A charge nurse is teaching a newly licensed nurse about substance use disorders during pregnancy.
Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

Choice A rationale

Consuming milk with iron supplements significantly inhibits iron absorption due to the high calcium content in milk. Calcium competes with iron for absorption sites in the small intestine, forming insoluble complexes that reduce the bioavailability of iron. This would counteract the intended therapeutic effect of the iron supplementation, leading to suboptimal iron levels.

Choice B rationale

Doubling an iron dose can lead to iron toxicity, which is dangerous, especially during pregnancy. Excessive iron intake can cause gastrointestinal distress, liver damage, and metabolic acidosis. Adhering to the prescribed dosage is crucial for safe and effective supplementation, preventing adverse effects while achieving therapeutic iron levels.

Choice C rationale

Maintaining adequate fiber intake (normal range 25-30 grams daily) is crucial during iron supplementation. Iron often causes constipation due to its effect on gastrointestinal motility. Dietary fiber adds bulk to stool, promoting regular bowel movements and alleviating constipation, which is a common and uncomfortable side effect of iron therapy.

Choice D rationale

Vitamin K is essential for blood coagulation, but taking 100 milligrams daily during pregnancy without a specific medical indication is excessive and potentially harmful. The normal recommended daily allowance for vitamin K during pregnancy is much lower, around 90 micrograms. High doses could interfere with anticoagulant medications or have unknown fetal effects.

Choice A rationale

Initiating feeding on the less sore breast is generally recommended when nipples are sore or cracked. The newborn's initial suck is often the strongest and most vigorous, which can exacerbate pain and damage on an already compromised nipple. Starting on the less sore side allows for a gentler initial latch and flow.

Choice B rationale

Using breast pads with a moisture-proof lining can trap moisture against the nipples, creating a warm, damp environment that promotes bacterial or fungal growth, potentially worsening soreness or leading to infection. Air drying and absorbent, breathable pads are generally preferred for nipple healing.

Choice C rationale

Reducing feeding frequency can lead to breast engorgement, which further complicates breastfeeding and can decrease milk supply. Frequent, shorter feedings are often more comfortable for the mother and help maintain milk production while allowing the nipples to heal gradually.

Choice D rationale

Applying colostrum to the nipples after feeding is beneficial due to its immunological properties and moisturizing effect. Colostrum contains antibodies and growth factors that can promote healing, reduce inflammation, and provide a protective barrier against infection, aiding in the recovery of sore and cracked nipples.