A nurse is collecting data on a client for manifestations of pain. Which of the following findings is an objective indicator of pain?
The client rates their pain as an 8 on a scale of 0 to 10.
The client reports a burning sensation.
The client grimaces when they move.
The client states the pain is located on their abdomen.
The Correct Answer is C
A. This is a subjective indicator of pain. The pain rating is based on the client’s personal experience and perception of their pain intensity. It reflects the individual’s feelings rather than observable data.
B. This statement is also subjective. Describing pain as a "burning sensation" comes from the client's personal experience and interpretation of their symptoms, which cannot be measured or observed by others.
C. This is an objective indicator of pain. A grimace is an observable behavior that can indicate discomfort or pain. It is something that the nurse can see and assess, making it an objective finding.
D. This is another subjective indicator. While knowing the location of pain is important for diagnosis and treatment, the statement reflects the client’s personal experience of pain and cannot be measured or observed directly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. This is an important strategy for fall prevention. Regular exercise helps improve strength, balance, flexibility, and coordination, which can significantly reduce the risk of falls. Physical activity also enhances overall health and mobility, making it easier for older adults to perform daily tasks safely.
B. Removing all rugs and carpets can reduce tripping hazards, but it’s not always practical or aesthetically pleasing. Instead, it’s advisable to secure rugs with non-slip backing and ensure they are not placed in high-traffic areas. Therefore, while removing some rugs can be helpful, not all should be removed.
C. Medications that cause drowsiness can increase the risk of falls by impairing balance, coordination, and alertness. Older adults should be encouraged to discuss their medications with healthcare providers to minimize side effects that may contribute to fall risks.
D. In fact, social engagement can promote physical activity and mental well-being, both of which can help reduce fall risk. Limiting social activities can lead to isolation, which may negatively impact an older adult's physical and emotional health.
Correct Answer is C
Explanation
A. Bending at the hips can strain the back muscles. It's better to bend at the knees to lift with the leg muscles.
B. Keeping your feet together reduces stability. It's better to have a wide stance with your feet shoulder- width apart to maintain balance.
C. Standing close to the object reduces the distance the object needs to be lifted and minimizes the strain on the back muscles.
D. Twisting the spine while lifting can cause serious back injuries. It's important to avoid twisting and lift with straight back and legs.
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