A nurse is preparing to administer gentamicin 2 mg/kg IM to a client who has pelvic inflammatory disease and weighs 132 lb. Available is gentamicin injection 40 mg/mL. How many mL should the nurse administer?

(Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

Postpartum hemorrhage (PPH) is severe vaginal bleeding after childbirth. It can occur within 24 hours of delivery (primary PPH) or up to 12 weeks postpartum (secondary PPH) ¹. PPH can cause serious complications and even death if not treated promptly and effectively¹.
The client in the question is at risk for PPH because she has a rapid labor and a high degree of cervical dilation. These factors can cause uterine atony, which is the failure of the uterus to contract and compress the blood vessels after delivery. Uterine atony is the most common cause of PPH, accounting for up to 80% of cases². Other risk factors for PPH include placental abruption, placenta previa, overdistended uterus, multiple pregnancy, prolonged labor, operative delivery, retained placenta, coagulation disorders, and infection²³.

a) Hyperemesis gravidarum is a condition of severe nausea and vomiting during pregnancy that can cause dehydration, electrolyte imbalance, weight loss, and nutritional deficiencies. It usually occurs in the first trimester and resolves by the second trimester. It is not related to PPH⁴.
b) Ectopic pregnancy is a condition where the fertilized egg implants outside the uterus, usually in the fallopian tube. It can cause abdominal pain, vaginal bleeding, and rupture of the tube. It is a medical emergency that requires prompt diagnosis and treatment. It occurs in early pregnancy and cannot be diagnosed at 12 weeks of gestation by amniocentesis.
d) Incompetent cervix is a condition where the cervix dilates prematurely and painlessly during pregnancy, leading to preterm labor and delivery or pregnancy loss. It usually occurs in the second trimester and can be treated with cervical cerclage or progesterone. It is not associated with PPH.

Sore nipples are a common problem for breastfeeding mothers, especially in the first few days or weeks after delivery. They can cause pain, discomfort, and frustration, and may interfere with breastfeeding success and satisfaction. The most common cause of sore nipples is poor latch, which means that the newborn does not attach to the breast correctly and does not suckle effectively. Poor latch can result from various factors, such as improper positioning, tongue-tie, inverted or flat nipples, engorgement, or thrush.

The nurse should assess the newborn's latch while breastfeeding to identify and correct any problems that may cause sore nipples. The nurse should observe the following signs of a good latch:
- The newborn's mouth is wide open and covers most of the areola (the dark area around the nipple).
- The newborn's chin and nose touch the breast, and the cheeks are rounded and not dimpled.

- The newborn's tongue is visible under the lower lip and curls around the breast.
- The newborn's lips are flanged outwards and not tucked inwards.
- The newborn's jaw moves rhythmically and smoothly, and swallowing sounds are audible.
- The mother feels a gentle tugging sensation on the nipple, but no pain or pinching.

The nurse should also teach the mother how to achieve a good latch by using different positions, supporting the breast with her hand, tickling the newborn's lower lip with her nipple, and bringing the newborn to the breast when their mouth is wide open. The nurse should also encourage the mother to seek help from a lactation consultant or a peer support group if she has persistent or severe nipple pain.

a) Instructing the client to wait 4 hours between daytime feedings is not an appropriate action for the nurse to take. This may reduce nipple soreness temporarily, but it can also cause breast engorgement, milk supply reduction, mastitis, or poor weight gain in the newborn. The nurse should advise the client to feed the newborn on demand, usually every 1.5 to 3 hours during the day and every 3 to 4 hours at night.
b) Offering supplemental formula between the newborn's feedings is not an appropriate action for the nurse to take. This may interfere with breastfeeding initiation and establishment, as it can reduce the mother's milk supply, confuse the newborn's sucking pattern, increase the risk of nipple preference or rejection, and expose the newborn to potential allergens or infections. The nurse should support exclusive breastfeeding for the first six months of life, unless there is a medical indication for supplementation.
c) Having the client limit the length of breastfeeding to 5 minutes per breast is not an appropriate action for the nurse to take. This may not be enough time for the newborn to get enough milk, especially the hindmilk that is richer in fat and calories. It may also prevent proper drainage of the breast and lead to engorgement or mastitis. The nurse should advise the client to let the newborn feed until they are satisfied and release the breast on their own, which may take 10 to 20 minutes per breast on average.