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?
Alert
Restless
Anxiety
Pacing
The Correct Answer is C
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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Administering epinephrine is the immediate priority when managing anaphylaxis. Epinephrine is the first-line treatment for anaphylaxis as it helps to rapidly reverse severe allergic symptoms, such as airway constriction, swelling, and hypotension.
A. While assessing the client's neurologic status is important for monitoring their overall condition, it may not be the immediate priority when the client is experiencing symptoms of an allergic reaction, particularly anaphylaxis.
B. While consulting an allergy specialist may be necessary for further evaluation and management of the client's allergic condition, it is not the immediate priority.
D. While determining the cause of the hives is important for identifying the allergen and preventing future allergic reactions, it is not the immediate priority during an acute episode of anaphylaxis.
Correct Answer is A
Explanation
This statement encourages the client to express their own perspectives, beliefs, and preferences regarding their health and well-being. It fosters client autonomy and acknowledges the importance of understanding the client's cultural context and values when developing a treatment plan. This statement aligns with the principles of the CFI tool.
C. This statement imposes the nurse's perspective on the client and may not be culturally sensitive.
D. This statement imposes the nurse's beliefs and assumptions on the client and may not be culturally sensitive.
B. This statement may not be appropriate without further exploration of the client's experiences, beliefs, and cultural context. It imposes Western diagnostic categories on the client without considering the cultural validity of these categories or the client's own explanatory model of illness.
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