A nurse is working with a local group that is in the process of reducing the use of pesticides in community gardens. The nurse should identify that the group is in which of the following stages of change?

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. "You have already consented to this treatment, so you must continue." This response disregards the client’s autonomy. Clients have the right to withdraw consent and stop treatment at any time, even after initially agreeing to it.
B. "I will let your doctor know that you want to discontinue treatment." This response respects the client’s right to make decisions about their care and ensures that the healthcare team is informed to support the client appropriately. It demonstrates advocacy and ethical practice.
C. "You should discuss this with your family and see if they agree." While family input can be helpful, the final decision rests with the client, not their family. This response may undermine the client’s autonomy.
D. "I know this treatment is difficult for you, but you will feel better." This is a minimizing statement that may come across as dismissive. It does not acknowledge the client’s feelings or support their decision-making process.