A nurse is evaluating a patient for signs of pain. Which of the following is an objective sign of pain?
The patient reports a burning sensation.
The patient grimaces when they move.
The patient rates their pain as an 8 on a scale of 0 to 10.
The patient states the pain is located in their abdomen.
The Correct Answer is B
Choice A rationale
A patient reporting a burning sensation is a subjective sign of pain. It relies on the patient’s personal experience and verbal report.
Choice B rationale
A patient grimacing when they move is an objective sign of pain. It is observable and does not rely on the patient’s verbal report.
Choice C rationale
A patient rating their pain as an 8 on a scale of 0 to 10 is a subjective sign of pain. It relies on the patient’s personal experience and verbal report.
Choice D rationale
A patient stating the pain is located in their abdomen is a subjective sign of pain. It relies on the patient’s personal experience and verbal report.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Vasogenic cerebral edema is the most common type of cerebral edema associated with stroke. It involves swelling outside of brain cells, and leaky blood vessels cause it.
Choice B rationale
Osmotic cerebral edema is not typically associated with stroke. It is more commonly seen in conditions like diabetes-related ketoacidosis and hyponatremia.
Choice C rationale
Cellular, or cytotoxic, cerebral edema can occur due to traumatic brain injury and stroke. However, it is not the most common type of cerebral edema associated with stroke.
Choice D rationale
Interstitial cerebral edema is not typically associated with stroke. It is more commonly seen in conditions like hydrocephalus and meningitis.
Correct Answer is A
Explanation
Choice A rationale
Anhidrosis, or the inability to sweat normally, is a potential side effect of anticholinergic agents. These medications block the action of acetylcholine, a neurotransmitter that stimulates sweat glands among other functions. If a patient taking an anticholinergic agent for Parkinson’s disease experiences anhidrosis, they should report it to their healthcare provider as it can lead to overheating and heat stroke.
Choice B rationale
Tremors are a common symptom of Parkinson’s disease, and anticholinergic medications are often used to help control them. Therefore, while tremors should be monitored, they are not typically a side effect that needs to be reported unless they worsen or become unmanageable.
Choice C rationale
Drooling can be a symptom of Parkinson’s disease, but it is not typically a side effect of anticholinergic medications. In fact, these medications can sometimes cause dry mouth.
Choice D rationale
Rigidity, like tremors, is a common symptom of Parkinson’s disease. Anticholinergic medications can help manage rigidity, so it is not typically a side effect that needs to be reported unless it worsens.
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