While performing an admission history on a confused patient, a licensed practical nurse (LPN) assists the registered nurse (RN) by collecting secondary information about the patient. An example of secondary information would be that
The patient's spouse reports experiencing marital issues.
The patient reports a history of chest pain.
The patient complains of chronic constipation.
The patient verbalizes anxiety about hospitalization.
The Correct Answer is A
A. The patient's spouse reporting experiencing marital issues is a perfect example of secondary information as it comes from someone other than the patient and might affect the patient's care or emotional well-being indirectly.
B. The patient reports a history of chest pain, is an example of primary information. This is because the patient directly reports the symptoms of their health condition.
C. The patient complaining of chronic constipation is an example of primary information. This is because the patient is directly reporting their own health condition.
D. The patient verbalizes anxiety about hospitalization is also primary information, directly provided by the patient concerning their feelings about the current care environment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A: Applying pressure over a bony prominence helps assess for pitting edema, a common indicator of fluid retention causing swelling. This action provides objective data to confirm the patient's subjective observation.
B: Percussion is not typically used to assess edema. It is more suitable for assessing the density of underlying structures.
C: Elevating the feet may help alleviate swelling but does not confirm the presence of edema.
D: Documenting the observation is important, but further assessment is needed to confirm the patient's concern.
Correct Answer is D
Explanation
A: Bradycardia is typically not associated with acute pain; instead, pain usually triggers a sympathetic response, leading to tachycardia.
B: Hypoglycemia has no direct correlation with acute pain levels.
C: Pain tends to increase, not decrease, the respiratory rate due to stress and increased metabolic demand.
D: Acute pain can lead to elevated blood pressure as part of the body's stress response, which includes activation of the sympathetic nervous system.
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