Nokea
While assessing the breastfeeding mother 24 hours postdelivery, the nurse notes that the client’s breasts are hard and painful. Which interventions should be implemented by the nurse? Select all that apply.
- A. Tell her to feed a small amount from both breasts at each feeding.
- B. Apply ice packs to the breasts at intervals between feedings.
- C. Give supplemental formula at least once in a 24-hour period.
- D. Administer an anti-inflammatory medication prescribed pm.
- E. Apply warm, moist packs to the breasts between feedings.
- F. Pump the breasts as needed to ensure complete emptying.
Correct Answer: B,D,F
Rationale: Moving the baby from the initial breast to the second breast during the feeding, before the initial breast is completely emptied, may result in neither breast being totally emptied and thus promote continued engorgement. Because engorgement is caused, in part, by swelling of the breast tissue surrounding the milk gland ducts, applying ice at intervals between feedings will help to decrease this swelling. Giving supplemental formula, thus limiting the time the baby nurses at the breast, prevents total emptying of the breast and promotes increased engorgement. Administering anti-inflammatory medication will decrease breast pain and inflammation. Because heat application increases blood flow, moist heat packs would exacerbate the engorgement. Pumping the breasts may be necessary if the infant is unable to completely empty both breasts at each feeding. Pumping at this time will not cause a problematic increase in breast milk production.
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What information should the nurse also include about the side effects of iron supplementation?
- A. You may notice that your stools will be black.
- B. Your teeth will become stained.
- C. Vomiting is likely to occur.
- D. You may have diarrhea several times per day.
Correct Answer: A
Rationale: Black stools are a common side effect of iron supplements due to unabsorbed iron, unlike the other options.
The postpartum client is being discharged to home with a streptococcal puerperal infection. The client is taking antibiotics but asks the nurse what precautions she should take at home to prevent spreading the infection to her husband, newborn, and toddler. Which is the best response by the nurse?
- A. “No precautions are necessary since you are taking antibiotics.”
- B. “You should always wear a mask when caring for your newborn and toddler.”
- C. “Wash your hands before caring for your children and after toileting and perineal care.”
- D. “Your husband should provide all cares for both children until your infection is gone.”
Correct Answer: C
Rationale: The course of an endometrial infection is approximately 7 to 10 days, and thus standard precautions should be in place for that period of time even if the client has started antibiotics. Puerperal infections are not spread by droplets, and thus a mask is not necessary. Other than hand hygiene, no additional precautions need to be taken by the client in her home. The client is able to provide cares for her children, but hand washing is required before cares.
The nurse includes which topic in the prenatal education plan for a first-time mother?
- A. Breastfeeding techniques
- B. Advanced labor pain management
- C. Neonatal surgical procedures
- D. Postpartum weight loss strategies
Correct Answer: A
Rationale: Breastfeeding techniques are essential for a first-time mother to ensure successful feeding and bonding with the newborn.
The nurse is caring for the postpartum family. The nurse determines that paternal engrossment is occurring when which observation is made of the newborn’s father?
- A. Talks to his newborn from across the room
- B. Shows similarities between his and the baby’s ears
- C. Expresses feeling frustrated when the infant cries
- D. Seems to be hesitant to touch his newborn
Correct Answer: B
Rationale: Not making face-to-face contact with the infant during communication demonstrates a lack of engrossment. In North American culture, engrossment is demonstrated by the father touching the infant, making eye contact with the infant, and verbalizing awareness of features in the newborn that are similar to his and that validate his claim to that newborn. Feelings of frustration are not uncommon to fathers and are characteristic of the second stage, or reality stage, of the transition to fatherhood but are not a sign of engrossment. A hesitation to touch the infant demonstrates a lack of engrossment.
The nurse is assessing pregnant clients. During which time frames should the nurse expect clients to report frequent urination throughout the night? Select all that apply.
- A. Before the first missed menstrual period
- B. During the first trimester
- C. During the second trimester
- D. During the third trimester
- E. One week following delivery
Correct Answer: B,D
Rationale: Urinary frequency is most likely to occur in the first and third trimesters. First-trimester urinary frequency occurs as the uterus enlarges in the pelvis and begins to put pressure on the bladder. In the third trimester, urinary frequency returns due to the increased size of the fetus and uterus placing pressure on the bladder. Women do not typically experience urinary changes before the first missed menstrual period. During the second trimester, the uterus moves into the abdominal cavity, putting less pressure on the bladder. Nocturnal frequency occurring a week after delivery may be a sign of a UTI.