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A nurse is caring for a client who is breastfeeding and states that her nipples are sore and cracking. Which of the following actions should the nurse take?

A.

Assess and ensure the newborn has a successful latch.

B.

Recommend increasing the length of time between feedings.

C.

Educate the client to apply mineral oil to the nipples between feedings.

D.

Educate the client to keep the nipples covered between breastfeeding sessions.

Answer and Explanation

The Correct Answer is A

Choice A rationale

 

Ensuring the newborn has a successful latch is crucial for preventing and treating sore and cracked nipples. A poor latch can cause nipple trauma and pain.

 

Choice B rationale

 

Increasing the length of time between feedings is not recommended as it can lead to engorgement and further complications. Frequent breastfeeding helps maintain milk supply and prevents issues like mastitis.

 

Choice C rationale

 

Applying mineral oil to the nipples is not recommended. Instead, using expressed breast milk or medical-grade lanolin can promote healing.

 

Choice D rationale

 

Keeping the nipples covered between breastfeeding sessions is not necessary and can sometimes exacerbate the problem. Allowing the nipples to air dry or using hydrogel pads can be more beneficial.

 


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Correct Answer is A

Explanation

Choice A rationale

Asking the client if she has thoughts of or considered harming herself or her newborn is the priority action. This assessment is crucial for identifying postpartum depression and potential risks to the client and her newborn. Early identification and intervention can prevent harm.

Choice B rationale

Anticipating a prescription for an antidepressant is important but secondary to assessing immediate safety concerns. Medication can be part of the treatment plan after assessing the client’s mental state.

Choice C rationale

Assisting the family to identify prior use of positive coping skills is beneficial for long-term management but is not the immediate priority. The nurse must first ensure the client’s and newborn’s safety.

Choice D rationale

Reinforcing postpartum and newborn care discharge teaching is important for overall care but does not address the immediate concern of potential harm due to postpartum depression.

Correct Answer is A

Explanation

Choice A rationale

Galactopoiesis is the process of lactation maintenance and is reliant on breast stimulation and milk removal. This stage involves the ongoing production of milk in response to the infant’s demand.

Choice B rationale

Lactogenesis II refers to the onset of copious milk secretion that occurs around 2-3 days postpartum. It is triggered by the withdrawal of progesterone following the delivery of the placenta.

Choice C rationale

Mammogenesis is the development of the mammary glands during pregnancy. It involves the growth and differentiation of the breast tissue in preparation for lactation.

Choice D rationale

Lactogenesis I refers to the initial stage of milk production that begins during pregnancy and continues through the early postpartum period. It is hormonally driven and prepares the breasts for lactation. .

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