A nurse is documenting in a client's health record using the subjective, objective, assessment, and plan (SOAP) charting model. Which of the following information should be included in the subjective component?
Client's skin is pale and diaphoretic
Client reports chest pain after mowing lawn this morning
Client administered nitroglycerin 0.3 mg SL for chest pain
Client's blood pressure is 182/98 mm Hg
The Correct Answer is B
Choice A reason: Client's skin is pale and diaphoretic is not included in the subjective component, but in the objective component. The objective component records the measurable and observable data that the nurse collects from the client, such as vital signs, physical examination findings, and laboratory results.
Choice B reason: Client reports chest pain after mowing lawn this morning is included in the subjective component. The subjective component records the data that the client verbalizes or expresses, such as symptoms, feelings, preferences, and beliefs.
Choice C reason: Client administered nitroglycerin 0.3 mg SL for chest pain is not included in the subjective component, but in the plan component. The plan component records the interventions and actions that the nurse implements or plans to implement for the client, such as medications, treatments, referrals, and education.
Choice D reason: Client's blood pressure is 182/98 mm Hg is not included in the subjective component, but in the objective component. The objective component records the measurable and observable data that the nurse collects from the client, such as vital signs, physical examination findings, and laboratory results.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: This action is correct because airway protection is the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's airway patency, breathing, and oxygenation, and intervene as needed to secure and maintain the airway. The nurse should also monitor the client for signs of aspiration, bleeding, or obstruction, and suction the airway as needed.
Choice B reason: This action is incorrect because stabilizing cardiac arrhythmias is not the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's circulation, blood pressure, and pulse, and intervene as needed to treat any arrhythmias, shock, or hemorrhage. However, this is not a priority over the client's airway, which is essential for survival.
Choice C reason: This action is incorrect because preventing musculoskeletal disability is not the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's mobility, sensation, and alignment, and intervene as needed to prevent or treat any fractures, dislocations, or nerve injuries. However, this is not a priority over the client's airway, which is essential for survival.
Choice D reason: This action is incorrect because decreasing intracranial pressure is not the first priority for a client who is unconscious and has trauma to multiple systems. The nurse should assess the client's level of consciousness, pupillary response, and neurological status, and intervene as needed to prevent or treat any increased intracranial pressure, cerebral edema, or brain injury. However, this is not a priority over the client's airway, which is essential for survival.
Correct Answer is D
Explanation
Choice A reason: Professional identity is not the correct answer, as it refers to the sense of belonging and alignment with the values and norms of the nursing profession. Joining a professional organization does not necessarily imply that the nurse has a strong professional identity, as they may have other motives or interests for doing so.
Choice B reason: Quality improvement is not the correct answer, as it refers to the systematic and continuous actions that lead to measurable improvement in health care services and outcomes. Joining a professional organization does not directly contribute to quality improvement, as it depends on the nurse's involvement and participation in the organization's activities and initiatives.
Choice C reason: Risk management is not the correct answer, as it refers to the process of identifying, analyzing, and reducing the potential for harm or loss in health care settings. Joining a professional organization does not affect risk management, as it does not change the nurse's responsibility or accountability for their practice.
Choice D reason: Professional commitment is the correct answer, as it refers to the degree of loyalty, dedication, and engagement that the nurse has towards the nursing profession. Joining a professional organization is an example of professional commitment, as it shows that the nurse is interested in advancing their knowledge, skills, and career, and in contributing to the development and improvement of the profession.
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