A nurse is reinforcing teaching about the correct use of infant car seats with the parent of a newborn.
Which of the following statements by the parent indicate an understanding of the teaching?

Choice A rationale: A fundal height of 27 cm at 21 weeks gestation exceeds the expected range. Normally, fundal height in centimeters should approximate gestational age between 20 and 36 weeks, with a ±2 cm margin. At 21 weeks, a fundal height of 19–23 cm is acceptable. A measurement of 27 cm suggests possible fetal macrosomia, polyhydramnios, or gestational diabetes, especially in a client with elevated glucose levels and obesity. This warrants follow-up.

Choice B rationale: Fetal heart tones of 145/min fall within the normal range of 110 to 160 beats per minute. This rate reflects appropriate fetal autonomic regulation and oxygenation. Variability in fetal heart rate is expected and indicates a healthy intrauterine environment. No arrhythmia or bradycardia is present. Therefore, this finding does not require follow-up and supports normal fetal well-being at this gestational age.

Choice C rationale: A 1-hour glucose level of 220 mg/dL following a 100-g oral glucose load exceeds the threshold of less than 180 mg/dL. This result indicates impaired glucose tolerance and supports the diagnosis of gestational diabetes mellitus (GDM). GDM increases risks for fetal macrosomia, shoulder dystocia, and neonatal hypoglycemia. Follow-up is required to initiate dietary management, glucose monitoring, and possibly pharmacologic therapy to prevent maternal and fetal complications.

Choice D rationale: A 3-hour glucose level of 142 mg/dL exceeds the normal range of 70 to 115 mg/dL. This result confirms abnormal glucose metabolism and supports the diagnosis of gestational diabetes. The 3-hour value reflects delayed glucose clearance and persistent hyperglycemia. This finding, in conjunction with other elevated values, meets criteria for GDM and necessitates follow-up for glycemic control, nutritional counseling, and fetal surveillance to mitigate adverse outcomes.

Choice E rationale: A blood pressure of 140/88 mm Hg meets the threshold for gestational hypertension, defined as systolic ≥140 mm Hg or diastolic ≥90 mm Hg after 20 weeks gestation. Although the client denies symptoms of preeclampsia, such as headache or visual changes, her history of chronic hypertension and obesity increases risk. Continued monitoring and possible adjustment of antihypertensive therapy are warranted to prevent progression to preeclampsia or eclampsia.

Choice F rationale: Denial of headaches, visual disturbances, and epigastric pain suggests absence of preeclampsia symptoms. These symptoms reflect end-organ involvement and vasospasm in severe hypertensive disorders. Their absence supports stable maternal status. However, clinical vigilance remains important due to the client’s elevated blood pressure and risk factors. At this time, no follow-up is required solely based on symptom denial.

Choice A rationale

Applying vitamin E oil to the nipples is not generally recommended; it offers little benefit and could potentially introduce unnecessary substances to the infant during feeding. Lanolin cream or purified lanolin is often recommended for sore nipples because it provides moisture, promotes healing by creating a barrier, and is safe for the baby to ingest. Proper latch technique is the primary intervention for preventing nipple soreness.

Choice B rationale

Limiting feeding time to 5 to 10 minutes per breast is incorrect and can lead to inadequate milk intake and insufficient stimulation for milk production. The infant should be allowed to feed for as long as they actively suckle and swallow, usually 15 to 20 minutes or until the breast feels softer, ensuring they receive the higher-calorie hindmilk.

Choice C rationale

Positioning the baby on a pillow at the level of the breast promotes a more comfortable and effective latch. Proper positioning allows the infant's mouth to be level with the nipple, ensuring the baby can take in a large portion of the areola and preventing strain on the mother's back, which facilitates a deeper and more comfortable latch for effective milk transfer.

Choice D rationale

Ensuring just the nipple is in the baby's mouth is an incorrect technique and is a common cause of nipple soreness and inadequate milk transfer. The baby needs to take in a large portion of the areola to effectively compress the milk sinuses underneath, achieving a deep latch that stimulates milk release and minimizes nipple trauma.