Per the guidelines set forth by the American Academy of Pediatrics (AAP) regarding infant nutrition, which of the following statements is accurate?

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. —.

Choice A rationale

Uterine atony, the lack of uterine muscle tone, is the most common cause of immediate postpartum hemorrhage (PPH). The boggy (soft, not firm) and displaced fundus (to the right) strongly suggest the uterus is not contracting effectively, which allows blood vessels at the placental site to bleed freely. Furthermore, a distended bladder due to incomplete or infrequent voiding (last void 4 hours ago) can physically displace the uterus, impairing its ability to contract and leading to atony, heavy bleeding, and clot formation.

Choice B rationale

While a bleeding disorder can cause PPH, it is less likely to be the primary cause when classic signs of uterine atony are present. A bleeding disorder would typically be associated with generalized bleeding from all sites and possibly abnormal coagulation lab values (e.g., prolonged PT/INR, PTT, low platelet count-normal: 150,000-450,000/μ L). The physical assessment findings of a boggy, displaced fundus are more indicative of a mechanical issue with uterine contraction.

Choice C rationale

A 4th-degree laceration extends through the anal sphincter and rectal mucosa, causing pain and a risk for infection or dehiscence. While it contributes to overall blood loss, it typically causes steady, bright red bleeding despite a firm fundus. The fundal displacement and boggy consistency with large clots are the hallmark signs pointing away from the laceration as the primary source of the current heavy bleeding.

Choice D rationale

A hematoma is a collection of blood in the connective tissue, often in the vagina or perineum, characterized by severe pain, pressure, and possibly a tense, firm, bulging mass. While the patient is sore, the main concern here is the heavy vaginal bleeding accompanied by the boggy and displaced fundus. A hematoma generally does not cause the profuse, clot-filled bleeding that results from uterine atony. —.