A nurse is planning to administer misoprostol 50 mcg intravaginally for cervical ripening to a client who is at 40 weeks of gestation.

Available is misoprostol 200 mcg tablets. How many tablets should the nurse plan to administer?

🧾 Explanation

1. Moderate lochia rubra
   • Normal up to 1–2 weeks postpartum. Not related to mastitis.
2. Temperature 38.4°C
   • Still febrile after 24 hrs of antibiotics → infection not yet controlled.
3. Purulent nipple discharge
   • New finding. Indicates possible breast abscess or worsening mastitis.
4. Hemoglobin 12 g/dL
   • Stable and within normal range. Not relevant to mastitis progression.
5. WBC 35,000/mm³
   • Increased from 28,000 → worsening systemic inflammatory response.
6. Decreased pain
   • Symptomatically better, but this may reflect partial relief from antibiotics/analgesics rather than full resolution. Still, it’s a positive sign.

Summary:

• Improving: Pain relief.
• Unrelated: Lochia rubra, hemoglobin.
• Worsening: Persistent fever, purulent nipple discharge, rising WBC.

This mixed picture suggests partial response but possible complication (breast abscess). The nurse should notify the provider promptly, anticipate breast ultrasound to rule out abscess, and continue close monitoring.

Choice A rationale

Consistent crying is considered a late cue of hunger in a newborn. Crying, a complex physiological and behavioral response, requires a high expenditure of energy and is an indication that the newborn is already significantly distressed by hunger and needs to be fed immediately to avoid excessive agitation and difficulty latching.

Choice B rationale

The rooting reflex involves the newborn turning their head toward any stimulation of their cheek or mouth and opening their mouth, which is an innate physiological response critical for locating the nipple. This is a primary early hunger cue, indicating the newborn is ready and searching for a food source, initiating feeding efforts.

Choice C rationale

Sucking motions, such as rapid, repetitive sucking on the lips, tongue, or anything near the mouth, are direct early behavioral manifestations of the newborn's innate physiological need for nourishment. This action is a preparatory step for feeding, indicating readiness for oral intake and satiation of hunger.

Choice D rationale

Hand-to-mouth movements are a key early hunger cue, demonstrating the newborn's increasing drive to seek oral stimulation and food. This behavior is part of the newborn's reflexive self-soothing and exploratory repertoire, signaling a rising level of hunger before the onset of overt distress or crying.

Choice E rationale

The Babinski reflex is a normal neurological response in infants where the great toe extends upward and the other toes fan out when the sole of the foot is firmly stroked. It is a primitive reflex related to neurological development and is not an indicator of hunger or feeding readiness.