The nurse observes the client as he paces the floor and talks to himself. The nurse documents this as "Client confused and agitated." This is an example of

An observation

A judgment

Subjective data

Objective data

Answer and Explanation

The Correct Answer is B

Choice A rationale: An observation is a factual statement of what the nurse sees, hears, feels, or smells.
Choice B rationale: This is because the nurse is interpreting the client's behavior and not describing it objectively.
Choice C rationale: subjective data is information that the client tells the nurse, such as feelings, perceptions, or opinions.
Choice D rationale: Objective data is information that the nurse obtains through physical examination, tests, or measurements.

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Correct Answer is A

Explanation

Choice A rationale: Clozapine is an antipsychotic medication associated with agranulocytosis which is a condition where the bone marrow does not provide enough white blood cells. This increases an individual’s risk of infections. Therefore, frequent blood tests should be performed on an individual taking this medication to monitor the WBC count and stop the medication if need be.
Choice B rationale: clozapine is not associated with a low hemoglobin level. Anemia may be caused by conditions such as iron deficiency, chronic conditions such as chronic kidney disease, and vitamin B12 deficiency.
Choice C rationale: An increase in white blood cell count is not a side effect of clozapine but can be caused by infections. Clozapine causes low white blood cell count.
Choice D rationale: blood in urine is not a side effect of clozapine but can be caused by the use of medications such as cyclophosphamide.

A. To tell the client that help can be more effective if she shares her feelings B. To interpret this action as an indication that the client is finished with the conversation C. To ask the client a question so the interaction can continue D. To remain silent and be attentive to the client's nonverbal communication

Correct Answer is D

Explanation

Choice A rationale: this may imply that the client is not cooperating and may make them feel guilty thus discouraging any further communication which may be useful in generating a treatment plan for the patient.
Choice B rationale: assuming that the client has completed her conversation is incorrect since it is an opportunity to explore the client’s feelings and thoughts that may be missed.
Choice C rationale: this is not the best action since it may interrupt the client’s natural process of reflection and expression while pressuring him/her to respond to the questions asked.
Choice D rationale: remaining silent and being attentive to the client’s nonverbal communication shows respect for the client’s pace and readiness to speak.
Furthermore, it demonstrates the nurse’s presence and their support.

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The nurse observes the client as he paces the floor and talks to himself. The nurse documents this as "Client confused and agitated." This is an example of

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is A

Explanation

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Correct Answer is D

Explanation

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