The nurse is assessing the breast of a woman who is 1 month postpartum. The woman reports a painful area on the left breast, a temperature of 38.2°C, and malaise. The nurse notes a local area on the same breast to be red and warm to touch.
The nurse calls the healthcare provider to report which suspected issue?

Choice A rationale

A blood pressure of 160/110 mm Hg meets the criteria for severe hypertension (≥ 160/≥ 110 mm Hg). The presence of 4+ proteinuria and facial/extremity edema, coupled with severe range hypertension, precisely defines preeclampsia with severe features, indicating significant maternal risk.

Choice B rationale

Gestational hypertension is characterized by a blood pressure ≥ 140/90 mm Hg on two occasions, without proteinuria. This client's blood pressure is in the severe range, and proteinuria is present, ruling out isolated gestational hypertension as the correct diagnosis.

Choice C rationale

Eclampsia is diagnosed when a patient with preeclampsia develops new-onset generalized tonic-clonic seizures or unexplained coma. While the patient's findings indicate severe preeclampsia, the absence of seizure activity or coma means the condition has not progressed to eclampsia yet.

Choice D rationale

Preeclampsia without severe features is defined by blood pressure ≥ 140/90 mm Hg but < 160/110 mm Hg and proteinuria ≥ 0.3 g in a 24-hour urine specimen. This client's blood pressure of 160/110 mm Hg places her directly in the severe features category.

Choice A rationale

Facial paralysis in a newborn after a forceps delivery is most often due to trauma to the facial nerve (cranial nerve VII), typically caused by pressure from the instrument against the nerve where it exits the stylomastoid foramen. This injury is usually a temporary neuropraxia (a physiological block with intact axons) which resolves spontaneously as the swelling subsides and compression is relieved, often within a few days to a few weeks, making close monitoring appropriate.

Choice B rationale

Phototherapy is the standard treatment for neonatal hyperbilirubinemia (jaundice), a condition where unconjugated bilirubin levels are elevated (normal total bilirubin is <5 mg/dL in the first 24 hours), which is a metabolic issue. Facial paralysis is a mechanical nerve injury related to birth trauma, and therefore, phototherapy has no therapeutic effect on nerve function or paralysis resolution.

Choice C rationale

While a neurologist consultation might be needed for persistent or severe paralysis that does not begin to show signs of improvement after several weeks, initial management involves expectant monitoring. The vast majority of these injuries are mild and transient, making immediate, routine referral unnecessary and potentially causing undue parental anxiety without an immediate need for specialized intervention.

Choice D rationale

There is typically no physiological contraindication to immediate or continued breastfeeding with this type of facial nerve injury. However, the nurse should assess the infant's ability to latch and suck effectively, as paralysis might compromise the motor function required for feeding, but is not a reason to universally prohibit all attempts at breastfeeding.