A nurse is caring for a client recovering from surgery who has stopped initiating conversation, avoids eye contact, and is repeatedly fidgeting with their hands. The client was previously cooperative and communicative. How should the nurse interpret these changes in behavior?
The client is demonstrating post-operative behavior that requires increased monitoring without interventions.
The client is experiencing medication side effects and requires a dosage adjustment.
The client is experiencing significant pain and requires more pain medication.
The client is feeling anxious and requires further assessment and emotional support.
The correct answer is focused on anxiety, as the observed non-verbal behaviors—withdrawal, avoidance of eye contact, and restlessness—align with common signs of emotional distress. Further assessment and emotional support are necessary to address the underlying issue. The incorrect answers incorrectly attribute the behavior to physical causes (e.g., unmanaged pain or medication side effects) or minimize its significance as routine post-operative behavior. Misinterpreting these cues can result in missed opportunities to appropriately address a client’s emotional needs.
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NCLEX RN
Psychosocial Integrity
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