A nurse is providing medication teaching about disulfiram for a client who has alcohol use disorder. Which of the following statements by the client indicates an understanding of the teaching?

Rationale for Correct Choices

• Mastitis: The client is breastfeeding and presents with a visible cracked nipple, which provides an entry point for bacteria. Mastitis is a common postpartum infection of the breast tissue, particularly when nipple trauma or milk stasis is present, increasing the risk of inflammation and infection.

• Cracked nipple: The cracked nipple is a clear portal of entry for bacteria, especially Staphylococcus aureus. This physical finding directly predisposes the client to mastitis, making it the most immediate risk factor in this scenario.

Rationale for Incorrect Choices

• Perineal hematoma: A perineal hematoma typically occurs shortly after delivery due to trauma to the perineal blood vessels. This client is 2 weeks postpartum, with only mild perineal discomfort reported, making a hematoma unlikely at this stage.

• Endometritis: Endometritis usually presents within the first week postpartum with fever, uterine tenderness, and foul-smelling lochia. This client denies abdominal pain, has no fever, and reports normal lochia, making endometritis unlikely.

• Large for gestational age newborn: While the client delivered a newborn weighing 4,508 g, this factor primarily increases the risk for birth trauma, shoulder dystocia, or perineal injury. It does not directly predispose to mastitis.

• Group B streptococcus: Group B strep status primarily affects the newborn risk and prophylactic antibiotic decisions during labor. In the absence of postpartum infection symptoms in the mother, GBS is not the key factor contributing to mastitis in this client.

Rationale:
A. Obtain a prescription to refer the client to physical therapy: A referral to physical therapy is appropriate because therapists can design individualized exercises to improve balance, coordination, and strength. This intervention promotes safe mobility, enhances independence, and reduces fall risk for clients with post-stroke weakness.

B. Instruct the client to wear sandals when ambulating: Sandals do not provide adequate foot support or traction and increase the risk of tripping or falling. Clients with right-sided weakness should wear well-fitting, non-skid shoes to ensure safety and stability during ambulation.

C. Encourage the client to dim the lights in hallways: Poor lighting impairs visibility and increases the risk of falls, especially for clients with weakness or gait instability. Adequate illumination in hallways and pathways is essential for safety during ambulation.

D. Instruct the client to place throw rugs on bathroom floors: Throw rugs are a major fall hazard due to their tendency to slip or bunch up. The nurse should advise removing rugs or securing them with non-slip backing to create a safe, stable walking environment.