A nurse is caring for a client who is 10 hours postpartum following a vaginal delivery and reports discomfort at the episiotomy site.
Which of the following actions should the nurse take?
Apply witch hazel compresses.
Administer aspirin.
Have the client use a warm pack.
Instruct the client to sit on a soft pillow.
The Correct Answer is A
Choice A rationale
Applying witch hazel compresses (such as Tucks pads) is an effective and preferred action for postpartum perineal discomfort, including episiotomy pain. Witch hazel contains tannins and volatile oils that provide an astringent and anti-inflammatory effect. This action helps to reduce swelling, soothe the tissues, and offer immediate, localized pain relief at the episiotomy site.
Choice B rationale
Administering aspirin (acetylsalicylic acid) for postpartum discomfort is generally contraindicated. Aspirin is a non-steroidal anti-inflammatory drug (NSAID) with antiplatelet effects, which could increase the risk of bleeding postpartum, especially from the placental insertion site or the episiotomy wound. Preferred analgesics are typically acetaminophen or ibuprofen, which have less impact on coagulation.
Choice C rationale
Having the client use a warm pack is not the initial treatment for episiotomy pain within the first 24 hours. Heat promotes vasodilation, which can increase edema and pain in the acutely inflamed and traumatized tissues. Cold therapy (e.g., ice packs) is the standard initial treatment because it causes vasoconstriction, which minimizes swelling and provides a local anesthetic effect.
Choice D rationale
Instructing the client to sit on a soft pillow might seem helpful, but it can sometimes be detrimental. Sitting on a soft, ring-shaped, or inflated pillow can cause the client to press outward on the soft tissues of the perineum, potentially increasing pressure and discomfort on the episiotomy incision. Sitting on a firm surface with the buttocks shifted can be more comfortable for some.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Carrots are an excellent source of β-carotene, a precursor to Vitamin A, and fiber, but they contain minimal amounts of iron. Iron is critical during pregnancy for supporting the expanded maternal red blood cell mass and fetal development, with a recommended intake of 27 mg per day for pregnant women.
Choice B rationale
Chicken breast is a source of heme iron (approximately 0.7 mg per 100g serving), which is highly bioavailable (absorbed at 15% to 35%) compared to non-heme iron. Although organ meats and red meat have more iron, lean poultry is a significantly better source than the other listed options for increasing intake.
Choice C rationale
Apples are a good source of fiber, Vitamin C, and antioxidants, but they contain only trace amounts of iron. While Vitamin C aids in the absorption of non-heme iron (from plant sources), the apple itself does not contribute significantly to the daily required intake.
Choice D rationale
Feta cheese is primarily a source of calcium, protein, and fat, with a high sodium content, but it contains negligible amounts of iron. Dairy products, in general, are poor sources of iron, and high calcium intake can sometimes inhibit the absorption of iron.
Correct Answer is D
Explanation
Choice A rationale
This statement is incorrect. While lactational amenorrhea method (LAM) offers some protection, it is only highly effective under strict conditions: amenorrhea, exclusive breastfeeding, and less than six months postpartum. Ovulation can resume even while breastfeeding, so additional contraception is often necessary to prevent unintended pregnancy.
Choice B rationale
There is no scientific evidence to support the claim that taking birth control pills while breastfeeding increases the risk for breast cancer. This statement is false and should not be used to counsel the client. The primary concern with combined estrogen-progestin pills in lactating women is the potential suppression of milk supply.
Choice C rationale
Combined estrogen-progestin birth control pills are generally contraindicated or strongly discouraged during the initial weeks to months of breastfeeding. The estrogen component can decrease the quantity and quality of breast milk, potentially interfering with successful lactation. However, progestin-only pills are considered safe and not contraindicated.
Choice D rationale
Progestin-only birth control pills (the "mini-pill") are the preferred hormonal contraceptive for lactating clients. The absence of estrogen means they are less likely to negatively impact breast milk supply or composition. Progestin-only pills primarily work by thickening cervical mucus and inhibiting ovulation, offering effective contraception while minimizing risks to the breastfeeding infant.
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