A nurse is attending to a newborn who was delivered at 39 weeks of gestation and is now 36 hours old.

The newborn has been breastfeeding 3 to 4 times per day and has voided once since birth but has not passed meconium stool yet.

Which of the following observations should the nurse report to the provider?

The correct answer is choiceb. Do you notice increased cramping with breastfeeding?

Choice A rationale:Swelling in the feet is not directly related to the need for PRN pain medication following a cesarean birth. Swelling can be a common postpartum symptom due to fluid retention and changes in blood chemistry, but it does not specifically indicate pain that requires medication.

Choice B rationale:Increased cramping with breastfeeding is a common occurrence due to the release of oxytocin, which causes uterine contractions. This can be quite painful and may necessitate PRN pain medication to manage the discomfort.

Choice C rationale:Leakage from the incision could indicate a complication such as infection or wound dehiscence. While this is a serious concern that requires medical attention, it is not directly related to the typical pain management needs following a cesarean birth.

Choice D rationale:The ability to pass gas is an important indicator of the return of bowel function after surgery, but it is not directly related to the need for PRN pain medication. It is more relevant to assessing gastrointestinal recovery rather than pain levels.

Choice A rationale
Asking when the client last ate meat is not relevant for assessing dietary intake in a client who adheres to a vegan diet. Vegans do not consume meat or any other animal products.
Choice B rationale
While vitamin C is an important nutrient, it is not typically a concern for vegans as it is abundant in fruits and vegetables. Therefore, asking about vitamin C supplementation may not provide the most useful information about the client’s dietary intake.
Choice C rationale
Protein intake is a key concern for individuals following a vegan diet, as many sources of protein are animal-based. Vegans can get protein from foods like lentils, chickpeas, beans, tofu, and nuts. Therefore, asking about daily protein intake can provide valuable information about the client’s dietary habits and nutritional status.
Choice D rationale
Shellfish are not part of a vegan diet, so asking if the client has considered eating shellfish would not be relevant or appropriate.