When performing a focused gastrointestinal system assessment, the practical nurse (PN) asks a male client when his last bowel movement occurred. The client answers, "Three days ago.”. Which action should the PN implement first?

The correct answer is **b. Oral feeding of a two-year-old child after application of a hip spica cast.**

Choice A rationale:

Participation in staff rounds to record notes regarding client goals is not an appropriate task to delegate to a UAP. This task requires clinical assessment, judgment, and documentation skills that are within the scope of practice of a licensed practical nurse (PN), but not a UAP.

Choice B rationale:

Oral feeding of a two-year-old child after application of a hip spica cast is an appropriate task that the PN can delegate to a UAP. Feeding a stable patient is a routine task that does not require advanced nursing skills or clinical judgment. As long as the child is not at high risk for complications, this task can be safely delegated to a UAP with proper training and supervision.

Choice C rationale:

Evaluation of a client's incisional pain following narcotic administration is not an appropriate task to delegate to a UAP. This task requires clinical assessment, evaluation of medication effects, and critical thinking skills that are within the scope of practice of a PN, but not a UAP.

Choice D rationale:

Assessment of the placement and patency of a nasogastric feeding tube is not an appropriate task to delegate to a UAP. This task requires specialized nursing skills and clinical judgment to ensure the safety and effectiveness of the feeding tube. It is within the scope of practice of a PN, but not a UAP.

The correct answer is choice A: Never scratch under the cast.

Choice A rationale:

It is important not to scratch under the cast because inserting objects can lead to skin injury and infection. If itching occurs, blowing cool air from a hair dryer into the cast is recommended.

Choice B rationale:

While mild swelling and some discomfort are common after a cast is applied, patients should not expect an increase in pain. Persistent or severe pain could indicate complications such as increased swelling, decreased blood flow, or pressure on nerves and should be evaluated by a healthcare provider.

Choice C rationale:

Applying a cold pack to “hot spots” on the cast is not recommended as it can lead to moisture accumulation and skin problems. Instead, to manage swelling and discomfort, ice can be applied over the cast, covered with a thin towel, for 20 minutes every two hours while awake during the first 48 hours.

Choice D rationale:

Keeping the injured leg in a dependent position is not advised because it can increase swelling and pain. The affected limb should be elevated above the level of the heart to reduce swelling and promote healing.