A nurse is completing a client's history and physical examination. Which of the following information should the nurse consider subjective data?
Blood pressure
Cyanosis
Nausea
Petechiae
The Correct Answer is C
Objective data:
Blood pressure (can be measured by the nurse)
Cyanosis (can be observed by the nurse)
Petechiae (can be observed by the nurse)
So, the subjective data in this list is "Nausea." This is information that the client shares with the nurse about their symptoms or feelings.
The objective data includes A-"Blood pressure," B-"Cyanosis," and D-"Petechiae," which are findings that the nurse can measure or observe during the physical examination.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The client's statement, "I really want to see my first grandchild born before I die. Is that too much to ask?" indicates that the client is experiencing the stage of bargaining in the grieving process. During this stage, individuals may try to negotiate or make deals with a higher power or with fate in an attempt to postpone or change the outcome of their situation. In this case, the client is expressing a desire to live long enough to witness the birth of their first grandchild, which represents an attempt to negotiate with their illness and impending death.
It's important for the nurse to be supportive and empathetic during this stage of grieving and to provide emotional support to the client as they navigate their feelings and thoughts about their illness and impending death. Explanation: The client's statement, "I really want to see my first grandchild born before I die. Is that too much to ask?" indicates that the client is experiencing the stage of grieving known as bargaining.
In the context of the five stages of grief proposed by Elisabeth Kübler-Ross, bargaining is the third stage. During this stage, individuals may attempt to negotiate or make deals with a higher power or the universe to change the outcome of their situation. They may express thoughts like "If only I could see this happen before I die," as a way to find some sense of control or hope amidst their terminal illness.
In this scenario, the client's desire to see their first grandchild born reflects the bargaining stage, where they are trying to find meaning and hope in their terminal condition by wishing for a specific event to occur before their passing.
The other stages of grief include:
A. Anger - In this stage, individuals may feel resentful, frustrated, or outraged about their situation or the circumstances leading to their illness.
B. Acceptance - The final stage in Kübler-Ross's model, acceptance, involves coming to terms with one's imminent death and finding peace and resolution.
D. Depression - In this stage, individuals may experience profound sadness and a sense of loss related to their impending death and the life they will leave behind.
Correct Answer is A
Explanation
Prior to meeting with a client who is experiencing complicated grieving, the nurse should engage in self-reflection and examine their own attitudes, biases, and emotional responses related to loss and grieving. This is important because the nurse's own experiences and beliefs can influence their ability to provide empathetic and non-judgmental care to the client. By acknowledging and understanding their own feelings and reactions, the nurse can better support the client in their grieving process.
The other options are not appropriate for the following reasons:
B- Evaluating previous methods of interventions: While it is essential for the nurse to have knowledge and skills related to grief counseling and interventions, focusing solely on previous methods may not be helpful for the client's unique situation. Each individual's grieving process is different, and what worked for one client may not work for another.
C- Establishing goals for the process and presenting them to the client: While setting goals for the therapeutic relationship is important, it should be a collaborative process between the nurse and the client. The nurse should work with the client to identify their needs and goals related to the grieving process and develop a plan of care together.
D- Sharing personal information related to loss experienced by the nurse: It is not appropriate for the nurse to share their own personal experiences of loss with the client. The focus of the therapeutic relationship should be on the client's needs and experiences, not the nurse's. Sharing personal information can shift the focus away from the client and may not be helpful or therapeutic for them.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.