The nurse is continuing to care for the child.

Exhibits

After reviewing the discharge instructions with the family, which of the following statements by a parent indicate an understanding of the teaching?
For each statement by the parent, click to specify if the statement reflects an understanding or indicates a need for reinforcement of the discharge teaching.

Rationale:
A. Ask an experienced nurse to assist with the procedure: Seeking assistance from an experienced nurse promotes patient safety and supports proper skill development. The newly licensed nurse can observe, perform the procedure under supervision, and ensure that the client receives competent care while staying within professional practice boundaries.

B. Delegate the task to an assistive personnel: Tracheal suctioning is a sterile and invasive procedure that requires nursing judgment and assessment, which are outside the scope of practice for assistive personnel.

C. Identify that the task is in the scope of RN practice and perform the suctioning: Although tracheal suctioning is within an RN’s scope, the nurse should not perform it independently without adequate training or supervision.

D. Refuse to take the assignment: Refusing the assignment entirely is inappropriate because the nurse has a duty to provide care within their level of competence. Instead, the nurse should seek guidance and supervision to safely complete the procedure.

Rationale for Correct Choices

• Endometritis: The client’s postpartum course—cesarean delivery, prolonged rupture of membranes, and postpartum Day 3 fever—places her at high risk for endometritis, a uterine infection. Signs include uterine tenderness, boggy fundus, and foul-smelling lochia.

• Uterus and lochia assessment: The firm but tender uterus with boggy areas and moderate dark brown, foul-smelling lochia are classic indicators of endometritis. These assessment findings directly reflect the infection within the uterine cavity and help guide immediate intervention.

Rationale for Incorrect Choices

• Mastitis: While the client reports firm, warm breasts with nipple discomfort, these symptoms alone without localized redness, unilateral involvement, or systemic malaise are not sufficient to diagnose mastitis. The uterine and lochia findings are more indicative of endometritis.

• Postpartum hemorrhage: Although uterine atony can cause bleeding, the client’s fundus is firm after massage and the lochia is moderate, making hemorrhage less likely at this point. Hemoglobin remains within normal limits, further reducing the likelihood of acute postpartum hemorrhage.

• Fever: Fever is a symptom rather than a diagnosis. While present (38.2° C), it supports the presence of infection but does not specify which type, so it is not the best standalone choice for the evidence used to identify the condition.

• Elevated WBC (markedly 33,000/mm3) confirm a systemic infection, it is a general sign of infection that could apply to any source (e.g., wound or mastitis). The assessment of the uterus and lochia specifically localizes the infection to the reproductive tract.