A nurse is caring for a postpartum client who is breastfeeding their newborn and reports that their nipples have become sore and cracked.
Which of the following statements should the nurse make?

Choice A rationale

A perineal hematoma is a collection of blood in the connective tissue beneath the skin, often caused by trauma during childbirth. The reported findings of increasing perineal pain, pressure, purplish discoloration, and swelling are classic signs. The purplish hue indicates extravasated blood, and the swelling reflects the accumulation of fluid, which can exert significant pressure on surrounding tissues, leading to severe discomfort and a palpable mass.

Choice B rationale

Retained placental fragments typically manifest as persistent or excessive postpartum bleeding, often bright red, and can lead to uterine subinvolution and infection. While pain might be present due to uterine contractions, it would not typically present as a localized, purplish, swollen area on the perineum. This finding is not consistent with the pathophysiology of retained placental fragments, which primarily affects the uterus.

Choice C rationale

A laceration is a tear in the soft tissues of the perineum or vagina, resulting in bright red bleeding, pain, and sometimes a visible opening. While pain is present, a laceration would not typically present with a 4 cm purplish discoloration and significant swelling without active, bright red bleeding from the tear site itself. The described findings are more indicative of internal bleeding and tissue accumulation rather than an open wound.

Choice D rationale

Ecchymosis is a bruise, characterized by superficial extravasation of blood into the skin or mucous membranes, resulting in a purplish discoloration. While the purplish discoloration is consistent, ecchymosis alone typically does not involve the significant palpable swelling and increasing pressure described. The extent of swelling and pressure points to a deeper collection of blood, distinguishing it from simple superficial bruising.

Choice A rationale

The American Academy of Pediatrics recommends that infants remain in a rear-facing car seat until they reach the maximum height or weight allowed by the car seat manufacturer, which often corresponds to approximately 2 years of age or older. This position provides superior protection for the infant's head, neck, and spine in the event of a frontal collision by distributing crash forces more effectively.

Choice B rationale

A five-point harness, not a four-point harness, is the standard and safest restraint system for infant and child car seats. The five points of attachment (shoulders, hips, and crotch) distribute crash forces across the strongest parts of the body, providing maximum protection and preventing ejection from the seat.

Choice C rationale

For a rear-facing car seat, the shoulder harness straps should be positioned at or *below* the baby's shoulders. This ensures that the straps are snug and correctly restrain the child, preventing upward movement and potential ejection during a collision. Placing them above the shoulders would not provide optimal restraint.

Choice D rationale

An infant car seat should be positioned at a 45-degree angle, not a 30-degree angle. This reclined position is crucial for maintaining an open airway for the infant, especially newborns who lack full head and neck control, and for preventing their head from falling forward, which could obstruct breathing.