nurse is contributing to the plan of care for a client who is postpartum and has mastitis. Which of the following actions should the nurse plan to take?
Prepare the client for an abdominal sonogram.
Encourage the client to continue to breastfeed
Encourage the client to wear a bra that is loose fitting
Limit the client's daily fluid intake.
The Correct Answer is B
(A) Prepare the client for an abdominal sonogram:
An abdominal sonogram is not relevant for diagnosing or treating mastitis, which is an infection of the breast tissue. Mastitis typically requires assessment of the breast and possibly a breast ultrasound if an abscess is suspected, but not an abdominal sonogram.
(B) Encourage the client to continue to breastfeed:
Continuing to breastfeed is recommended for clients with mastitis. Breastfeeding helps to drain the breast and can speed up recovery. It also helps to prevent complications such as breast abscess and supports continued milk production.
(C) Encourage the client to wear a bra that is loose fitting:
While wearing a comfortable bra is important, a loose-fitting bra may not provide the necessary support for engorged or painful breasts. A well-fitting, supportive bra is usually recommended to provide comfort without being too tight, which can exacerbate symptoms.
(D) Limit the client's daily fluid intake:
Limiting fluid intake is not recommended and is not beneficial for treating mastitis. Adequate hydration is important for overall health and helps maintain milk supply. Encouraging the client to drink plenty of fluids is essential for recovery and continued breastfeeding.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
(a) Pedal edema
Pedal edema, or swelling of the feet and ankles, is a common finding during pregnancy due to increased fluid retention and pressure on the lower extremities from the growing uterus. While pedal edema should be monitored, it is not typically a concerning finding unless it is severe or accompanied by other symptoms suggestive of preeclampsia.
(b) BP of 132/84 mm Hg
A blood pressure of 132/84 mm Hg is within the normal range for pregnancy. However, if the client's blood pressure continues to increase or is accompanied by other symptoms of hypertension, such as proteinuria or headaches, it may warrant further evaluation.
(c) Weight gain of 1 kg (2.2 lb)
Weight gain during pregnancy is expected and can vary from person to person and from week to week. A weight gain of 1 kg (2.2 lb) over the course of a month is within the normal range for pregnancy and may not require immediate reporting to the provider unless there are other concerning symptoms.
(d) Double vision
Double vision (diplopia) can be a symptom of several conditions, including preeclampsia, which is a serious complication of pregnancy characterized by high blood pressure and proteinuria. Double vision can also be caused by other neurological or ophthalmologic conditions. Given its potential association with preeclampsia and other serious conditions, the nurse should promptly report double vision to the provider for further evaluation and management.
Correct Answer is A
Explanation
(A) "You should check the identity of individuals who come to remove your baby from the room":
It's crucial for parents to verify the identity of anyone who comes to take their baby out of the room. This helps ensure the baby's safety and prevents unauthorized individuals from taking the baby. Hospital staff usually wear identification badges, and parents should be encouraged to ask for and verify this identification.
(B) "We will scan your baby's identification bracelet each time check on him":
While scanning the baby's identification bracelet might be part of some hospital protocols for specific purposes like medication administration or matching mother and baby during certain procedures, it is not typically done every time a nurse checks on the baby. Continuous scanning is not a standard practice and would be logistically impractical.
(C) "We will match the bracelet on your baby with his footprint record each shift":
Matching the baby's bracelet with footprint records each shift is not a standard safety protocol. Footprints are usually taken at birth for records but are not routinely matched every shift. Identification is more reliably ensured through the use of identification bands worn by both the mother and the baby.
(D) "Your baby will wear an electronic bracelet when he is out of your room":
In many hospitals, electronic bracelets are used as a security measure, but they are typically worn by the baby at all times, not just when the baby is out of the room. This measure helps prevent abduction and ensures the baby's location is monitored continuously.
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