4: Showing the client how to avoid injury with injections is part of implementing safe care.

Answer to Question 2

Correct Answer: 4
Rationale 1: In this case, the client and the spouse are not in a good frame of mind to listen to or retain any kind of teaching/learning experience and so the planned intervention should not be initiated.
Rationale 2: In this situation, the nurse does not need assistance.
Rationale 3: This is not a situation where the nurse must supervise care that has been delegated.
Rationale 4: Just before implementing an intervention, the nurse must reassess the client to make sure the intervention is still needed or to discover if there are new data that indicate a need to change the priorities of care. In this case, the client and the spouse are not in a good frame of mind to listen to or retain any kind of teaching/learning experience. Instead, the nurse reassesses the situation and implements a more appropriate intervention.