A nurse is providing discharge teaching to a new guardian about car seat safety.
Which of the following statements by the guardian indicates an understanding of the teaching?

🧾 Explanation

1. Moderate lochia rubra
   • Normal up to 1–2 weeks postpartum. Not related to mastitis.
2. Temperature 38.4°C
   • Still febrile after 24 hrs of antibiotics → infection not yet controlled.
3. Purulent nipple discharge
   • New finding. Indicates possible breast abscess or worsening mastitis.
4. Hemoglobin 12 g/dL
   • Stable and within normal range. Not relevant to mastitis progression.
5. WBC 35,000/mm³
   • Increased from 28,000 → worsening systemic inflammatory response.
6. Decreased pain
   • Symptomatically better, but this may reflect partial relief from antibiotics/analgesics rather than full resolution. Still, it’s a positive sign.

Summary:

• Improving: Pain relief.
• Unrelated: Lochia rubra, hemoglobin.
• Worsening: Persistent fever, purulent nipple discharge, rising WBC.

This mixed picture suggests partial response but possible complication (breast abscess). The nurse should notify the provider promptly, anticipate breast ultrasound to rule out abscess, and continue close monitoring.

Choice A rationale: The cervix being closed and thick at 42 weeks gestation is unfavorable and increases the risk for labor complications. At this stage, the cervix should ideally be effaced and dilated to allow for labor progression. A closed, thick cervix indicates poor readiness for labor, which may necessitate induction with cervical ripening agents. Failure of the cervix to ripen increases the risk of prolonged labor, failed induction, and cesarean delivery, making this a significant complication risk factor.

Choice B rationale: Being at 42 weeks gestation is post-term, which increases the risk for labor complications. Post-term pregnancy is associated with oligohydramnios, macrosomia, meconium aspiration, and placental insufficiency. These conditions can lead to fetal distress, shoulder dystocia, and increased rates of operative delivery. Therefore, advanced gestational age beyond 41 weeks is a recognized risk factor for complications, requiring close monitoring and often induction of labor to reduce maternal and neonatal morbidity.

Choice C rationale: A fetal heart rate of 150/min is within the normal baseline range of 110 to 160 beats per minute. This indicates adequate fetal oxygenation and no evidence of tachycardia or bradycardia. Since the FHR is normal and reassuring, it does not increase the risk for labor complications. Continuous monitoring is still important, but this specific finding is not a complication risk factor.

Choice D rationale: Clear to white mucus-like vaginal discharge is a normal physiologic finding in pregnancy, known as leukorrhea. It results from increased estrogen and cervical gland activity. This type of discharge is not associated with infection, rupture of membranes, or preterm labor. Since it is expected and benign, it does not increase the risk for labor complications. Only abnormal discharges such as foul-smelling, green, or bloody secretions would be concerning.

Choice E rationale: Vertex presentation, specifically left occiput anterior, is the most favorable fetal position for vaginal delivery. It allows for optimal alignment of the fetal head with the maternal pelvis, facilitating descent and rotation during labor. Malpresentations such as breech or transverse would increase the risk for complications, but vertex LOA is ideal. Therefore, this finding is favorable and does not increase the risk for labor complications.