A nurse is reinforcing teaching about preventing mastitis with a client who is breastfeeding.
Which of the following instructions should the nurse include?
You should use a breast pump if you plan to return to work.
Cover your breasts immediately after feedings.
Wear an underwire bra between feedings.
Wash your nipples with soap and water daily.
The Correct Answer is A
The correct answer is Choice A
Choice A rationale: Using a breast pump helps maintain milk supply and prevent milk stasis, which reduces the risk of developing mastitis. Mastitis is an infection of the breast tissue that can cause pain, swelling, warmth, and redness.
Choice B rationale: Covering breasts immediately after feedings does not directly prevent mastitis. Proper hygiene and ensuring complete breast emptying are more effective measures for preventing mastitis. Covering may trap moisture and bacteria, potentially leading to infection.
Choice C rationale: Wearing an underwire bra between feedings can restrict milk flow and cause clogged ducts, increasing the risk of mastitis. Non-restrictive, well-fitting bras are recommended to ensure proper milk drainage and breast comfort.
Choice D rationale: Washing nipples with soap and water daily can strip natural oils, causing dryness and cracks. Cracked nipples are entry points for bacteria, increasing mastitis risk. Instead, cleaning with plain water is recommended to maintain nipple integrity.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Auscultating the newborn’s bowel sounds is important for assessing gastrointestinal function, but it is not the first priority in managing a newborn with neonatal abstinence syndrome (NAS). Initial care should focus on stabilizing the newborn and addressing withdrawal symptoms.
Choice B rationale
Swaddling the newborn in blankets can help provide comfort and reduce excessive stimulation, which is beneficial for newborns with NAS. However, it is not the first priority. The primary focus should be on assessing and stabilizing the newborn’s vital signs.
Choice C rationale
Weighing the newborn’s wet diaper is important for monitoring fluid balance and hydration status, but it is not the first priority in managing NAS. Initial care should focus on stabilizing the newborn and addressing withdrawal symptoms.
Choice D rationale
Determining the newborn’s respiratory rate is the first priority in managing a newborn with NAS. Assessing and stabilizing the newborn’s vital signs, including respiratory rate, is crucial to ensure the newborn’s immediate health and safety. .
Correct Answer is C
Explanation
Choice A rationale
Verifying that the newborn is Rh-negative is not necessary for administering Rh(D) immune globulin. The medication is given to Rh-negative mothers to prevent Rh sensitization, regardless of the newborn’s Rh status.
Choice B rationale
A positive Coombs test indicates that the mother has already been sensitized to Rh-positive blood cells, making Rh(D) immune globulin ineffective in preventing sensitization.
Choice C rationale
Administering Rh(D) immune globulin within 72 hours after birth is crucial to prevent Rh sensitization in future pregnancies. This timing ensures that the mother’s immune system does not produce antibodies against Rh-positive blood cells.
Choice D rationale
Rh(D) immune globulin is typically administered intramuscularly, not into the abdomen. The preferred sites are the deltoid muscle or the anterolateral aspect of the thigh.
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