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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","C","D"]
Explanation
A. If any interventions were taken in response to abnormal blood pressure readings (e.g., administering medication, adjusting treatment plans), it should be recorded to provide a complete picture of the
client’s care.
B. This is also crucial information to include. Blood pressure readings can vary based on the client's position (e.g., sitting, standing, lying down), so documenting the position helps provide context for the reading and ensures consistency in monitoring.
C. This is important to document as well. Indicating whether the blood pressure was taken on the right arm, left arm, or another site (like the thigh) is necessary, as different sites can yield different readings and can be relevant for assessing trends over time.
D. Documenting the client’s response to any interventions is vital. This includes how the client reacted to medications or changes in treatment based on their blood pressure readings. It helps in evaluating the effectiveness of interventions and planning future care.
E. This information is not typically documented in the context of a specific blood pressure reading. While it’s important for care planning to know how often blood pressure should be monitored, the actual frequency does not need to be recorded with each individual reading.
Correct Answer is C
Explanation
A. This organization focuses on health and medicine at a national policy level, conducting research and providing expert advice on health-related issues. While it plays a crucial role in shaping healthcare policy, it is not specifically a nursing organization and may not be the best fit for a nurse seeking to engage specifically with nursing practice.
B. This organization is aimed at nursing students and focuses on their educational experiences, advocacy, and professional development. Once the nurse graduates and becomes a registered nurse, this organization would no longer be relevant to them.
C. The ANA is a professional organization that represents registered nurses and advocates for nursing practice, standards, and rights at a national level. Joining the ANA would allow the nurse to be involved in policy-making, continuing education, and various initiatives that promote the nursing profession and improve healthcare.
D. This organization is primarily focused on nursing education and the improvement of nursing education programs. While it plays an important role in promoting quality nursing education, it may not be the best fit for a registered nurse seeking to engage with broader nursing issues at a national level.
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