A nurse is reinforcing discharge instructions for a client.At 4 weeks postpartum, the client should contact the provider for which of the following client findings?
Sore nipple with cracks and fissures.
Scant nonodorous white vaginal discharge.
Uterine cramping during breastfeeding.
Decreased response with sexual activity.
The Correct Answer is A
Choice A rationale
Sore nipples with cracks and fissures can indicate an infection or improper breastfeeding technique, requiring medical attention.
Choice B rationale
Scant nonodorous white vaginal discharge is normal postpartum and does not require contacting the provider.
Choice C rationale
Uterine cramping during breastfeeding is a normal physiological response due to oxytocin release.
Choice D rationale
Decreased response with sexual activity can be normal postpartum and does not necessarily require immediate medical attention.
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Correct Answer is B
Explanation
Choice A rationale
Obtaining a prescription for an antibiotic is not the first recommendation for a client who is 3 days postpartum and breastfeeding with hard and warm breasts. Antibiotics are typically prescribed if there is a confirmed infection, such as mastitis, which is characterized by symptoms like fever, chills, and flu-like symptoms. In this case, the client is experiencing normal postpartum breast engorgement, which does not require antibiotics.
Choice B rationale
Expressing milk from both breasts is the correct recommendation. Breast engorgement is common in the early postpartum period as the milk comes in. Expressing milk, either by breastfeeding frequently or using a breast pump, helps to relieve the fullness, reduce discomfort, and maintain milk production.
Choice C rationale
Wearing a nipple shield is not recommended for breast engorgement. Nipple shields are typically used for issues like latch difficulties or sore nipples, not for relieving engorgement. Using a nipple shield without proper guidance can potentially interfere with milk transfer and breastfeeding success.
Choice D rationale
Applying a heating pad to the breasts is not recommended for engorgement. Heat can increase blood flow and exacerbate swelling. Instead, cold compresses or cold cabbage leaves are often recommended to reduce swelling and discomfort associated with engorgement.
Correct Answer is B
Explanation
Choice A rationale
Placing the client on seizure precautions is not appropriate for shaking chills during the immediate postpartum period. Shaking chills are a common physiological response after childbirth due to hormonal changes and the body’s effort to regulate temperature. Seizure precautions are reserved for clients with a history of seizures or those exhibiting signs of a seizure disorder.
Choice B rationale
Covering the client with warm blankets is the correct action. Shaking chills are often due to the body’s attempt to regain thermal balance. Providing warmth with blankets helps to alleviate the chills and provide comfort to the client.
Choice C rationale
Determining the client’s temperature is important but not the immediate action to take. While it is necessary to monitor for fever, which could indicate an infection, the priority is to provide comfort and warmth to the client experiencing chills.
Choice D rationale
Notifying the charge nurse is not the immediate action required. The nurse should first address the client’s immediate need for warmth and comfort. If the chills persist or are accompanied by other concerning symptoms, then notifying the charge nurse would be appropriate.