A client tells the nurse that he does not want to be bothered for a few hours. The nurse honors the request and does not assess the client's vital signs when scheduled
When seeing the client before the end of the shift, the nurse finds the client unresponsive. Which of the following does this outcome suggest? 1. The nurse should have planned to provide care with minimal distractions yet maintain client safety and ongoing assessment.
2. The nurse should adhere to a client's request regardless of the outcome.
3. The nurse was providing good client care.
4. There was no way to predict that the client's condition would change and the nurse is not at fault.
The nurse should have planned to provide care with minimal distractions yet maintain client safety and ongoing assessment.
Rationale: The nurse needs to provide safe and effective care and should have planned to continue care, keeping in mind the client's request for minimal distractions. If the nurse had continued to provide good client care, the client's condition change might have been detected sooner than the end of the shift and intervention could have been provided to avoid discovering the client unresponsive. The nurse should have provided care in spite of the client's request. Even though there was no way to predict that the client's condition would change, if the nurse would have continued with ongoing assessment, the client's condition might have been detected sooner and the client might not have been found unresponsive.
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