A nurse is reviewing the diet history of a newly pregnant woman.
The woman reports eating mostly processed foods with limited fruits, vegetables, and lean meats.

Which supplements should the nurse emphasize as MOST critical for this pregnancy?

Choice A rationale

Fundal massage is the primary intervention for postpartum hemorrhage caused by uterine atony. Souring a pad in 15 minutes indicates excessive bleeding, often due to a relaxed uterus. Massaging the fundus stimulates uterine muscle contractions, which constrict open blood vessels at the placental site. This action helps the uterus become firm and stops the hemorrhage. It is the fastest, non-invasive way to stabilize the patient before moving to secondary medical or pharmacological interventions.

Choice B rationale

Starting an intravenous infusion of Ringer's lactate is a supportive measure used to maintain circulating blood volume and replace lost fluids. While necessary if the patient becomes hemodynamically unstable or requires oxytocin administration, it does not address the root cause of the bleeding. The immediate priority is to stop the active blood loss through uterine contraction. Fluid resuscitation should follow or occur simultaneously with the physical assessment and stabilization of the uterine muscle tone.

Choice C rationale

Notifying the primary health care provider is essential when a patient experiences significant postpartum bleeding, but it is not the first action. The nurse must first perform life-saving interventions and gather assessment data to report. Delaying fundal massage to make a phone call allows continued blood loss, potentially leading to hypovolemic shock. Standard nursing protocols dictate that the nurse stabilizes the patient using standing orders or immediate physical interventions before seeking further medical direction.

Choice D rationale

Assessing vital signs provides data on the patient's systemic response to blood loss, such as tachycardia or hypotension. Normal blood pressure is typically 120÷80 mmHg and pulse 60 to 100 beats per minute. However, vital signs are often late indicators of shock in postpartum women due to increased blood volume. While important for the overall assessment, taking vitals takes more time than performing a fundal massage, which can immediately stop the source of the hemorrhage.

Choice B rationale

Any nipple discharge in a non lactating woman, especially if it is yellow, bloody, or serosanguinous, is abnormal and requires further investigation by a healthcare provider. While some hormonal changes occur during the menstrual cycle, spontaneous discharge is not a standard finding and could indicate an intraductal papilloma, infection, or malignancy. Patients must be taught that the only normal nipple discharge is breast milk during or after pregnancy. Recognizing and reporting abnormal discharge is a critical component of breast health education.

Choice C rationale

Performing a breast self examination at the same time each month, specifically several days after the menstrual period ends, is the correct technique. During this time, hormonal stimulation of the breast tissue is at its lowest, meaning the breasts are less likely to be tender or lumpy due to normal cyclic changes. This consistency allows the woman to become familiar with her normal breast tissue, making it easier to identify any new or unusual changes that may occur.

Choice D rationale

Using a systematic approach, such as a circular motion, vertical strip, or wedge pattern, ensures that all breast tissue, including the area under the nipple, is thoroughly palpated. Consistency in the method used helps the patient cover the entire breast area without missing any spots. Teaching a set way to perform the exam increases the likelihood of detecting small changes in the consistency or structure of the breast tissue, which is the primary goal of the self examination.

Choice A rationale

The axillary area, or armpit, contains the Tail of Spence, which is an extension of breast tissue where a significant percentage of breast cancers can develop. Including this area in a self examination is vital because lymph nodes in the axilla are often the first site of metastasis for breast malignancies. Patients should be instructed to feel for any lumps, thickening, or hard knots in the armpit to ensure a comprehensive assessment of all potential areas where breast pathology might arise.