The nurse takes a phone call from a client at two weeks postpartum. The client states, "My left breast hurts." What other question will the nurse ask her to determine if it is mastitis?
"Do you have an inverted nipple on the affected breast?"
"Do you have breast milk in the affected breast?"
"Is there a bruised area on the affected breast?"
"Is there a hardening of an area in the affected breast?"
The Correct Answer is D
A. An inverted nipple is not indicative of mastitis.
B. Presence of breast milk is expected postpartum and does not specifically indicate mastitis.
C. A bruised area is not a common sign of mastitis.
D. Mastitis often presents with localized pain, redness, swelling, and a hardening of the affected area of the breast. Asking about the presence of a hardening will help assess for mastitis.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Changing the client's position, especially if there's a cord compression causing variable decelerations, is a priority intervention to alleviate the decelerations.
B. Informing the primary care provider is important, but immediate action to address the decelerations should be taken first.
C. Vaginal examination is not the immediate priority when variable decelerations are observed; interventions to improve fetal oxygenation are more critical.
D. Continuous monitoring is essential, but addressing the cause of the variable decelerations by changing the client's position is the immediate action.
Correct Answer is B
Explanation
A. The uterine placement is not normal if it's to the right of midline. The fundus should be at the midline immediately after birth.
B. The urinary bladder is distended. A full bladder can displace the uterus and cause it to be off- center.
C. The uterus being filled with blood is not the primary reason for the displacement described.
It's more likely due to a distended bladder.
D. Infection inside the uterus is not the primary reason for the displacement described. A distended bladder is a more common cause.
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