A nurse is planning care for clients.
Which of the following tasks can the nurse delegate to an assistive personnel (AP)?
Providing tracheostomy care for a client.
Assessing a client who just returned from surgery.
Teaching a client who is preoperative how to use an incentive spirometer.
Obtaining a blood pressure for a client who is to be discharged later in the day.
The Correct Answer is D
The correct answer is Choice D: Obtaining a blood pressure for a client who is to be discharged later in the day.
Choice A rationale:
Providing tracheostomy care requires specialized training and assessment skills, which are beyond the scope of practice for assistive personnel (AP).
Choice B rationale:
Assessing a client who just returned from surgery involves clinical judgment and decision-making, which are responsibilities of a licensed nurse, not assistive personnel.
Choice C rationale:
Teaching a client how to use an incentive spirometer requires patient education skills and the ability to assess the client's understanding, which are tasks for a licensed nurse.
Choice D rationale:
Obtaining a blood pressure is a routine task that can be delegated to assistive personnel, as it does not require advanced clinical judgment or specialized training.
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Related Questions
Correct Answer is A
Explanation
Choice A rationale:
In the SOAP charting model, the subjective component is where the client's subjective information and feelings are documented. This includes the client's own reports of symptoms, sensations, and experiences. In this case, the client reporting chest pain after mowing the lawn this morning is a subjective statement made by the client. This information is valuable as it provides insight into the client's perception of their condition and helps healthcare providers understand their symptoms and experiences.
Choice B rationale:
The blood pressure reading (182/98 mm Hg) is an objective measurement, not a subjective statement from the client. Objective data includes measurable and observable information, like vital signs, lab results, and physical examination findings. This type of information is typically documented in the objective component of SOAP charting.
Choice C rationale:
The administration of nitroglycerin (0.3 mg SL) is also an objective action taken by the client, not a subjective statement. It falls under the plan section of the SOAP chart, where healthcare providers outline the actions or interventions taken.
Choice D rationale:
The description of the client's skin (pale and diaphoretic) is also objective data. It represents observable physical signs and is not part of the subjective component, which focuses on the client's own statements and feelings.
Correct Answer is A
Explanation
Choice A rationale:
Abstract thinking develops during the formal operational stage of Piaget's cognitive development theory. This stage typically occurs in adolescence and beyond. During this stage, individuals can think abstractly, solve complex problems, and reason about hypothetical situations. They can also engage in deductive reasoning, which allows them to think logically and systematically.
Choice B rationale:
The concrete operational stage in Piaget's theory, not the formal operational stage, is characterized by the development of logical thinking and operational thought. It typically occurs in children aged 7 to 11 and is marked by the ability to think logically about concrete events and objects.
Choice C rationale:
The sensorimotor stage is the earliest stage in Piaget's theory, occurring in infants from birth to about 2 years old. This stage is characterized by sensory and motor exploration of the environment, and abstract thinking has not yet developed at this stage.
Choice D rationale:
The preoperational stage in Piaget's theory, which typically occurs in children aged 2 to 7, is marked by the development of symbolic thought and language. However, abstract thinking is not a characteristic of this stage.
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