When prioritizing nursing problems

A. Pain:

Explanation: Pain is a subjective experience because it is based on the patient's feelings and emotions. It varies from person to person and can't be precisely measured or observed by others. Patients often describe their pain based on personal sensations, making it subjective information.

B. Headache:

Explanation: Like pain, a headache is a subjective symptom. Patients report their experience of a headache based on personal sensations, such as throbbing or pressure. It can't be directly measured or observed by healthcare providers; instead, it relies on the patient's description.

C. Lightheadedness:

Explanation: Lightheadedness is another subjective symptom. Patients may feel dizzy or unsteady, but this sensation can't be quantified objectively. It is based on the patient's perception of feeling lightheaded, making it subjective information.

D. Temperature:

Explanation: Temperature is objective data because it can be precisely measured using a thermometer. It provides a specific numerical value, such as 98.6°F (37°C). Objective data is observable and measurable, making temperature a clear example of objective information obtained through examination or assessment.

A. Evaluation:
Evaluation involves the assessment of a patient's response to nursing interventions and the effectiveness of the care plan. In this scenario, the nurse is not evaluating the patient's response to previous interventions but is rather in the process of conducting a new assessment.

B. Assessment:
This statement is correct. The nurse is in the assessment phase of the nursing process. She is collecting data by checking the patient's record, performing a physical examination (digital rectal exam), and noting the patient's complaint and signs of constipation (no bowel movement for three days, hard stool). Assessment is the first step of the nursing process and involves data collection to identify health problems and needs.

C. Nursing Diagnosis:
Nursing diagnosis involves analyzing the data collected during the assessment to identify actual or potential health problems. The nurse has not reached the stage of formulating a nursing diagnosis in this scenario; she is still gathering data.

D. Implementation:
Implementation is the phase of the nursing process where nursing interventions are carried out based on the nursing care plan. The nurse is not implementing interventions yet but is still in the process of data collection.