A client who is a gravida 5, para 5 client delivers a 10-pound (4,540 gram) infant.
In planning postpartum care, which assessment has the highest priority?

Choice A rationale

Gravida refers to the total number of pregnancies a woman has had, regardless of the outcome or duration. In this case, the client has had one miscarriage at 16 weeks, one fetal demise at 31 weeks, and is currently at 39 weeks gestation. Therefore, counting the current pregnancy along with the two previous pregnancies, the total gravida is 3 + 1 = 4.

Choice B rationale

Gravida 2 would inaccurately represent the total number of pregnancies. This calculation would exclude either the current pregnancy or one of the previous pregnancy losses, which contradicts the definition of gravida as the total count of all pregnancies.

Choice C rationale

Gravida 1 would be incorrect as it only counts the current pregnancy and completely disregards the two previous pregnancies, one ending in miscarriage and another in fetal demise. The term "gravida" encompasses all pregnancies, irrespective of outcome.

Choice D rationale

Gravida 3 would be incorrect as it would only account for the two previous pregnancies and the current one but would not include the miscarriage at 16-weeks gestation, which is still considered a pregnancy for gravida count. The current pregnancy is added to the total.

Choice A rationale

Propping a bottle can lead to several adverse outcomes for an infant. It increases the risk of aspiration, as the infant may not be able to control the milk flow adequately. It can also contribute to otitis media due to milk pooling in the eustachian tubes and is associated with dental caries, particularly bottle mouth syndrome, and impaired bonding.

Choice B rationale

Sharing the observation with the charge nurse without first addressing the issue directly with the mother is not the most immediate or appropriate action. The PN should first attempt to educate and guide the mother, as this is within the scope of practice for direct client care and education.

Choice C rationale

Asking the mother if she is too tired is speculative and may be perceived as judgmental, potentially creating a barrier to effective communication and education. The PN's role is to provide health education and guidance regarding safe infant feeding practices, focusing on the behavior rather than the mother's perceived fatigue.

Choice D rationale

While observing the infant's behavior during feeding is important for a comprehensive assessment, the immediate and most critical action is to intervene with the unsafe practice of bottle propping. Observing further without addressing the identified risk delays necessary education and intervention to ensure infant safety.