A nurse is assessing a client who reports feeling stress and anxiety. The client appears restless and is pacing in the room. The client is alert and oriented to person, place, and time. Which of the following findings is subjective?
Alert
Restless
Anxiety
Pacing
The Correct Answer is C
Anxiety is a subjective emotional state characterized by feelings of worry, nervousness, or unease. If the client reports feeling anxious, this would be considered subjective because it is based on their own perception of their emotional state.
A. Alert refers to the client's level of consciousness and awareness of their surroundings.
B. Restlessness refers to a feeling of agitation or inability to stay still.
D. Pacing is an observable behavior where the client is walking back and forth in the room.
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Correct Answer is B
Explanation
Leaning away from the client throughout the interview can convey a lack of interest or engagement in the conversation. It may appear as though the nurse is disinterested or uncomfortable, which could negatively impact the client's perception of the interaction.
A. Sitting at a slight angle across from the client is generally considered appropriate and allows for a comfortable and natural interaction
C. Maintaining an upright posture demonstrates attentiveness and professionalism during the interview.
D. Maintaining eye contact throughout the interview is generally considered a positive nonverbal behavior as it shows attentiveness, respect, and interest in the client's concerns.
Correct Answer is ["A","C","D","E","F"]
Explanation
The client's hearing deficit can certainly present a barrier to effective communication, as it may affect their ability to hear and understand verbal instructions or information provided by the nurse.
B. The loud volume of the client's television is not a barrier in this case as the client has hearing loss.
C. Having numerous visitors in the client's room can create distractions and make it challenging for the nurse to engage in private, focused communication with the client.
D. An increase in pain after ambulation can impact the client's ability to focus and engage in effective communication. The client may be preoccupied with managing their pain, which can hinder their receptiveness to communication from the nurse.
E. Adverse effects of opioid analgesic: Adverse effects of opioid analgesics, such as drowsiness or sedation, can impair the client's cognitive function and alertness, making it difficult for them to participate actively in communication with the nurse.
F. Using earphones while listening to music may create a physical barrier to communication, as it limits the nurse's ability to speak directly to the client or gain their attention.
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