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?
"Begin each feeding with the breast that is most sore, so the newborn spends less time on it.”.
"Use breast pads with a moisture-proof lining to keep the nipples moist.”.
"Breastfeed the baby less frequently to give the nipples time to heal.”.
"Apply colostrum to the nipples after feeding to help them heal.”.
The Correct Answer is D
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"D"}
Explanation
Complete the sentence: The nurse should massage the uterus and prepare to administer oxytocin.
Rationale for correct answers:
Uterine atony is the most common cause of postpartum hemorrhage (PPH), indicated by a boggy uterus and heavy bleeding with clots. Uterine massage stimulates uterine contractions, promoting involution and reducing bleeding. Oxytocin is a first-line uterotonic agent that increases uterine tone by stimulating smooth muscle contraction, helping to control hemorrhage. Normal hemoglobin is 11-16 g/dL; the client’s drop to 9.4 g/dL and hematocrit decrease to 27% (normal 33%-47%) indicate blood loss requiring prompt intervention.
Rationale for incorrect Response 1 options:
Inserting an indwelling urinary catheter is unnecessary here because the client emptied her bladder without difficulty, and urinary retention is not evident. Oxygen administration by nasal cannula is not indicated since the client’s respiratory rate is normal and there is no sign of hypoxia. Immediate oxygen is reserved for hypoxic or unstable patients.
Rationale for incorrect Response 2 options:
Administering oxygen by nasal cannula is not needed without hypoxia signs. Initiating a 1000 mL sodium chloride bolus might be considered later if hypovolemia or hypotension worsens but is not the immediate priority. Inserting an indwelling urinary catheter is not indicated as the bladder is emptying normally, and unnecessary catheterization risks infection.
Take-home points:
- Postpartum hemorrhage is primarily caused by uterine atony, presenting with a boggy uterus and heavy bleeding.
- Prompt uterine massage and administration of oxytocin are critical first-line interventions to control bleeding.
- Laboratory values such as hemoglobin and hematocrit help assess blood loss severity and guide management.
- Differentiation from other causes of bleeding (e.g., retained placenta, lacerations) requires assessment but initial treatment focuses on uterine tone restoration.
Correct Answer is ["C","D"]
Explanation
Choice C rationale
The client is tachycardic and has cool skin, indicating potential hypovolemia or shock due to excessive bleeding. Administering oxygen at 2 L/min via nasal cannula increases oxygen delivery to the tissues, improving cellular oxygenation and mitigating the effects of decreased circulating blood volume. This supports vital organ function and helps address tissue hypoxia, a common consequence of significant blood loss. Normal heart rate postpartum is 60-100 beats per minute.
Choice D rationale
Oxytocin is a uterotonic agent that stimulates uterine contractions. A boggy uterus and excessive bleeding are hallmark signs of uterine atony, the most common cause of postpartum hemorrhage. Initiating an infusion of oxytocin will promote uterine contraction, which compresses blood vessels and reduces blood loss, thereby addressing the underlying cause of the client's symptoms and preventing further hemorrhage. Normal lochia should be moderate in amount.
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