The client is able to ambulate without signs or symptoms of shortness

The client is able to ambulate without signs or symptoms of shortness of breath. Which statement by the nurse is the best example of an objective evaluation of the client’s goal attainment?

1. “Client has no pain after ambulating.”
2. “Client has no manifestations of nausea while up in hall.”
3. “Client walked well and did not have any problem when up.”
4. “Client has no evidence of respiratory distress when ambulating.”

ANSWER

ANS: 4
“Client has no evidence of respiratory distress when ambulating” is the best example of an objec-tive evaluation of the client’s goal attainment. It uses the same evaluative measures gathered during assessment and clearly describes objective data. “Client has no pain after ambulating” does not use the same evaluative measure gathered during assessment. The assessment measure concerned respiratory changes during ambulation, not pain. If the client’s pain level were going to be used as an evaluative measure, it would be optimal to have the client report the pain using a pain scale to make it more measurable for comparison. “Client has no manifestations of nausea while up in hall” is not the best example of an objective evaluation of the client’s goal attainment. It does not use the same evaluative measure gathered during assessment. The assessment measure concerned respiratory changes during ambulation, not nausea. Also, nausea is more subjective. “Client walked well and did not have any problem when up” is not the best example of an objec-tive evaluation. It includes the nurse’s interpretation rather than documentation of objective data.