A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

Change the perineal pad of a client who just transferred from labor and delivery.

Monitor vital signs during admission of a client who has gestational hypertension.

Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.

Observe an area of redness on the breast of a client who is 1 day postpartum.

Answer and Explanation

The Correct Answer is C

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.

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Correct Answer is C

Explanation

A. A hot pack to the perineum can be offered after 24 hours, but not before, as heat can increase bleeding.
B. A warm sitz bath can be offered after 24 hours, but not before, as heat can increase bleeding and infection risk.
C. The nurse should also apply an ice pack to the perineum for 20 minutes every 4 hours to reduce swelling and inflammation.
D. Providing a squeeze bottle of antiseptic solution is more related to perineal hygiene rather than pain relief.

A. “You can learn to feed him; I wasn’t comfortable the first time I fed a baby either.” B. “I’ll feed him today. Maybe tomorrow you can try it.” C. “Oh, this isn’t difficult. You’ll be fine doing this.’ D. “Feeding an infant can feel a little intimidating at first, but I’ll stay and help you.”

Correct Answer is D

Explanation

A. Dismissing the client's request without offering assistance or guidance is not supportive.
B. Delaying the client's request to tomorrow does not address her immediate needs.
C. Minimizing the client's concerns may make her feel unsupported and anxious.
D. Acknowledging the client's feelings and offering assistance conveys empathy and support.

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A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

Nursing Test Bank

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