After ambulating in the hall and returning to bed, the client states that her water broke.
The fetal heart rate is 85 beats per minute, and the vaginal exam reveals the cervix is 90% effaced, 2 cm dilated, vertex presentation, and fetal station -2. There is a pulsating cord felt in the anterior portion of the vagina.
Which intervention would the nurse perform immediately?

Choice A rationale

Sildenafil, a phosphodiesterase type 5 (PDE5) inhibitor, enhances the effects of nitric oxide, leading to vasodilation and increased blood flow to the penis, facilitating erection. However, sexual stimulation is required to trigger the release of nitric oxide and initiate this process; without it, the medication will not be effective.

Choice B rationale

A high-fat meal can actually decrease the absorption rate and extent of sildenafil. Fat delays gastric emptying and can bind to the medication, reducing the amount that reaches the bloodstream and potentially delaying or diminishing its effect.

Choice C rationale

Caffeine is a stimulant that primarily affects the central nervous system and may have a mild diuretic effect. It does not directly interfere with the mechanism of action of sildenafil, which targets the nitric oxide pathway in the penile tissue. Therefore, recent caffeine consumption is unlikely to be a primary reason for the lack of response.

Choice D rationale

Taking an additional dose of sildenafil without consulting a healthcare provider is not recommended and can be dangerous. Exceeding the prescribed dose can increase the risk of side effects such as headache, flushing, and priapism (prolonged erection). It does not address the underlying reason for the initial lack of response and could be harmful.

Choice A rationale

Massaging the breasts in a circular motion before and during breastfeeding can stimulate milk flow by encouraging the release of oxytocin, which triggers the milk ejection reflex (let-down). This action helps to empty the breasts more effectively, reducing pressure and relieving engorgement pain. The physical manipulation also improves circulation within the breast tissue.

Choice B rationale

Applying warm compresses to the breasts before breastfeeding helps to dilate the milk ducts, making it easier for milk to flow. The warmth also increases blood flow to the breast tissue, which can help to soften the areola and nipple, facilitating latch for the infant and easing discomfort associated with engorgement.

Choice C rationale

Frequent breastfeeding or regular pumping helps to remove milk from the breasts, which is the primary way to relieve engorgement. As milk accumulates, it causes pressure and pain. Regular emptying signals the body to regulate milk production and prevents further engorgement. Maintaining a consistent milk removal schedule is crucial.

Choice D rationale

Applying cold compresses to the breasts after breastfeeding helps to reduce swelling and inflammation. The cold temperature causes vasoconstriction, which decreases blood flow to the breast tissue, thereby alleviating pain and discomfort associated with engorgement. This is particularly helpful in between feedings.

Choice E rationale

Encouraging the client to wear a tight-fitting bra throughout the day is contraindicated for breast engorgement. Tight bras can restrict milk flow by putting pressure on the milk ducts, potentially worsening engorgement and increasing discomfort. Supportive but not restrictive bras are recommended.

Choice F rationale

Advising the client to limit fluid intake to reduce milk production is not recommended and can be harmful. Adequate hydration is essential for overall health and for maintaining milk supply. Limiting fluids will not effectively reduce engorgement and could lead to dehydration. Frequent milk removal is the key to managing engorgement.