The nurse instructs a class of postpartum women on methods to avoid nipple soreness while breastfeeding.
Which comment by a class participant indicates the need for further instruction?

The correct answer is choice B. The administration route of terbutaline will be changed from intravenous to oral.

This is because terbutaline is a medication that can be used to suppress preterm labor by relaxing the uterine smooth muscle.It can be given subcutaneously or intravenously for acute episodes of preterm labor, but it is not recommended for long-term use due to the risk of serious maternal and fetal adverse effects.Therefore, if the client’s condition stabilizes, the administration route of terbutaline will be changed from intravenous to oral, which has a lower bioavailability and less systemic effects.

Choice A is wrong because terbutaline is not usually self-administered parenterally by the client at home.It requires a trained health professional to give it as a shot under the skin or through a vein.

Choice C is wrong because the client does not need to remain in a private room without visitors until she has been without contractions for 48 hours.

This is an unnecessary restriction that may increase the client’s stress and anxiety.

The client should be encouraged to have social support and emotional comfort during this time.

Choice D is wrong because the client should not ambulate in the hallway after 12 hours without contractions.

This may stimulate uterine activity and cause a recurrence of preterm labor.

The client should follow the provider’s instructions on bed rest and activity limitations.

The correct answer is choice A. The patient has heart disease, and the antibiotics will decrease the risk to her fetus of developing endocarditis.Endocarditis is an infection of the inner lining of the heart and valves, which can be caused by bacteria entering the bloodstream during labor and delivery.Patients with mitral valve prolapse (MVP) are more prone to develop endocarditis because their valve leaflets are floppy and do not close tightly, creating a site for bacterial attachment.Antibiotics can help prevent this complication by killing the bacteria before they reach the heart.

Choice B is wrong because pericarditis is an inflammation of the outer layer of the heart, not the inner lining or valves.It is not related to MVP or bacterial infection.

Choice C is wrong because chorioamnionitis is an infection of the membranes and fluid that surround the fetus, not the heart.It is usually caused by bacteria ascending from the vagina or cervix, not from the bloodstream.

Choice D is wrong because delivering post-term does not increase the risk of systemic infection for the fetus.Systemic infection means infection that affects multiple organs or systems in the body, not just one specific site.