A nurse is teaching a group of clients about ways to prevent sexual transmission of human papillomavirus. Which of the following information should the nurse include?

Rationale for Correct Choices

• Endometritis: The client’s postpartum course—cesarean delivery, prolonged rupture of membranes, and postpartum Day 3 fever—places her at high risk for endometritis, a uterine infection. Signs include uterine tenderness, boggy fundus, and foul-smelling lochia.

• Uterus and lochia assessment: The firm but tender uterus with boggy areas and moderate dark brown, foul-smelling lochia are classic indicators of endometritis. These assessment findings directly reflect the infection within the uterine cavity and help guide immediate intervention.

Rationale for Incorrect Choices

• Mastitis: While the client reports firm, warm breasts with nipple discomfort, these symptoms alone without localized redness, unilateral involvement, or systemic malaise are not sufficient to diagnose mastitis. The uterine and lochia findings are more indicative of endometritis.

• Postpartum hemorrhage: Although uterine atony can cause bleeding, the client’s fundus is firm after massage and the lochia is moderate, making hemorrhage less likely at this point. Hemoglobin remains within normal limits, further reducing the likelihood of acute postpartum hemorrhage.

• Fever: Fever is a symptom rather than a diagnosis. While present (38.2° C), it supports the presence of infection but does not specify which type, so it is not the best standalone choice for the evidence used to identify the condition.

• Elevated WBC (markedly 33,000/mm3) confirm a systemic infection, it is a general sign of infection that could apply to any source (e.g., wound or mastitis). The assessment of the uterus and lochia specifically localizes the infection to the reproductive tract.

Rationale:
A. Encourage cultural practices to be incorporated into their care: Respecting and incorporating a Muslim client’s cultural and religious practices promotes culturally competent and patient-centered care. This approach fosters trust, comfort, and cooperation between the client and healthcare team.

B. Incorporate hot and cold practices into the client's care: Hot and cold theory is typically associated with Hispanic, Asian, and Middle Eastern folk medicine traditions, but not all Muslim clients follow this practice. Care should be based on the client’s individual beliefs.

C. Acknowledge that the client may be cared for by a male provider: Many Muslim women prefer to be cared for by female providers due to religious and cultural values of modesty. The nurse should make reasonable efforts to accommodate this preference whenever possible.

D. Have the client remove any face coverings to obtain their history: Muslim women who wear a niqab or hijab may choose to keep their face covered for modesty. The nurse should not insist on removal unless necessary for identification or assessment, and even then, it should be done privately with sensitivity to religious beliefs.