nurse is contributing to the plan of care for a client who is postpartum and has mastitis. Which of the following actions should the nurse plan to take?
Prepare the client for an abdominal sonogram.
Encourage the client to continue to breastfeed
Encourage the client to wear a bra that is loose fitting
Limit the client's daily fluid intake.
The Correct Answer is B
(A) Prepare the client for an abdominal sonogram:
An abdominal sonogram is not relevant for diagnosing or treating mastitis, which is an infection of the breast tissue. Mastitis typically requires assessment of the breast and possibly a breast ultrasound if an abscess is suspected, but not an abdominal sonogram.
(B) Encourage the client to continue to breastfeed:
Continuing to breastfeed is recommended for clients with mastitis. Breastfeeding helps to drain the breast and can speed up recovery. It also helps to prevent complications such as breast abscess and supports continued milk production.
(C) Encourage the client to wear a bra that is loose fitting:
While wearing a comfortable bra is important, a loose-fitting bra may not provide the necessary support for engorged or painful breasts. A well-fitting, supportive bra is usually recommended to provide comfort without being too tight, which can exacerbate symptoms.
(D) Limit the client's daily fluid intake:
Limiting fluid intake is not recommended and is not beneficial for treating mastitis. Adequate hydration is important for overall health and helps maintain milk supply. Encouraging the client to drink plenty of fluids is essential for recovery and continued breastfeeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
(A) Retained placental fragments:
Retained placental fragments can lead to postpartum hemorrhage (PPH) due to incomplete expulsion of the placenta or membranes, which can cause ongoing bleeding. Failure of the uterus to contract effectively after childbirth to compress blood vessels at the placental site can result in excessive bleeding. This is a significant risk factor for PPH and requires prompt intervention to prevent complications.
(B) Urinary tract infection:
While urinary tract infections (UTIs) can occur in the postpartum period, they are not typically considered significant risk factors for postpartum hemorrhage. UTIs are more commonly associated with symptoms such as dysuria, frequency, and urgency.
(C) Oligohydramnios:
Oligohydramnios, a condition characterized by decreased amniotic fluid volume, is not a direct risk factor for postpartum hemorrhage. Oligohydramnios may be associated with other pregnancy complications but is not directly related to the risk of postpartum hemorrhage.
(D) Breech presentation:
While breech presentation (when the baby's buttocks or feet are positioned to deliver first) may increase the risk of complications during labor and delivery, it is not specifically linked to postpartum hemorrhage. Breech presentation may necessitate interventions such as cesarean section delivery to reduce the risk of birth-related complications, but it is not a direct risk factor for postpartum hemorrhage.
Correct Answer is B
Explanation
(A) Apply elastic stockings before the client gets out of bed:
While elastic stockings can help prevent thrombophlebitis by promoting venous return and reducing the risk of blood pooling in the legs, applying them before the client gets out of bed may not be as effective as ambulation in preventing stasis and clot formation.
(B) Have the client ambulate as often as possible:
Ambulation helps prevent thrombophlebitis (inflammation of a vein with clot formation) by promoting blood circulation in the lower extremities. Moving the legs and walking encourage the calf muscles to contract, which aids in pushing blood back towards the heart, reducing the risk of blood stasis and clot formation.
(C) Apply warm, moist packs to the client's lower legs:
Applying warm, moist packs to the lower legs may provide comfort and relaxation, but it is not a primary measure for preventing thrombophlebitis. In fact, warm compresses may dilate blood vessels and potentially increase the risk of thrombosis in some cases.
(D) Administer NSAIDs every 4 to 6 hr:
Nonsteroidal anti-inflammatory drugs (NSAIDs) are not typically used for preventing thrombophlebitis. While NSAIDs can help manage pain and inflammation, they do not directly address the underlying mechanisms of thrombus formation or prevent blood stasis. Additionally, frequent administration of NSAIDs may carry risks of gastrointestinal bleeding and renal complications.
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