A nurse is collecting data from a client who is postoperative. Which of the following findings should the nurse identify as objective data?(Select All that Apply.)
The client is reporting nausea.
The client's urine output has been 150 mL over the past 3 hr.
The client states they are experiencing "extreme pain".
The client's current blood pressure is below their preoperative reading.
The client's right calf is swollen and warm to the touch.
Correct Answer : B,D,E
A. It reflects the client’s personal feelings and experiences regarding their condition. Since it is based on
the client's report rather than measurable findings, it does not qualify as objective data.
B. It provides measurable information about the client's urine output, which can be quantified and observed by the nurse. Objective data is factual and can be verified by anyone observing the situation.
C. Like the nausea report, this statement is based on the client’s personal experience and perception of
pain. It cannot be measured objectively, making it subjective.
D. Blood pressure readings are measurable and can be objectively compared to preoperative values. This information provides concrete data regarding the client's current condition.
E. The observations of swelling and warmth can be directly assessed and are factual findings that can be confirmed by the nurse during the physical examination.
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Related Questions
Correct Answer is D
Explanation
A. Adequate hydration is crucial for overall health, particularly for those in the nursing profession, which can be physically demanding. Nurses should be encouraged to drink sufficient water daily to maintain hydration, rather than restricting intake.
B. This recommendation is insufficient for most adults. While individual sleep needs can vary, most adults require between 7 to 9 hours of sleep per night for optimal functioning, health, and recovery. Thus, suggesting only 5 hours is not supportive of good self-care practices.
C. While any exercise is better than none, recommending only once a week is not ideal. Current guidelines generally suggest that adults engage in at least 150 minutes of moderate aerobic activity each week, spread across several days.
D. This is a beneficial self-care practice. Preparing and bringing healthy meals to work supports proper nutrition, energy levels, and overall health. It helps nurses avoid unhealthy options that may be more convenient in a work setting and promotes better dietary choices.
Correct Answer is D
Explanation
A. Offering approval or disapproval can create a judgmental atmosphere, potentially making clients feel defensive or unsupported. Therapeutic communication should focus on understanding and empathizing with the client rather than evaluating their feelings or actions.
B. This technique can be problematic in therapeutic communication. Asking clients to explain their feelings or behaviors may come off as interrogative or dismissive, which can hinder open dialogue. It’s often more effective to explore the client’s feelings without requiring justification.
C. While offering sympathy may seem caring, it can shift the focus from the client’s feelings to the nurse's emotions. Sympathy often implies pity and can create a power imbalance, whereas therapeutic communication should aim for empathy—understanding and validating the client's experiences without imposing one's own feelings.
D. This is a key technique in therapeutic communication. Open-ended questions encourage clients to express themselves freely, providing more information and facilitating deeper conversations. They invite exploration and help build rapport, making clients feel heard and understood.
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