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    W4 nur 226 adult health proctored exam ( med surg) exemplify

    A nurse is caring for a client who is receiving treatment for an acute asthma attack. Following treatment, the nurse auscultates the client's lungs and asks the client how they feel. Which step of the nursing process does this reflect?

    Explanation & Rationale

    Choice A reason: Assessment involves collecting baseline data about a client’s condition before interventions are implemented. Although auscultation and questioning are assessment techniques, in this scenario they are performed after treatment to determine the effectiveness of care, not to establish initial data. Choice B reason: Intervention refers to actions taken to address a nursing diagnosis, such as administering medications or providing treatments. The nurse is not implementing a treatment in this situation but is instead determining the response to a previously performed intervention. Choice C reason: Diagnosis involves analyzing assessment data to identify nursing problems. This step occurs before planning and intervention. The nurse’s actions here are not aimed at identifying a problem but at determining whether treatment goals have been met. Choice D reason: Evaluation is the step of the nursing process in which the nurse determines the effectiveness of interventions by reassessing the client and comparing outcomes to expected goals. Auscultating lung sounds and asking the client how they feel after asthma treatment directly reflects evaluation.

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