During a health assessment, a client complains of palpitations. Which of the following is subjective data?
Vomiting.
Blood pressure reading.
Auscultation of heart murmur.
Client’s complaint of palpitations.
The Correct Answer is D
Choice A rationale
Vomiting is objective data as it can be observed and measured by the nurse.
Choice B rationale
Blood pressure reading is objective data as it is a measurable and observable finding.
Choice C rationale
Auscultation of heart murmur is objective data as it is an observable finding during a physical examination.
Choice D rationale
Client’s complaint of palpitations is subjective data as it is based on the client’s personal experience and cannot be directly observed or measured by the nurse.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Any competent adult regardless of age or health status can create an advance directive. Advance directives are legal documents that allow individuals to specify their preferences for medical care in case they become unable to communicate their wishes. Competence is the key requirement, meaning the individual must be able to understand and make decisions about their medical care.
Choice B rationale
Only individuals with terminal illnesses is incorrect. While individuals with terminal illnesses may benefit from having an advance directive, it is not a requirement. Advance directives are available to any competent adult, regardless of their health status.
Choice C rationale
Only individuals over the age of 65 is incorrect. Advance directives can be created by any competent adult, regardless of age. It is important for all adults to consider having an advance directive to ensure their medical preferences are known and respected.
Choice D rationale
Only individuals with chronic medical conditions is incorrect. While individuals with chronic medical conditions may benefit from having an advance directive, it is not a requirement.
Advance directives are available to any competent adult, regardless of their health status.
Correct Answer is C
Explanation
Choice A rationale
Asking the client to demonstrate emptying of the colostomy bag is an action that would be part of the implementation or evaluation phase, not the planning phase.
Choice B rationale
Describing which supplies would be needed is also part of the implementation phase. The planning phase focuses on assessing the client’s needs and readiness to learn.
Choice C rationale
Determining the client’s readiness to learn is a crucial step in the planning phase. It ensures that the client is prepared and willing to engage in the learning process, which is essential for effective education.
Choice D rationale
Identifying the client’s learning needs is part of the assessment phase, which precedes the planning phase. The planning phase involves using the information gathered during the assessment to develop a teaching plan.
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