A nurse manager is evaluating the performance of a newly licensed nurse after performing a client interview. Which of the following nonverbal actions by the newly licensed nurse should be identified as appearing too relaxed?

The nurse sat at a slight angle across from the client.

The nurse leaned away from the client throughout the interview.

The nurse maintained an upright posture.

The nurse maintained eye contact throughout the interview.

Answer and Explanation

The Correct Answer is B

Leaning away from the client throughout the interview can convey a lack of interest or engagement in the conversation. It may appear as though the nurse is disinterested or uncomfortable, which could negatively impact the client's perception of the interaction.
A. Sitting at a slight angle across from the client is generally considered appropriate and allows for a comfortable and natural interaction
C. Maintaining an upright posture demonstrates attentiveness and professionalism during the interview.
D. Maintaining eye contact throughout the interview is generally considered a positive nonverbal behavior as it shows attentiveness, respect, and interest in the client's concerns.

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Correct Answer is D

Explanation

Not knowing what triggered the allergic reaction is a significant concern and may indicate a need for allergy testing and evaluation by an allergy specialist. Identifying the trigger allergen is crucial for implementing avoidance strategies, preventing future allergic reactions, and managing the client's overall health and well-being.
A. While the administration of epinephrine indicates the severity of the allergic reaction and the need for immediate treatment, it may not be the most important indication for referral to an allergy specialist on its own.
B. A biphasic reaction refers to the recurrence of symptoms after an initial resolution of an allergic reaction. Biphasic reactions can occur within hours or days after the initial reaction and can be severe or even life-threatening. This, however, does not necessitate need for a specialist.
C. While severe hypoglycemia can occur in some cases of anaphylaxis, it may not be the primary indication for referral to an allergy specialist.

A. Alert B. Restless C. Anxiety D. Pacing

Correct Answer is C

Explanation

Anxiety is a subjective emotional state characterized by feelings of worry, nervousness, or unease. If the client reports feeling anxious, this would be considered subjective because it is based on their own perception of their emotional state.

A. Alert refers to the client's level of consciousness and awareness of their surroundings.

B. Restlessness refers to a feeling of agitation or inability to stay still.

D. Pacing is an observable behavior where the client is walking back and forth in the room.

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A nurse manager is evaluating the performance of a newly licensed nurse after performing a client interview. Which of the following nonverbal actions by the newly licensed nurse should be identified as appearing too relaxed?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is planning care for a client who experienced an anaphylactic reaction. Which of the following findings should the nurse identify as the most important indication for a referral to an allergy specialist?

Correct Answer is D

Explanation

A nurse is assessing a client who reports feeling stress and anxiety. The client appears restless and is pacing in the room. The client is alert and oriented to person, place, and time. Which of the following findings is subjective?

Correct Answer is C

Explanation

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