A nurse is assessing a patient who reports feeling stress and anxiety.
The patient appears restless and is pacing in the room.
The patient is alert and oriented to person, place, and time.
Which of the following findings is subjective?
Restless
Pacing
Anxiety
Alert .
The Correct Answer is C
Choice A rationale
Restlessness is an observable behavior, making it an objective finding.
Choice B rationale
Pacing is also an observable behavior, so it is considered an objective finding.
Choice C rationale
Anxiety is a subjective finding because it is based on the patient’s personal experience and cannot be directly observed.
Choice D rationale
Alertness is an objective finding because it can be directly observed and measured.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Fairness refers to treating all people equally and making decisions without favoritism or prejudice. This is not the most fitting answer because the scenario does not provide information about the nurse treating all patients equally.
Choice B rationale
Confidence in nursing involves trust in one’s abilities and clinical judgment. Although confidence is important in all nursing actions, this scenario does not specifically highlight the nurse’s confidence.
Choice C rationale
Advocacy in nursing refers to the nurse’s role in standing up for the rights and needs of their patient. While notifying the provider could be seen as a form of advocacy, the nurse’s actions in this scenario are more closely aligned with accountability.
Choice D rationale
Accountability in nursing refers to the responsibility of nurses to execute their duties according to standards, being answerable for their actions. In this scenario, the nurse demonstrates accountability by acknowledging the medication error, assessing the patient for any adverse effects, and reporting the incident.
Correct Answer is A
Explanation
Choice A rationale
Before repositioning a patient, the nurse should first elevate the height of the patient’s bed. This allows the nurse to work at a comfortable height and reduces the risk of injury.
Choice B rationale
While tightening the abdominal muscles can help with lifting and moving, it is not the first action the nurse should take when preparing to reposition a patient.
Choice C rationale
Positioning the feet in line with the shoulders can provide a stable base of support when moving or lifting. However, this is not the first action the nurse should take when preparing to reposition a patient.
Choice D rationale
Pivoting the feet in the direction of the move can help with turning and moving. However, this is not the first action the nurse should take when preparing to reposition a patient.
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