Which of the following are examples of nursing implementations? (Select All That Apply)
changing a surgical dressing
return demonstration by the patient
changing an ostomy bag
planning patient outcomes
analyzing assessment data
Correct Answer : A,B,C
A. Changing a surgical dressing: This is an example of a nursing implementation. Nurses frequently change dressings as part of their patient care responsibilities.
B. Return demonstration by the patient: This is also an example of a nursing implementation. Nurses often educate patients and then assess their understanding through return demonstrations to ensure the patient can perform tasks correctly at home.
C. Changing an ostomy bag: This is another example of a nursing implementation. It involves hands-on care for patients with ostomies, a responsibility often carried out by nurses.
D. Planning patient outcomes: While planning patient outcomes is crucial for nursing care, it falls more under the category of nursing interventions and nursing process rather than direct implementations.
E. Analyzing assessment data: Analyzing assessment data is part of the nursing process and helps in making decisions about nursing care. While it's essential, it's not a direct implementation action.
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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 D
Explanation
A. Pain:
Explanation: Pain is a subjective experience because it is based on the patient's feelings and emotions. It varies from person to person and can't be precisely measured or observed by others. Patients often describe their pain based on personal sensations, making it subjective information.
B. Headache:
Explanation: Like pain, a headache is a subjective symptom. Patients report their experience of a headache based on personal sensations, such as throbbing or pressure. It can't be directly measured or observed by healthcare providers; instead, it relies on the patient's description.
C. Lightheadedness:
Explanation: Lightheadedness is another subjective symptom. Patients may feel dizzy or unsteady, but this sensation can't be quantified objectively. It is based on the patient's perception of feeling lightheaded, making it subjective information.
D. Temperature:
Explanation: Temperature is objective data because it can be precisely measured using a thermometer. It provides a specific numerical value, such as 98.6°F (37°C). Objective data is observable and measurable, making temperature a clear example of objective information obtained through examination or assessment.
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