A nurse is providing care for a client with painful nipples due to breastfeeding.
What intervention is appropriate?
Applying hot compresses to the breasts prior to feeding.
Teaching latching and releasing of suction techniques.
Instructing women to rub colostrum on their nipples after a feeding session.
Air-drying nipples for 10 minutes at the end of the feeding session.
The Correct Answer is B
Choice A rationale
Applying hot compresses to the breasts prior to feeding is not recommended for painful nipples due to breastfeeding. It may exacerbate pain and discomfort.
Choice B rationale
Teaching latching and releasing of suction techniques helps ensure that the baby latches correctly and releases properly from the breast, which can prevent and alleviate nipple pain and trauma.
Choice C rationale
Rubbing colostrum on the nipples after a feeding session is beneficial as colostrum has healing properties, but it does not address the immediate technique-related cause of painful nipples.
Choice D rationale
Air-drying nipples for 10 minutes at the end of the feeding session can be helpful for healing, but proper latching techniques are more effective in preventing nipple pain.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale: Oxytocin is the hormone responsible for the let-down reflex during breastfeeding. It is released from the posterior pituitary gland in response to the baby’s suckling. This hormone causes the milk ducts to contract and eject milk from the alveoli into the ducts, making it available for the baby.
Choice B rationale: Progesterone plays a role in preparing the breast tissue for lactation during pregnancy, but it does not directly trigger the let-down reflex.
Choice C rationale: Hindmilk is the milk produced later in a feeding session, which is richer in fat and calories. It is not a hormone and does not cause the let-down reflex.
Choice D rationale: Foremilk is the initial milk released during breastfeeding, which is higher in water content. It is also not a hormone and does not cause the let-down reflex.
Correct Answer is D
Explanation
Choice A rationale
Placing the patient in a Trendelenburg position is not the immediate priority. This position is often used to manage shock or to improve blood flow to the brain, but it does not directly address the cause of heavy lochia. It may not be the most effective first intervention in this situation.
Choice B rationale
Notifying the physician is important, but the nurse should first attempt to control the bleeding. The physician can be notified after initial measures to stop the bleeding are taken. Immediate intervention by the nurse is crucial in this scenario to stabilize the patient.
Choice C rationale
Administering Methylergonovine can help control postpartum hemorrhage, but this should be done after attempting non-pharmacological measures like fundal massage. Methylergonovine can have side effects and should be used with caution.
Choice D rationale
Massaging the fundus until it is firm is the immediate priority. This can help expel clots and stimulate uterine contraction, which can reduce bleeding. It is a direct and immediate intervention to address the heavy lochia.
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