NCLEX: After nursing care for risk related to tertiary prevention, the nurse evaluates the client response. Which action…

Community / public health nursing Health Promotion and Maintenance

Case Study

After nursing care for risk related to tertiary prevention, the nurse evaluates the client response. Which action best demonstrates evaluation?

Question

A. Assume the intervention worked unless the client complains.
B. Schedule reassessment next shift without checking current status.
C. Reassess the targeted finding, compare it with the expected outcome, and revise the plan if goals are not met.
D. Change the plan before determining whether the finding improved.

Rationale

Correct answer: C. Reassess the targeted finding, compare it with the expected outcome, and revise the plan if goals are not met.

Rationale: Evaluation compares current findings with expected outcomes and guides whether the plan continues or changes.

Hint: Apply ABCs, client stability, and NCSBN clinical judgment steps before choosing an intervention.

Level: Foundational

Difficulty: Easy

Subtopic: Tertiary prevention