A nurse is assessing a client who is postoperative.. Which of the following findings should the nurse identify as objective data?
(Select All that Apply.)
The client's current blood pressure is below their preoperative reading.
The client's right calf is swollen and warm to the touch.
The client is reporting nausea.
The client states they are experiencing "extreme pain".
The client's urine output has been 150 mL over the past 3 hr.
Correct Answer : A,B,E
A. Blood pressure is a measurable physiological parameter that can be accurately recorded by the nurse using a sphygmomanometer. It provides concrete evidence of the client’s current condition compared to their preoperative baseline.
B. The swelling and warmth of the calf are observable and measurable physical signs that the nurse can assess through physical examination. These findings can be documented and evaluated independently of the client's personal feelings or reports.
C. Nausea is a symptom experienced and reported by the client. It cannot be directly measured or observed by the nurse but rather is based on the client's personal sensations and experiences.
D. Pain is a personal experience and is reported by the client. The description of pain, including its intensity and quality, is based on the client's own perception and cannot be directly measured by the nurse.
E. Urine output is a quantifiable measurement that can be recorded and assessed by the nurse. It
provides concrete information about the client’s fluid balance and renal function over a specific period.
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Related Questions
Correct Answer is B
Explanation
A. An advanced beginner nurse is someone who has moved beyond the novice stage but still lacks the experience and confidence of an expert nurse. Precepting new staff members usually requires a higher level of expertise, so this choice is not the best fit for a preceptor role.
B. They possess a high level of intuition and can make complex decisions quickly based on a wealth of experience. Experts are often seen as leaders, mentors, and preceptors because they have the knowledge and skill to guide others effectively.
C. A proficient nurse is skilled and experienced but not at the expert level. While proficiency is important for precepting, being an expert is typically the most appropriate stage for someone responsible for teaching and guiding new staff members.
D. Competent nurses are competent at performing their job duties, but they may not have the level of expertise and experience required to effectively precept and mentor new staff members.
Correct Answer is ["C"]
Explanation
A. While burnout can certainly impact communication, it's more of a consequence of poor communication and teamwork rather than a direct barrier to it. Addressing communication issues can help mitigate burnout.
B. Privacy laws are essential to protect patient information but are not inherently barriers to communication. Effective communication can occur while maintaining patient privacy.
C. This is a direct barrier to interprofessional communication. If team members don't understand each other's responsibilities, it can lead to confusion, duplication of efforts, and a breakdown in communication.
D. While understanding scope of practice is crucial for effective collaboration, it's not a barrier to communication itself. In fact, clear role definitions can enhance communication.
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