A nurse is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. Which of the following entries should the nurse make in the medical record?

A. Request a prescription for terbutaline from the provider. Terbutaline is a tocolytic used to stop preterm labor, not indicated in this postpartum scenario. The client is already on uterotonic therapy (methylergonovine), which is appropriate for postpartum uterine atony.
B. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab is inappropriate because the pad is asceptic.

C. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr. This is incorrect. Breastfeeding is usually safe with most antibiotics, including clindamycin, and mothers with postpartum infections can typically continue breastfeeding unless advised otherwise by the provider.
D. Initiate contact precautions. Contact precautions are not necessary unless the client has an identified or suspected infection that is transmissible by direct contact (e.g., MRSA). Standard precautions are sufficient for routine postpartum care and suspected endometritis.
E. Monitor the height and tone of the client’s fundus. The fundus is tender and was initially boggy, indicating risk for uterine atony or subinvolution. Monitoring tone and height helps detect complications such as hemorrhage or infection.
F. Instruct the client to wash her hands before and after changing her perineal pad. Hand hygiene is essential to prevent the spread of infection to the perineal area or incision and to promote general postpartum hygiene.
G. Encourage the client to maintain a semi-Fowler’s position to enhance uterine drainage. This position helps promote lochia drainage, reduce uterine pooling, and may help with comfort and resolution of infection by improving uterine drainage.

A. Remove the thermometer from client's room for use on another client. Clients with C. difficile should have dedicated equipment (e.g., thermometers, stethoscopes) to prevent cross-contamination. Reusing equipment between patients increases the risk of infection transmission.
B. Wear a gown when providing care. Contact precautions are required for clients with C. difficile, including wearing a gown to protect against contamination from infectious material or surfaces.
C. Wear an N95 respirator when providing care. C. difficile is spread through the fecal-oral route, not airborne. A surgical mask is not required, and an N95 respirator is unnecessary unless another airborne condition is present.
D. Change gloves after contact with infectious material. Gloves must be changed after contact with contaminated materials to prevent spreading spores to other surfaces or clients. This is a standard part of contact precaution practices.
E. Wash hands with an alcohol-based cleaner. Alcohol-based hand sanitizers are ineffective against C. difficile spores. Handwashing with soap and water is required after caring for a client with this infection to properly remove the spores.