A nurse is providing care for a client receiving normal saline when th

A nurse is providing care for a client receiving normal saline when the IV infiltrates. Which of the following nursing actions represents the evaluation phase of the nursing process?

1. IV is discontinued.
2. Warm compress applied to IV site.
3. Site reinspected for presence of swelling.
4. IV site observed as having significant swelling.

ANSWER

ANS: 3
Evaluation, the final step of the nursing process, is crucial to determine whether, after application of the nursing process, the client’s condition or well-being improves. The remaining options rep-resent the assessment and implementation phases.