If a woman develops cracked and bleeding nipples after breastfeeding for eight days, the nurse would be correct in determining the most likely cause is which of the following?
An early sign of mastitis.
Inadequate breastfeeding positioning and latch.
Normal irritation from initiation of breastfeeding.
Infrequent breastfeeding sessions throughout the day.
The Correct Answer is B
Choice A rationale
Mastitis is an infection of the breast tissue, commonly presenting with localized pain, redness (erythema), warmth, swelling, and a fever. While cracked nipples can be an entry point for the bacteria causing mastitis, the primary and immediate cause of cracked and bleeding nipples is typically a mechanical injury from improper suction and friction, not the infection itself.
Choice B rationale
The most common mechanical cause of sore, cracked, or bleeding nipples is inadequate positioning or a poor latch. A shallow latch causes the nipple to rub against the roof of the baby's mouth instead of deep in the pharynx, leading to excessive friction and trauma. Correcting the latch ensures the nipple is positioned past the gum line, minimizing friction and allowing the nipple to rest comfortably.
Choice C rationale
Some initial nipple tenderness can be common in the first few days as the skin adjusts to the suction and moisture of breastfeeding. However, cracked and bleeding nipples are a sign of significant tissue trauma, indicating an incorrect technique, which is not considered normal or expected irritation, and requires prompt correction to prevent further damage and potential secondary infection.
Choice D rationale
Infrequent breastfeeding sessions primarily lead to engorgement or milk stasis, which can increase the risk of mastitis. While an engorged breast can make latching difficult, the direct cause of the cracked nipple trauma is the mechanical stress from the baby's mouth, regardless of the frequency. Frequent, correct breastfeeding is essential for successful lactation. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Lochia, the endometrial lining's post-delivery sloughing, is generally less following a cesarean birth than a vaginal delivery because the surgeon directly sponges the uterine cavity during the procedure. This manual removal of some decidua and blood reduces the overall volume of lochia expelled in the subsequent postpartum period. The normal progression (rubra → serosa → alba) and total duration, however, remain similar to a vaginal birth, just in smaller daily amounts.
Choice B rationale
Lochia is composed of blood, mucus, and tissue from the placental site and decidua. It is not greater after a cesarean section. The surgical cleansing of the uterus by the obstetrician removes a significant portion of the blood and tissue that would otherwise be expelled over the first postpartum week. Therefore, a larger volume of lochia would be an atypical finding and may signal a complication like uterine atony or hemorrhage.
Choice C rationale
The volume of lochia is not about the same as a vaginal delivery. A vaginal delivery necessitates the mother to expel all decidual tissue and blood without manual or surgical assistance, resulting in a significantly greater total volume of discharge. The surgical procedure is what differentiates the postpartum lochia volume, making it noticeably less than a vaginal birth, typically around half the volume initially.
Choice D rationale
Saturated clots and mucus are not expected; lochia is a normal vaginal discharge. While lochia rubra contains some small clots (no larger than a plum) for the first few days, saturation of a perineal pad within 15 minutes or the presence of large clots (egg-sized or larger) suggests postpartum hemorrhage and necessitates immediate intervention, which is an abnormal finding. —.
Correct Answer is B
Explanation
Choice A rationale
Uterine cramping pain, often called afterpains, is a normal physiological process, especially in multiparous women or those who are breastfeeding. This pain is caused by oxytocin-mediated uterine contractions that help the uterus involute and compress blood vessels, which reduces the risk of hemorrhage.
Choice B rationale
A heart rate of 108 beats/minute (tachycardia) is a finding that warrants further investigation. The normal postpartum heart rate is typically 60-100 beats/minute (although mild, transient bradycardia may occur). Persistent tachycardia can be an early sign of hypovolemia due to hemorrhage, infection (sepsis), or pain.
Choice C rationale
Deep red, fleshy-smelling lochia (Lochia rubra) is the expected discharge for the first 3-4 days postpartum. The fleshy odor is normal, originating from the sloughing decidua, and indicates normal uterine healing and cleansing. An offensive odor would suggest an infection.
Choice D rationale
Diaphoresis (profuse sweating) is a normal physiological mechanism in the postpartum period. It is the body's way of eliminating the increased fluid volume accumulated during pregnancy and the excess fluid retained during labor. This is a normal process of diuresis and fluid balance restoration.
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