A nurse is providing teaching to a client who gave birth 8 hr ago and is exclusively breastfeeding. Which of the following information should the nurse include?

Rationale for Correct Choices:

• Endometritis: The client has systemic signs (feeling unwell, low-grade fever), elevated WBC count, and local uterine findings indicating infection. Endometritis is a common complication postpartum, especially after cesarean birth with membrane rupture exceeding 24 hours.
• Uterus and lochia assessment: The presence of a boggy, tender uterus and foul-smelling, dark brown lochia are classic signs of endometritis. These findings, in the setting of cesarean delivery and prolonged rupture of membranes, point to uterine infection as the primary concern.

Rationale for Incorrect Choices:

• Pneumonia: The client lacks hallmark signs of pneumonia, such as productive cough, abnormal sputum, or abnormal chest auscultation like crackles or wheezing. Normal respiratory rate and oxygenation further reduce the likelihood of a lower respiratory tract infection.
• Mastitis: Typically presents with unilateral breast pain, erythema, warmth, and systemic symptoms like high fever and malaise. The client’s symptoms are more consistent with engorgement, making mastitis an unlikely cause.
• Lung sounds: While lung sounds are diminished at the bases, they are otherwise clear, and the client has normal respiratory rate and oxygen saturation. These findings do not support a diagnosis of pneumonia and may simply reflect postoperative atelectasis or limited mobility.
• Breast and nipple changes: Breast fullness and nipple discomfort are expected during lactation and suggest engorgement rather than mastitis. There is no redness, localized heat, or severe pain reported.

A. Wart-like texture: A wart-like texture is more typical of squamous cell carcinoma or benign lesions like seborrheic keratosis. Melanomas usually do not have a rough, wart-like surface.
B. Firm and rubbery: Firm, rubbery nodules are more consistent with benign skin growths such as dermatofibromas. Melanomas tend to have irregular texture and color rather than a uniform firmness.
C. A central crater with rolled borders: This description fits basal cell carcinoma, which often presents with a pearly nodule and central ulceration. Melanomas do not commonly have this crater-like appearance.
D. Asymmetric with variegated ring: Melanomas are typically asymmetric with uneven, irregular borders and multiple colors. This variegation and asymmetry are classic warning signs distinguishing melanoma from other lesions.