A nurse is caring for a client who is 1 day postpartum and breastfeeding her newborn. The client reports sore nipples. Which of the following actions should the nurse take?

This is the food that the nurse should recommend to the client who practices a vegan diet and is trying to increase intake of vitamin B2. Vitamin B2, also known as riboflavin, is an essential nutrient that is involved in energy metabolism, growth, and cell function¹. It is found in small amounts in a variety of plant foods, such as avocados, mushrooms, almonds, leafy green vegetables, and soybeans³. However, some of the best sources of riboflavin are animal products, such as dairy products and eggs¹. Therefore, vegans may need to consume fortified foods or supplements to meet their daily requirements of riboflavin.
Fortified soy milk is a good option for vegans because it contains added riboflavin, as well as other nutrients such as calcium, vitamin B12, and vitamin D. One cup of fortified soy milk can provide about 0.5 milligrams of riboflavin, which is about 45% of the recommended daily amount for women and 38% for men⁴. Other fortified vegan foods that may contain riboflavin include breakfast cereals, nutritional yeast, and plant- based meat alternatives²⁵.

The other options are not correct because they are not good sources of riboflavin.
a) Raw carrots
Raw carrots are a healthy vegetable that provide vitamin A, fiber, and antioxidants. However, they are not a good source of riboflavin. One medium carrot contains only 0.02 milligrams of riboflavin, which is less than 2% of the recommended daily amount⁴.
b) Fresh citrus fruits
Fresh citrus fruits are a great source of vitamin C, folate, and potassium. However, they are not a good source of riboflavin. One medium orange contains only 0.04 milligrams of riboflavin, which is about 4% of the recommended daily amount⁴.
c) Brown rice
Brown rice is a whole grain that provides complex carbohydrates, fiber, and minerals. However, it is not a good source of riboflavin. One cup of cooked brown rice contains only 0.05 milligrams of riboflavin, which is about 5% of the recommended daily amount⁴.

The Apgar score is a method for assessing the health and well-being of a newborn baby immediately after birth. It is based on five criteria: appearance (skin color), pulse (heart rate), grimace (reflex irritability), activity (muscle tone), and respiration (breathing effort). Each criterion is given a score of 0, 1, or 2, depending on the baby's condition. The total score ranges from 0 to 10, with higher scores indicating better health. The Apgar score is determined at one and five minutes after birth, and sometimes at 10 minutes if the score is low or the baby needs resuscitation. The purpose of the Apgar score is to identify babies who need immediate medical attention and to monitor their response to treatment. The Apgar score is not a predictor of long-term outcomes or developmental problems .
One of the criteria that the nurse should measure when assigning an Apgar score is muscle tone. Muscle tone refers to the degree of tension or stiffness in the baby's muscles. It reflects the baby's neuromuscular function and oxygenation. Muscle tone can be assessed by observing the baby's posture, movement, and resistance to passive flexion or extension of the limbs .
The scoring system for muscle tone is as follows:
- Score 0: No movement; limp and floppy
- Score 1: Some flexion of arms and legs; weak or sluggish movement
- Score 2: Active movement; arms and legs flexed and resist extension
Therefore, the newly hired nurse who says that the nurse should measure the newborn's muscle tone
when assigning an Apgar score indicates an understanding of the teaching.

The other statements show a lack of knowledge or misunderstanding of the Apgar scoring:
- a) "The nurse should determine the Apgar score at 2 and 7 minutes after birth." This is not correct because the standard times for determining the Apgar score are one and five minutes after birth, not two and seven minutes. The one-minute score reflects how well the baby tolerated the delivery process, while the five-minute score reflects how well the baby adapted to the extrauterine environment .
- b) "The nurse should identify that the newborn is in severe distress with an Apgar score of 8." This is not correct because an Apgar score of 8 indicates that the newborn is in good condition and does not need any intervention. An Apgar score of 7 to 10 means that the newborn has normal vital signs and reflexes and only needs routine care. An Apgar score of 4 to 6 means that the newborn has moderate distress and may need some assistance with breathing or stimulation. An Apgar score of 0 to 3 means that the newborn has severe distress and needs immediate resuscitation .
- c) "The nurse should wait for the first Apgar score before initiating resuscitation efforts." This is not correct because waiting for the first Apgar score can delay life-saving interventions for a newborn who needs resuscitation. The nurse should initiate resuscitation efforts as soon as possible if the newborn shows any signs of distress, such as apnea, gasping, cyanosis, bradycardia, or poor muscle tone. The nurse should not rely on the Apgar score alone to decide whether to resuscitate or not, but use it as a tool to monitor the baby's response to treatment .