A nurse is collecting data from a client who is experiencing delirium. Which of the following findings should the nurse expect?

Choice A reason: Carrying the newborn to the nursery risks dropping due to postpartum fatigue or weakness. Scientifically, this increases injury potential, as maternal strength is compromised early postpartum, making it an unsafe practice compared to staff-assisted transport protocols.

Choice B reason: Requesting licenses is impractical and delays care; ID badges suffice for security. Scientifically, this overcomplicates verification, as hospitals use standardized identification, reducing abduction risk effectively without burdening staff or compromising timely newborn management.

Choice C reason: Missing ID bands threaten security, risking mix-ups or abduction. Alerting staff ensures immediate correction, aligning with scientific safety protocols, as dual identification (mother and baby) is critical postpartum to prevent errors or unauthorized removal in healthcare settings.

Choice D reason: Leaving the newborn unattended in the bassinet risks theft or falls, especially in an unsecured room. Scientifically, constant supervision or staff notification is safer, as postpartum units prioritize vigilance to protect vulnerable infants from preventable harm.

Choice A reason: Sims’ position is for rectal exams, not central catheter insertion. Trendelenburg or supine is used, so this is incorrect for TPN prep.

Choice B reason: Verifying TPN amount is ongoing care, not insertion prep. Initial placement confirmation via x-ray takes precedence over infusion monitoring here.

Choice C reason: Clean technique risks infection in central lines; sterile is required. This compromises TPN safety, making it an incorrect preparatory step.

Choice D reason: Chest x-ray confirms catheter tip placement in the vena cava for TPN. It’s a critical prep step to ensure safe administration begins.