A nurse is providing preoperative teaching to an older adult female client who is scheduled for a laminectomy and uses supplements. Which of the following supplements should the nurse identify as increasing the client's risk for hypotension during surgery?

Rationale:

A. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: Most antibiotics, including clindamycin, are safe for breastfeeding. Mothers are encouraged to continue breastfeeding unless the medication is contraindicated, which it is not in this case.

B. Instruct the client to wash her hands before and after changing her perineal pad: Good perineal hygiene prevents spread of infection, particularly in clients with postpartum endometritis who are shedding infectious organisms in lochia. Handwashing is a key element in infection control.

C. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Semi-Fowler’s positioning promotes lochial drainage by using gravity, reducing the risk of retained secretions and supporting infection resolution.

D. Monitor the height and tone of the client's fundus: Fundal monitoring is essential for assessing uterine involution and identifying worsening atony or infection. A boggy uterus may indicate continued risk for hemorrhage or poor uterine tone.

E. Initiate contact precautions: Endometritis is not a condition requiring contact isolation unless there is evidence of another communicable infection (e.g., C. difficile). Standard precautions are sufficient.

F. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic that relaxes uterine muscle and is used to delay preterm labor. It is contraindicated postpartum and would worsen uterine atony.

G. Obtain a culture specimen of the lochia from the client's perineal pad using sterile swab: A lochia culture can identify the causative pathogen of suspected endometritis and guide antibiotic therapy if initial treatment is ineffective.

Rationale:

A. "I will obtain the client's weight every other day.": Clients receiving TPN require daily weight monitoring to evaluate fluid balance and nutritional effectiveness. Monitoring every other day may delay detection of complications such as fluid overload or inadequate nutrition.

B. "I will monitor the client's blood glucose level every 8 hours.": Blood glucose levels should typically be monitored every 4 to 6 hours, especially during initiation or rate adjustments of TPN. Longer intervals may miss signs of hyperglycemia, a common complication of TPN.

C. "I will hang a new bag of TPN and IV tubing every 24 hours.": Changing the TPN solution and tubing every 24 hours is standard protocol to prevent catheter-related bloodstream infections. TPN solutions are high in glucose, which can promote microbial growth if not properly managed.

D. "I will increase the rate of the TPN infusion to ensure the correct amount is given.”: The TPN infusion rate must never be adjusted without a provider’s order. Altering the rate can lead to serious complications such as hyperglycemia, electrolyte imbalance, or fluid overload.