The nurse is teaching a new mother about breastfeeding. The client tells the nurse that her sister became very uncomfortable when she tried to breastfeed because she had too much milk. Which suggestion should the nurse provide to help this client deal with the discomfort associated with engorged breasts?

A. One-hour glucose screen: The one-hour glucose screen is typically performed at 24-28 weeks gestation to screen for gestational diabetes. This is a standard test for all pregnant women during this time frame, regardless of ethnicity, and should be included in the client teaching.
B. Repeat HIV test: While HIV screening is important during pregnancy, a repeat HIV test at 28 weeks is not typically recommended for all women unless they are at high risk or have specific risk factors.
C. Multiple marker screening: This screening is usually done earlier in pregnancy, typically between 15-20 weeks, to assess the risk of certain fetal conditions like Down syndrome and neural tube defects. It is not performed at 28 weeks.
D. Direct Coombs' test: The Direct Coombs' test is typically performed on newborns, not on pregnant women, to check for hemolytic disease. However, Rh-negative women are often screened with the indirect Coombs' test at 28 weeks to check for antibodies, not the direct Coombs' test.

Rationale for Correct Choices:

• Cause: A plugged duct: A plugged duct occurs when milk is not adequately drained from the breast, leading to a blockage. The client's symptoms of a red, warm, firm spot on the outer aspect of the breast point to this condition, as a plugged duct is commonly associated with localized inflammation in the breast.
• Findings: The firm red area at the outer breast aspect indicates mastitis. This localized area of inflammation is characteristic of mastitis, which usually involves a blocked milk duct that becomes infected, causing redness and swelling.

Rationale for Incorrect Choices:

• Cracked nipples: Cracked nipples can lead to discomfort and potential infections, but the main issue described in this case is a red, firm area on the breast, not nipple damage. Cracked nipples are more likely to cause localized pain rather than the specific symptoms of mastitis seen here.
• Poor latch: A poor latch could contribute to breastfeeding issues and discomfort, but it is not the primary cause of the plugged duct or the localized inflammation described. The firm, red area and symptoms point more to a plugged duct than to issues with latch.
• Fever, chills, and fatigue: While these are symptoms of mastitis, they are systemic symptoms of infection rather than direct evidence of the cause of the mastitis. These symptoms indicate the progression of the infection.
• Foul-smelling lochia rubra: Foul-smelling lochia rubra suggests endometritis, not mastitis. While both are infections, the lochia is not related to the breast infection described here. Therefore, it is not a relevant finding for this particular diagnosis.