A postpartum client has been diagnosed with mastitis in her right breast.
Which self-care measure should the nurse recommend to help alleviate discomfort and improve drainage in the affected breast?
Begin breastfeeding exclusively from the left breast until the infection resolves.
Incorporate massage and hand expression on the affected breast to relieve engorgement.
Apply cold compresses to the right breast before feedings.
Discontinue breastfeeding completely until symptoms subside.
The Correct Answer is B
Choice A rationale
Exclusively breastfeeding from the unaffected breast will lead to stasis of milk in the infected right breast, which is contraindicated in mastitis management. Milk stasis provides an excellent medium for bacterial growth and exacerbates the inflammation and pain associated with the infection, hindering resolution. Continued emptying of the affected breast is crucial to clear the infection and improve lymphatic and venous drainage, thus alleviating symptoms.
Choice B rationale
Massage helps to break up clogged milk ducts and move the milk toward the nipple, promoting more complete breast emptying. Hand expression further aids in draining the affected area and relieving engorgement, which reduces pressure and discomfort. Efficient milk removal is the most critical intervention to resolve milk stasis and prevent the progression of the infection and potential abscess formation.
Choice C rationale
Applying cold compresses typically acts as an analgesic and anti-inflammatory measure by causing vasoconstriction, thereby reducing edema and pain after a feeding. However, applying cold before a feeding can inhibit the let-down reflex (milk ejection reflex), making it harder for the infant to drain the breast effectively, which is counterproductive.
Choice D rationale
Discontinuing breastfeeding from the affected breast would lead to significant milk stasis, which is a primary predisposing factor and complication of mastitis. The stasis would worsen the inflammation and provide a favorable environment for bacteria to multiply. The recommendation is to continue breastfeeding (or pumping) frequently to ensure adequate drainage and expedite recovery, often with the guidance of a healthcare professional. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Morphine is a common first-line opioid used to manage severe symptoms of NAS, such as tremors, seizures, and autonomic dysfunction, by targeting the same opioid receptors affected by maternal substance use. A decreased environmental stimulation plan of care, including swaddling, quiet, dark spaces, and gentle handling, is vital to minimize CNS irritability and hyperactivity often seen in NAS, promoting neurobehavioral organization and reducing energy expenditure.
Choice B rationale
Phenobarbital, an anticonvulsant and sedative, is often used as a second-line or adjunct therapy for NAS, particularly when seizures are present or if the infant is non-responsive to the primary opioid. Delaying feeding is inappropriate; infants with NAS often have poor suck/swallow coordination and increased caloric needs due to hyperactivity and may require small, frequent feedings or high-calorie formulas to prevent dehydration and ensure adequate growth.
Choice C rationale
Amoxicillin is an antibiotic used to treat bacterial infections and has no role in the pharmacological management of Neonatal Abstinence Syndrome (NAS), which is a neurobehavioral condition caused by in utero exposure to opioids or other substances. Placing the infant on the abdomen is a maneuver sometimes used to relieve respiratory distress or congestion but is not a primary or specific intervention for the CNS irritability and hypertonia characteristic of NAS.
Choice D rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and fever relief and is not indicated for the management of the complex neurobehavioral and autonomic symptoms of NAS. Applying barrier cream is routine skin care for all neonates to prevent diaper rash; while helpful for the diarrhea associated with NAS, it is not the most specific or critical component of the overall plan of care for severe symptoms. —.
Correct Answer is A
Explanation
Choice A rationale
Initial hearing screens often yield false-positive results due to residual amniotic fluid, vernix caseosa, or middle ear effusion that can interfere with the sound transmission within the ear canal. The American Academy of Pediatrics recommends rescreening infants who fail the initial test, typically before discharge, to allow time for the ear canal to clear. If the infant fails the repeat screening, a definitive diagnostic evaluation is then necessary.
Choice B rationale
Scheduling an immediate specialist consult is premature after a single failed screening. Most initial failures resolve upon rescreening, which is the standard of care to avoid unnecessary anxiety and medical appointments. A referral is only warranted after the newborn fails the repeat screening to confirm a possible permanent hearing loss with a more comprehensive audiologic assessment within a few weeks.
Choice C rationale
A failed initial hearing screen does not automatically signify a permanent disability or necessitate an immediate social services consult. The focus remains on re-evaluation and appropriate follow-up. While providing comfort is always essential, escalating to social services based on a single failed screen is an overreaction and not the correct clinical intervention at this stage.
Choice D rationale
Initiating speech therapy services is inappropriate because the newborn's ability to hear has not yet been definitively determined. Speech therapy is implemented much later, usually when a confirmed hearing impairment impacts language development, typically after 6 months of age. The current priority is to confirm or rule out hearing loss via rescreening and diagnostic testing. —.
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