Which of the following is classified as subjective data in a nursing assessment?

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Question 1 of 5

Which of the following is classified as subjective data in a nursing assessment?

Correct Answer: B

Rationale: The correct answer is B because subjective data in a nursing assessment refers to information provided by the patient, such as feelings, perceptions, and symptoms. In this case, the client stating 'I feel nauseated' represents subjective data. This type of information cannot be measured or observed directly. A, C, and D are incorrect: A: Heart rate of 90 beats per minute is an objective measurement that can be directly observed. C: Blood pressure of 130/80 mmHg is also an objective measurement that can be directly observed. D: Skin appears flushed is an objective observation that can be directly seen.

Question 2 of 5

A client is scheduled for surgery for an abdominal hysterectomy. During the preoperative assessment, the client states, 'I am very nervous and scared to have surgery.' What client outcome is the priority?

Correct Answer: B

Rationale: The correct answer is B: Resolve the client’s anxiety. Addressing the client's anxiety is the priority because it can impact their overall surgical experience, recovery, and outcomes. Resolving anxiety can improve the client's emotional well-being, enhance cooperation during surgery, and reduce postoperative complications related to stress. Providing emotional support and reassurance should be the initial focus to help the client feel more comfortable and confident about the upcoming surgery. The other choices are not the priority in this situation: A) Evaluating the need for antibiotics can be addressed later in the preoperative process, C) Providing preoperative education is important but not the immediate priority over addressing anxiety, and D) Preparing the client for surgery includes various components, but emotional well-being should be addressed first.

Question 3 of 5

Which of the following reflects the importance of client-centered care during the evaluation phase?

Correct Answer: B

Rationale: The correct answer is B because client-centered care emphasizes involving clients in decision-making. During evaluation, assessing if the care plan aligns with the client's preferences and goals ensures personalized and effective care. This approach enhances client satisfaction, engagement, and outcomes. Incorrect choices: A: Not considering the client's input goes against client-centered care principles. C: Prioritizing institutional policies over client feedback neglects the client's individual needs. D: Focusing solely on measurable clinical outcomes may not capture the holistic view of the client's well-being.

Question 4 of 5

Which of the ff. nursing actions is most appropriate when doing perineal care on an uncircumcised male patient?

Correct Answer: C

Rationale: The correct answer is C, which is to replace the foreskin over the head of the penis after washing. This is important to prevent any irritation or injury to the sensitive foreskin and glans. Leaving the foreskin retracted (A) can lead to discomfort and potential injury. Not retracting the foreskin (B) may not allow for proper cleaning. Using alcohol and a cotton swab (D) can be too harsh and irritating to the delicate tissues. Therefore, option C is the most appropriate and gentle approach to maintain proper hygiene and prevent any complications.

Question 5 of 5

.A client complains of urinary discomfort and a burning sensation while urinating. A urethral smear shows evidence of urethritis, and the client is prescribed antibiotics and instructed to drink 2-3 L of water daily. For which of the ff reasons is the client advised to drink the specified amount of water?

Correct Answer: B

Rationale: Step 1: Antibiotics are prescribed to treat urethritis, indicating a bacterial infection in the urinary tract. Step 2: Increasing water intake (2-3 L daily) promotes renal blood flow, dilutes urine, and helps flush out bacteria from the urinary tract, aiding in the elimination of infection. Step 3: Adequate hydration helps prevent the formation of concentrated urine, reducing the risk of recurrent urinary tract infections. Step 4: Therefore, choice B is correct as it directly addresses the underlying cause of the client's symptoms. Summary: Choices A, C, and D are incorrect as they do not directly target the bacterial infection causing the urinary discomfort. Drinking water will not specifically help with incontinence, eliminate odors, or provide pain relief.

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