A nurse on a postpartum unit is giving discharge instructions to a client whose newborn had a circumcision with the Plastibell technique. Which of the following client statements indicates understanding of circumcision care?

"I'll apply petroleum jelly to his penis with diaper changes."

"I'll make sure his diaper is loose in the front."

"I'll expect the plastic ring to fall off by itself within a couple of days."

"I'll wash his penis with warm water and mild soap each day."

Answer and Explanation

The Correct Answer is B

A.   Applying petroleum jelly is not recommended with the Plastibell technique as it may interfere with the ring falling off.
B.   The client should also keep the diaper loose in the front to prevent pressure or irritation on the penis.
C. The ring to fall off by itself within 5 to 10 days. Do not try to remove it yourself or pull on it.
D.   Washing with warm water and mild soap is generally good hygiene but may not be necessary for circumcision care.

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Correct Answer is C

Explanation

A. Changing the perineal pad of a client who has just been transferred from the labor ward is a task that should not be delegated to an assistive personnel (AP) since it is beyond their scope.
B. Monitoring vital signs during the admission of a client with gestational hypertension requires nursing judgment and assessment skills.
C. Providing a sitz bath to a client with a fourth-degree laceration and is 2 days post- partum can be delegated to an AP. This task does not require the nurse's clinical judgment or assessment skills, and it can be safely performed by the AP following the nurse's instructions.
D. Observing an area of redness on the breast requires nursing assessment and intervention.

A. A newborn who is 18 hr post-delivery and has acrocyanosis B. A newborn who is 24-hr post-delivery and has not passed meconium C. A newborn who is 24 hr post-delivery and has persistent tachycardia with a heart rate of 180 bpm D. A newborn who is 24 hr post-delivery and has not voided

Correct Answer is C

Explanation

A. Acrocyanosis is a normal finding in newborns and does not require immediate intervention.
B. Not passing meconium within the first 24 hours is not uncommon and may be normal.
C. Persistent tachycardia in a newborn, especially with a heart rate of 180 bpm, requires immediate intervention as it may indicate a cardiac or other medical issue.
D. Not voiding within the first 24 hours may be normal, but it should be monitored.

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A nurse on a postpartum unit is giving discharge instructions to a client whose newborn had a circumcision with the Plastibell technique. Which of the following client statements indicates understanding of circumcision care?

Nursing Test Bank

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Correct Answer is C

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