A nurse is providing teaching to a client who has stress incontinence. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

Rationale:

A. Initiate contact precautions: Endometritis is not typically caused by a pathogen requiring contact precautions (like MRSA or C. difficile). Standard precautions are sufficient unless otherwise indicated.

B. Inform the client she will need to formula feed her newborn until she has received antibiotics for 24 hr: The prescribed antibiotics (e.g., clindamycin) are generally considered safe for breastfeeding, and lactation should be encouraged unless specifically contraindicated.

C. Monitor the height and tone of the client's fundus: Fundal tenderness, foul-smelling lochia, and fever are signs of endometritis. Ongoing fundal assessment is important to evaluate uterine involution and identify potential complications like subinvolution or abscess formation.

D. Request a prescription for terbutaline from the provider: Terbutaline is a tocolytic used to relax the uterus in cases of hyperstimulation during labor not for treating uterine infection or postpartum discomfort.

E. Obtain a culture specimen of the lochia from the client's perineal pad using a sterile swab: Culturing lochia helps identify the causative organism of the uterine infection and guide antibiotic therapy. This is a standard step in suspected endometritis cases.

F. Encourage the client to maintain a semi-Fowler's position to enhance uterine drainage: Positioning the client with the head elevated allows for better lochia drainage, preventing accumulation that could worsen infection or discomfort.

G. Instruct the client to wash her hands before and after changing her perineal pad: Good perineal hygiene helps prevent the spread of infection and supports recovery, especially in the context of suspected endometritis.

Rationale:

A. "Tell me how you are feeling about your mom dying.": This encourages the daughter to express her emotions, which is an important first step in processing grief and finding the right words to support her mother. It shows empathy and opens a therapeutic conversation.

B. "You sound like you have questions about your mom dying. Let's talk about it.": This response invites the daughter to engage in a meaningful discussion about her concerns. It provides emotional support and creates a safe space for her to ask questions and gain clarity.

C. "Let's talk about your mom's cancer and how things will progress from here.": Educating the daughter about the disease process and what to expect during hospice care can reduce anxiety and help her feel more prepared to have honest conversations with her mother.

D. "Tell her not to worry. She still has plenty of time left.": This response offers false reassurance and avoids the reality of the situation. It can prevent the daughter from addressing important emotional or end-of-life discussions with her mother.

E. "Hospice will take good care of your mom, so I wouldn't worry about that.": Although hospice provides excellent care, this response shifts the focus away from the daughter’s emotional needs and discourages open communication about death and dying.