A nurse is reviewing the electronic health record for a client who has a new diagnosis of mastitis.
Which of the following manifestations should the nurse identify as associated with mastitis?

Choice A rationale

Collecting a blood sample for culture is generally not indicated for localized lactational mastitis unless the client exhibits signs of systemic sepsis or hemodynamic instability. Mastitis is typically a regional infection of the breast tissue rather than a systemic bloodstream infection. Standard diagnostic protocols focus on local symptoms like erythema, warmth, and pain, rather than blood cultures, which would likely yield negative results in a non-septic patient.

Choice B rationale

Applying warm compresses to the affected breast before breastfeeding helps to stimulate the let-down reflex and improve milk flow. Heat causes vasodilation, which can assist in relieving the ductal obstruction that often precedes or accompanies mastitis. Increased blood flow to the area may also facilitate the delivery of immune cells to the site of infection. Maintaining milk drainage is critical to prevent the formation of a breast abscess during treatment.

Choice C rationale

Administering prescribed analgesia, such as ibuprofen or acetaminophen, is essential for managing the significant pain and inflammation associated with severe mastitis. Ibuprofen is often preferred because its anti-inflammatory properties help reduce tissue edema in the mammary glands. Effective pain management encourages the client to continue frequent breastfeeding or pumping, which is necessary to clear the infection and maintain a healthy milk supply while preventing further stasis.

Choice D rationale

Proper hand hygiene is a fundamental intervention to prevent the introduction of exogenous pathogens, such as Staphylococcus aureus, into the breast tissue through cracked or abraded nipples. Bacteria often enter the ductal system via the nipple-areola complex. Teaching the client to wash their hands thoroughly before touching their breasts or nursing reduces the bacterial load on the skin, thereby limiting the risk of reinfection or worsening the current condition.

Choice E rationale

Collecting a sample of breast milk for culture is indicated in cases of severe, recurrent, or hospital-acquired mastitis to identify the specific causative pathogen and determine antibiotic sensitivity. While many cases are treated empirically, a culture ensures that the prescribed antimicrobial therapy is effective against the organism present. This is particularly important if the client does not show improvement within forty-eight hours of starting standard antibiotic treatment.

Choice F rationale

Instructing the client to stop breastfeeding is contraindicated because sudden cessation of lactation can lead to severe milk stasis, increasing the risk of abscess formation. Continued and frequent emptying of the breast is the primary mechanical treatment for mastitis. The infection is located in the breast tissue, not the milk itself, and the antibodies present in the milk actually help protect the infant. Breastfeeding should continue on the affected side.

Choice A rationale

Dysuria, or painful urination, is more commonly a symptom of urinary tract infections, cystitis, or sexually transmitted infections rather than a primary indicator of ovarian cancer. While a very large ovarian mass could potentially press on the bladder and cause urinary frequency or urgency, dysuria itself is not a classic hallmark of early or late-stage ovarian malignancy. Clinical focus for ovarian cancer usually remains on gastrointestinal and vague abdominal symptoms that persist over several weeks.

Choice B rationale

Abdominal pain or pelvic discomfort is a frequent manifestation of ovarian cancer. As the tumor grows, it can cause pressure on surrounding organs, stretching of the ovarian capsule, or the accumulation of fluid in the peritoneal cavity, known as ascites. This pain is often described as persistent bloating or a feeling of fullness. Because these symptoms are vague and mimic digestive issues, ovarian cancer is often diagnosed at later stages, making abdominal assessment a priority.

Choice C rationale

While ovarian cancer can cause an increase in abdominal girth due to ascites or tumor growth, it is more often associated with unexplained weight loss rather than generalized weight gain. The metabolic demands of the malignancy and the feeling of early satiety often lead to a decreased caloric intake and cachexia. If a client reports their clothes feeling tighter around the waist but their overall weight is stable or decreasing, it strongly suggests fluid accumulation or a mass.

Choice D rationale

Amenorrhea is not a reliable indicator of ovarian cancer. Many individuals diagnosed with ovarian cancer are postmenopausal and have already ceased menstruation. In premenopausal clients, menstrual irregularities can occur, but the total absence of a period is less common than other symptoms like persistent bloating or pelvic pressure. Therefore, healthcare providers look for more specific signs of adnexal masses rather than relying on the client's menstrual status to support a diagnosis of ovarian malignancy.