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Exhibits

Which education by the nurse will help resolve the issue for the client? Select all that apply.

Wear an underwire bra around the clock.

Apply warm compresses to affected area before feeding.

Pump breasts if feeding will be missed, due to absence from the infant.

Pump breastmilk and feed it to infant instead of nursing.

Finish antibiotics even if symptoms improve.

Maintain activity due to the risk of blood clots with extra rest.

Wash hands before handling the breast.

Start infant on the unaffected side, so there is less pain when infant is the hungriest.

Vary breastfeeding positions at each feeding.

Answer and Explanation

Correct Answer : B,C,E,G,H,I

A.   Wear an underwire bra around the clock. Tight-fitting bras, especially underwire bras, can contribute to milk stasis by restricting milk flow and increasing the risk of clogged ducts. Instead, the client should wear a well-fitted, supportive bra without underwire to promote comfort and adequate milk drainage.
B.   Apply warm compresses to affected area before feeding. Warm compresses help increase circulation, promote milk let-down, and relieve pain in cases of mastitis. Applying warmth before breastfeeding can help soften the breast and improve milk flow, reducing milk stasis.
C.   Pump breasts if feeding will be missed, due to absence from the infant. Milk stasis occurs when the breast is not emptied regularly, increasing the risk of mastitis. Pumping or hand-expressing milk when unable to breastfeed prevents engorgement and reduces the likelihood of infection.
D.   Pump breastmilk and feed it to infant instead of nursing. Direct breastfeeding is preferred unless the pain is too severe or an abscess has formed. Pumping can be beneficial to relieve engorgement, but exclusive pumping is not necessary in mastitis unless advised by a healthcare provider. Continued direct breastfeeding helps clear infection by draining the affected breast.
E.   Finish antibiotics even if symptoms improve. Mastitis is commonly treated with antibiotics, and completing the full course prevents recurrence and antibiotic resistance. Stopping antibiotics early can lead to incomplete eradication of bacteria and persistent infection.
F.   Maintain activity due to the risk of blood clots with extra rest. Rest is essential for recovery from infection, and while postpartum clients have a slightly higher risk for blood clots, moderate rest should be encouraged. The client should engage in light activity as tolerated but should not avoid rest, as fatigue can contribute to a weakened immune response.
G.   Wash hands before handling the breast. Mastitis can be caused by bacterial contamination from the skin, baby’s mouth, or hands. Proper hand hygiene before breastfeeding or pumping reduces the risk of introducing bacteria into milk ducts and worsening the infection.
H.   Start infant on the unaffected side, so there is less pain when infant is the hungriest. Babies suck more vigorously at the beginning of a feeding. Starting on the unaffected side reduces pain and discomfort in the affected breast while ensuring the infant is still able to empty both breasts adequately.
I.   Vary breastfeeding positions at each feeding. Different nursing positions help ensure all milk ducts are effectively drained, reducing the risk of continued milk stasis. Positions such as cradle hold, football hold, or side-lying nursing can improve drainage in different areas of the breast.

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Free Nursing Study Resources

Correct Answer is []

Explanation

Remove some of the baby's clothing – Overdressing can contribute to heat retention and excessive sweating, worsening miliaria. Removing extra layers helps cool the baby and reduce further irritation.
Clean the area with warm water – Gently cleansing with warm water (without harsh soaps) helps soothe the rash, prevent secondary infections, and remove sweat buildup.

Alert child protective services – There is no evidence of neglect or abuse. Overdressing is common, especially in new parents who may not be aware of proper temperature regulation for infants.
Swab the area and send for a culture – Miliaria is a benign and self-limiting condition that does not require a culture unless there are signs of secondary bacterial infection (e.g., pustules, drainage, fever).
Hold the vaccines – There is no contraindication to routine vaccinations due to heat rash. Vaccinations should proceed as scheduled unless the baby has a moderate to severe illness (e.g., fever, systemic infection).

Temperature – Overheating can lead to worsening miliaria, dehydration, or even heat exhaustion in infants. Monitoring temperature ensures the baby is not overdressed or exposed to excessive heat.
Parent’s understanding of education – Since the father was not aware that overdressing contributed to the rash, assessing his understanding of proper clothing choices and environmental temperature regulation is essential for preventing recurrence.

White blood cell count – Miliaria is not an infectious process, so WBC monitoring is unnecessary unless an infection is suspected.
Weight – While weight monitoring is important for general growth, it is not a key indicator for assessing heat rash progression.
Hygiene – Poor hygiene is not the primary cause of miliaria. The issue is blocked sweat glands, not dirt or infection, so monitoring hygiene is not the priority.

A. Notify the operating room team. B. Administer a fluid bolus of 500 mL. C. Administer oxygen via face mask. D. Place the client in Trendelenburg.

Correct Answer is D

Explanation

A. Notify the operating room team. While an emergency cesarean delivery may be necessary, the immediate priority is relieving pressure on the prolapsed umbilical cord to prevent fetal hypoxia. Positioning the client first helps improve fetal oxygenation while preparing for further interventions.
B. Administer a fluid bolus of 500 mL. IV fluids can help maintain maternal blood pressure and improve placental perfusion, but they do not directly relieve cord compression. Repositioning the client to reduce cord compression takes priority over fluid administration.
C. Administer oxygen via face mask. Oxygen supplementation may help improve fetal oxygenation, but it does not address the underlying issue of cord compression. The first intervention should be to reposition the client to relieve pressure on the cord before providing supplemental oxygen.
D. Place the client in Trendelenburg. A prolapsed umbilical cord is a medical emergency requiring immediate action to prevent fetal hypoxia. The Trendelenburg or knee-chest position uses gravity to shift the fetus away from the cord, reducing compression. The nurse should also manually elevate the presenting part if necessary and prepare for an emergency cesarean delivery.

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Exhibits

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