A nurse is contributing to the plan of care for a client who is postpartum and has mastitis. Which of the following actions should the nurse plan to take?
"Prepare the client for an abdominal sonogram."
"Limit the client's daily fluid intake."
"Encourage the client to wear a bra that is loose fitting."
"Encourage the client to continue to breastfeed."
The Correct Answer is D
A. An abdominal sonogram is not used to diagnose or manage mastitis. Mastitis is typically evaluated and managed through clinical examination and does not require imaging of the abdomen.
B. Limiting fluid intake is not recommended for managing mastitis. Adequate hydration is important to support the body's healing processes and help with milk production.
C. A bra should be supportive, not loose-fitting, to help manage mastitis. A well-fitting, supportive bra can help alleviate discomfort and provide proper support during breastfeeding.
D. Continuing to breastfeed or pumping milk is encouraged to help resolve mastitis. Frequent milk removal can help clear the infection and prevent complications, such as an abscess.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Blood pressure 156/80 mm Hg is incorrect. While this blood pressure reading is elevated, hypertension is not a typical immediate sign of postpartum hemorrhage. Hemorrhage is more commonly associated with hypotension (low blood pressure) due to fluid loss.
B. Temperature 38.3° C (101° F) is incorrect. A mild fever may be common in the first 24 hours postpartum due to normal inflammatory responses. It is not specifically indicative of postpartum hemorrhage, though a persistent fever could indicate an infection.
C. Respiratory rate 32/min is correct. An increased respiratory rate can be a sign of hypovolemia (due to significant blood loss), which may occur with postpartum hemorrhage. The body compensates for decreased blood volume by increasing the respiratory rate.
D. Apical pulse 66/min is incorrect. A heart rate of 66/min is within normal limits and would not be indicative of postpartum hemorrhage. In fact, a tachycardic (elevated) heart rate is more concerning in the case of hemorrhage as the body tries to compensate for blood loss.
Correct Answer is B
Explanation
A. Decreased muscle tone is not a typical manifestation of neonatal abstinence syndrome. Symptoms of neonatal abstinence syndrome usually include increased muscle tone and irritability.
B. An exaggerated Moro reflex is a sign of neonatal abstinence syndrome. This reflex can be more pronounced in infants experiencing withdrawal from substances.
C. A weak cry is not characteristic of neonatal abstinence syndrome. Infants with this syndrome may have a high-pitched, excessive, or persistent cry.
D. Neonates with abstinence syndrome are difficult to console. They may have persistent crying and be hard to calm, which contrasts with the ability to console easily.
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