A nurse is assessing a patient who reports feeling stress and anxiety.
The patient appears restless and is pacing in the room.
The patient is alert and oriented to person, place, and time.
Which of the following findings is subjective?
Restless
Pacing
Anxiety
Alert .
The Correct Answer is C
Choice A rationale
Restlessness is an observable behavior, making it an objective finding.
Choice B rationale
Pacing is also an observable behavior, so it is considered an objective finding.
Choice C rationale
Anxiety is a subjective finding because it is based on the patient’s personal experience and cannot be directly observed.
Choice D rationale
Alertness is an objective finding because it can be directly observed and measured.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Ascending muscle weakness is a classic symptom of Guillain-Barre syndrome. It often starts in the feet and legs before spreading to the upper body and arms.
Choice B rationale
Difficulty with urination is not a typical symptom of Guillain-Barre syndrome.
Choice C rationale
Ptosis (drooping of the upper eyelid) and diplopia (double vision) are not common symptoms of Guillain-Barre syndrome.
Choice D rationale
Ear distortion and pain are not associated with Guillain-Barre syndrome.
Correct Answer is B
Explanation
Choice A rationale
While it’s important for the client to understand the alternatives to the procedure, it’s typically the responsibility of the physician or surgeon to explain these alternatives, not the nurse.
Choice B rationale
One of the nurse’s responsibilities in the informed consent process is to confirm that the client is competent to sign for the procedure. This means ensuring that the client understands the procedure, its risks and benefits, and is making the decision voluntarily.
Choice C rationale
Discussing the risks of the procedure with the client is typically the responsibility of the physician or surgeon, not the nurse.
Choice D rationale
While the nurse may provide some information about what will occur during the procedure, it’s typically the responsibility of the physician or surgeon to provide detailed information about the procedure.
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