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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?

A.

Sore nipple with cracks and fissures.

B.

Scant nonodorous white vaginal discharge.

C.

Uterine cramping during breastfeeding.

D.

Decreased response with sexual activity.

Answer and Explanation

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 D

Explanation

Choice D rationale

Applying an ice pack to the perineum is the recommended action for unrelieved episiotomy pain within the first 24 hours following delivery. Ice helps reduce swelling and provides pain relief.

Choice A rationale

Placing a soft pillow under the client’s buttocks is not effective and can increase pressure and swelling on the perineal area, worsening the pain.

Choice B rationale

Positioning a heating lamp toward the episiotomy is not recommended as it can increase the risk of burns and does not effectively reduce swelling.

Choice C rationale

Preparing a warm sitz bath can be beneficial after the first 24 hours but is not the initial action for unrelieved pain within the first 8 hours.

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