On her first visit, a patient had a baseline hemoglobin of 13.0 gm and a hematocrit of 42.9%.She has been taking ferrous sulfate tablets and eating an iron-rich diet.She returned to the clinic at 30 weeks gestation and has a hemoglobin of 11.0 gm and a hematocrit of 36.3%.She is concerned and confused about why these lab values have gone down.
In responding, which physiological change during pregnancy should the nurse describe to the patient?

The correct answer is choice D. Wear a supportive bra.This will help suppress lactation and reduce the discomfort of engorgement.

The other choices are wrong because:

• Choice A. Manually express colostrum as necessary.This will stimulate milk production and prolong engorgement.

• Choice B. Apply hot compresses to the breasts.This will increase blood flow and swelling in the breasts and worsen engorgement.

• Choice C. Massage the breast tissue surrounding the areola.This will also stimulate milk production and prolong engorgement.

Normal ranges for breast engorgement are not applicable as it is a subjective experience that varies among women.However, some signs of engorgement include firm, tender, swollen breasts, flat or inverted nipples, and low-grade fever.Engorgement usually resolves within 24 to 36 hours after it begins.

The correct answer is choice A: To minimize the patient’s oxygen needs.

A neutral thermal environment is an environment in which a neonate maintains a normal body temperature while minimizing energy expenditure and oxygen consumption.This is important for the wellbeing of neonates, especially those who are preterm or have respiratory insufficiency.

Choice B is wrong because the conversion of glucose to lactic acid is not a desired outcome of a neutral thermal environment.This conversion occurs when there is inadequate oxygen supply to the tissues, resulting in anaerobic metabolism and metabolic acidosis.

Choice C is wrong because the absorption of surfactant from the alveoli is not affected by a neutral thermal environment.

Surfactant is a substance that reduces surface tension and prevents alveolar collapse.It is produced by type II alveolar cells and secreted into the alveoli.

Choice D is wrong because the metabolism of brown fat stores is not a desired outcome of a neutral thermal environment.

Brown fat is a specialized tissue that generates heat by nonshivering thermogenesis in response to cold stress.

It is located in the nape of the neck, between the scapulae, and around the kidneys and adrenals.It increases the metabolic rate and oxygen consumption of neonates.