During an assessment, a client who is not very talkative appears pale, diaphoretic, and restless in the bed and says "leave me alone." Which subjective data should the nurse document?
Not talkative
Pale and diaphoretic
"Leave me alone"
Restlessness
Encourage or provide oral hygiene after mealtime.
The Correct Answer is C
Subjective data refers to information that is reported by the client and cannot be directly observed or measured by the healthcare provider. In this case, the statement "leave me alone" is an example of subjective data that the nurse should document. This information provides insight into the client's feelings and emotions and can help guide the nurse's care and interventions.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
The most appropriate response by the nurse would be to explain to the client that antibiotics have no effect on viruses. Upper respiratory infections, such as the common cold, are caused by viruses and therefore antibiotics would not be effective in treating the infection. It is important for the nurse to educate the client about the appropriate use of antibiotics and to address any misconceptions they may have.
Correct Answer is A
Explanation
Primary prevention refers to actions taken to prevent the occurrence of a disease or condition. In this case, the nurse is educating women on the need for calcium to prevent bone loss, which is an example of primary prevention. By providing information on how to maintain strong bones and prevent bone loss, the nurse is helping to reduce the risk of conditions such as osteoporosis.
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