Identify the independent nursing actions. (Select All That Apply)
administering pain medication
teaching a patient how to change their dressing before they are discharged
changing a patient's diet from pureed to regular
giving a back rub.
repositioning a patient in bed
Correct Answer : B,D,E
A. Administering pain medication: Administering medication typically requires a healthcare provider's order. Nurses can administer medications, but this action is not independent; it relies on a prescription.
B. Teaching a patient how to change their dressing before they are discharged: This is an independent nursing action. Nurses are educated and trained to provide patient education. Teaching patients about wound care and dressing changes falls under their scope of practice and doesn't require a physician's order.
C. Changing a patient's diet from pureed to regular: Changing a patient's diet usually involves dietary guidelines set by a healthcare provider. Nurses can implement these dietary changes based on the provider's orders but cannot independently change a patient's diet without an order from a healthcare provider.
D. Giving a back rub: Providing comfort measures like a back rub is an independent nursing action. It falls under the domain of holistic nursing care and doesn't require a specific physician's order. Nurses often use such measures to promote relaxation and alleviate discomfort.
E. Repositioning a patient in bed: This is an independent nursing action. Regular repositioning is crucial for preventing pressure ulcers and maintaining a patient's comfort. Nurses assess the patient's mobility and reposition them as needed without requiring specific orders each time.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. itching:
This is a subjective symptom. Itching is a feeling experienced by the patient and cannot be directly observed by the nurse. The patient's report of itching is subjective until the nurse observes any visible signs of scratching or a rash.
B. headache:
Similar to itching, a headache is a subjective symptom. It is a feeling experienced by the patient and cannot be directly observed by others. The patient's report of a headache is subjective until the nurse observes signs such as the patient holding their head or wincing in pain.
C. rash:
In the given context, a red rash on the face and neck is objective data. Objective data refers to measurable and observable information about a patient's condition. In this case, the nurse can directly observe the rash, making it objective. Objective data is factual and can be verified by others.
D. nausea:
Nausea is also a subjective symptom. It is a feeling experienced by the patient and cannot be directly observed by others. The patient's report of nausea is subjective until the nurse observes signs such as the patient looking pale, sweating, or exhibiting other physical symptoms associated with nausea.
Correct Answer is C
Explanation
A. Objective:
Objective data refers to measurable and observable information, often obtained through assessments, tests, or observations. It includes vital signs, laboratory results, physical examination findings, and other data that can be quantified and documented. For example, a blood pressure reading, a recorded temperature, or the observation of a patient's skin color are objective data points.
B. Unreliable:
Unreliable data refer to information that cannot be trusted or depended upon due to its inconsistency or lack of credibility. If a patient provides information that is conflicting, constantly changing, or not coherent, it might be considered unreliable. In healthcare, it's crucial for data to be reliable to ensure accurate diagnosis and treatment.
C. Subjective:
Subjective data are patient-reported information based on their own feelings, experiences, or opinions. This information cannot be measured or observed by others and is typically obtained through patient interviews. Symptoms like pain, headache, or nausea fall into the category of subjective data because they are felt and described by the patient but cannot be independently verified by the healthcare provider.
D. Historical:
Historical data pertain to a patient's past medical history, including previous illnesses, surgeries, allergies, medications, and family medical history. It provides context for the patient's current health status and aids healthcare providers in understanding the patient's overall health background.
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