A nurse is reinforcing discharge instructions with a postpartum client about breastfeeding.
Which of the following statements by the client indicates an understanding of the teaching?

Choice B rationale

A Group B Streptococcus (GBS) culture is routinely performed between 35 and 37 weeks of gestation. This is a screening test to determine if the client is colonized with the bacteria in the vagina or rectum. Positive status indicates the need for intrapartum antibiotic prophylaxis to prevent transmission of GBS to the newborn, which can cause severe neonatal infection.

Choice C rationale

A clean-catch urine specimen is typically collected at the initial prenatal visit to screen for asymptomatic bacteriuria, which can lead to pyelonephritis if untreated. It is not usually performed every two months. Subsequent urinalysis is often done with every prenatal visit to check for protein, glucose, and ketones, which indicate other potential complications.

Choice D rationale

The maternal serum alpha-fetoprotein (MSAFP) screening is a blood test to check for the risk of neural tube defects and chromosomal abnormalities. This test is typically offered between 15 and 20 weeks of gestation, with the optimal time being 16 to 18 weeks, not at 6 weeks. Fetal protein production is insufficient for reliable screening at 6 weeks.

Choice A rationale

A screening for gestational diabetes mellitus (GDM) is generally performed much later in pregnancy, specifically between 24 and 28 weeks of gestation. An earlier screening (e.g., at 12 weeks) is reserved only for clients identified as having significant risk factors (e.g., obesity, family history, previous GDM). The standard screening is the 1-hour glucose challenge test.

Choice A rationale

Soft bumper pads in the crib increase the risk of suffocation or entrapment for the newborn. The current recommendation for safe sleep is a firm mattress in a crib that meets current safety standards, with only a fitted sheet. Cribs should be bare, with no soft objects, pillows, or loose bedding, to minimize the risk of Sudden Infant Death Syndrome (SIDS).

Choice B rationale

Placing a pillow under the newborn's head significantly increases the risk of suffocation or rebreathing exhaled air, which is a major risk factor for SIDS. Newborns should always be placed on their backs on a firm sleep surface for every sleep time. The head should remain uncovered, and the pillow offers no benefit, only hazard.

Choice C rationale

Using a warm, soapy washcloth on a newborn's delicate facial skin is unnecessary and may cause irritation or dryness. Newborns typically only require a plain water wash or a mild, non-soap cleanser for their face. Soap can remove the natural protective oils and disrupt the skin's barrier function.

Choice D rationale

Setting the maximum hot water temperature to 48.8°C (120°F) is a critical home safety precaution to prevent scalding burns. Water temperatures above this level can cause third-degree burns in a matter of seconds, especially in infants and young children whose skin is thinner and more vulnerable to thermal injury.