Exhibits

The nurse determines the client is in pain.

Which pain scales would be appropriate for this client? Select all that apply.

A. Folic acid. Folic acid is essential for neural tube development and significantly reduces the risk of neural tube defects (NTDs) such as anencephaly and spina bifida. Women planning to conceive should take at least 400–800 mcg of folic acid daily, beginning before conception and continuing during early pregnancy, to support proper neural tube closure.
B. Iron. Iron is important for preventing maternal anemia and supporting fetal growth, but it does not play a direct role in neural tube development. While iron supplementation is recommended during pregnancy, it does not prevent neural tube defects such as anencephaly.
C. Vitamin D. Vitamin D is crucial for calcium absorption and fetal bone development but does not impact neural tube formation. Deficiency can lead to rickets in newborns, but it is not associated with neural tube defects.
D. Calcium. Calcium supports maternal bone health and fetal skeletal development but does not influence neural tube formation. While necessary for overall pregnancy health, calcium supplementation does not prevent anencephaly or other NTDs.

• Plugged duct: A plugged duct occurs when milk is not effectively drained from the breast, leading to milk stasis and inflammation. If untreated, it can progress to mastitis, an infection caused by bacterial overgrowth in stagnant milk. The client's history of missing a feeding while shopping increases the likelihood of milk stasis, making a plugged duct the most likely cause of mastitis.
• Breast abscess: A breast abscess is a collection of pus that forms when mastitis is left untreated or does not respond to antibiotics. Unlike mastitis, an abscess is typically fluctuant (soft and fluid-filled), extremely tender, and may require drainage. Since the client’s mastitis symptoms have just begun, an abscess is unlikely at this stage.
• Engorgement : Breast engorgement occurs when the breasts overfill with milk, causing swelling and discomfort. While engorgement can increase the risk of mastitis, it is not an infection itself and does not directly cause mastitis unless milk stasis leads to bacterial overgrowth. Engorgement is bilateral, whereas mastitis is usually unilateral with localized redness, warmth, and fever.
• Nipple trauma with cracked skin: Cracked nipples can allow bacteria to enter the breast, increasing the risk of infection. However, mastitis is primarily caused by milk stasis, not just nipple trauma. In this client, there is no mention of nipple cracks or bleeding, making this a less likely cause.
• Firm, red, warm area on the right breast: A firm, red, warm, and tender area on the breast is a hallmark symptom of mastitis, indicating localized inflammation and infection. The presence of systemic symptoms (fever, chills, fatigue) further supports mastitis rather than another breast condition.
• Pus draining from the nipple: Pus or fluctuance (fluid-filled swelling) suggests a breast abscess, not mastitis. While untreated mastitis can lead to an abscess, this client’s symptoms do not indicate a severe or advanced infection requiring drainage.
• Generalized swelling of the entire breast: Severe engorgement can cause generalized swelling, but mastitis typically presents as a localized, inflamed area rather than affecting the entire breast. Engorgement also does not cause fever or systemic illness, which are present in mastitis.
• Pain that worsens with cold compresses: Cold compresses reduce inflammation and discomfort in mastitis. If cold worsens pain, it may suggest Raynaud’s phenomenon of the nipple, which is not related to mastitis. Mastitis pain is relieved with warmth, massage, and frequent breastfeeding.