A nurse is caring for a client who has COPD and is 5 kg (11 lb) below her ideal body weight. The client experiences shortness of breath when eating. Which of the following actions should the nurse take?

Rationale:

A. Conversion: Conversion involves the expression of psychological stress through physical symptoms without an underlying medical cause. The client is describing real pain rather than expressing a psychological conflict as a physical symptom, so this does not match conversion.

B. Displacement: Displacement occurs when a person redirects emotions or feelings from the original source to a safer target. The client is addressing the nurse directly about pain management, not redirecting feelings onto another target, so this is not displacement.

C. Introjection: Introjection involves internalizing the beliefs or values of another person. The client is expressing frustration about pain management rather than adopting someone else’s values or attitudes, so introjection does not apply here.

D. Projection: Projection occurs when a person attributes their own feelings, motives, or thoughts onto someone else. In this case, the client is suggesting that the nurse does not believe them, which reflects the client projecting their feelings of frustration and mistrust onto the nurse.

Rationale for correct choices

• Temperature 38.2° C (100.8° F). An elevated temperature in a postpartum client may indicate infection, especially in the context of prolonged rupture of membranes and cesarean delivery. Prompt follow-up is required to identify the source and initiate treatment to prevent progression to sepsis.

• WBC count 33,000/mm³. A markedly elevated WBC suggests an active inflammatory or infectious process. In postpartum clients, leukocytosis can signal endometritis, mastitis, or surgical site infection, necessitating immediate assessment and intervention.

• Client reports feeling unwell. A general feeling of being ill or "not right" in a postpartum client with fever is a significant subjective finding often preceding more objective signs of infection/sepsis.

• Uterus firm at 1 cm above the umbillous and tender to palpation. Uterine tenderness combined with fever and foul-smelling lochia is a cardinal sign of endometritis (infection of the uterine lining), the most common postpartum infection, especially after Cesarean section.

• Moderate amount of dark brown, foul-smelling lochia. Foul-smelling lochia is a hallmark of uterine infection such as endometritis. Combined with fever and leukocytosis, this finding warrants urgent evaluation, monitoring, and possible initiation of antibiotics.

• Breasts firm, heavy, and warm with nipple discomfort. These signs are consistent with mastitis, particularly in a breastfeeding client. Early recognition and treatment with supportive measures or antibiotics prevent worsening infection and systemic involvement.

• Fundus boggy but firmed with massage. A boggy fundus indicates uterine atony, which can lead to postpartum hemorrhage. Immediate attention is required to prevent excessive blood loss and maintain hemodynamic stability.

Rationale for incorrect choices

• Vital signs: Heart rate while slightly elevated can be physiologic due to postpartum recovery, mild fever, or pain. Respiratory rate is within normal limits for adults; does not indicate acute compromise. Blood pressure is within normal postpartum range and does not signal hemodynamic instability at this time. Oxygen saturation is normal, indicating adequate oxygenation.

• Surgical incision well approximated with slight edema, no redness or drainage: Mild edema at the incision site is expected and not indicative of infection at this time. Regular monitoring is appropriate.

• No bowel movement since birth, hypoactive bowel sounds: Delayed bowel movements and hypoactive sounds are common postpartum, especially after cesarean section. Monitoring and supportive care are sufficient unless other symptoms develop.