The practical nurse is caring for a preschooler with spina bifida who was admitted with a febrile urinary tract infection.
Which action should the practical nurse prioritize to minimize complications of vesicoureteral reflux?

Choice A rationale

While postpartum depression is a serious concern, immediately jumping to a question about suicidal thoughts can be alarming and may shut down communication unless other specific warning signs are present. A more gentle and open-ended approach is generally preferred initially to build rapport and gather information.

Choice B rationale

While it is true that many new mothers experience challenges with bonding, simply stating this without further exploration can minimize the client's feelings and prevent her from elaborating. It does not provide an opportunity for the client to express the depth or specifics of her emotional experience.

Choice C rationale

Focusing on the husband's bonding shifts the attention away from the client's expressed feelings and needs. While partner involvement is important, the immediate priority is to address the client's own emotional state and her perceived lack of bonding with her baby.

Choice D rationale

Encouraging the client to talk about her feelings provides an open-ended opportunity for her to express her concerns, explore the contributing factors, and feel heard. This therapeutic communication technique allows the nurse to gather more specific data and assess for potential postpartum mood disorders or other issues, promoting a client-centered approach.

Choice A rationale

Propping a bottle can lead to several adverse outcomes for an infant. It increases the risk of aspiration, as the infant may not be able to control the milk flow adequately. It can also contribute to otitis media due to milk pooling in the eustachian tubes and is associated with dental caries, particularly bottle mouth syndrome, and impaired bonding.

Choice B rationale

Sharing the observation with the charge nurse without first addressing the issue directly with the mother is not the most immediate or appropriate action. The PN should first attempt to educate and guide the mother, as this is within the scope of practice for direct client care and education.

Choice C rationale

Asking the mother if she is too tired is speculative and may be perceived as judgmental, potentially creating a barrier to effective communication and education. The PN's role is to provide health education and guidance regarding safe infant feeding practices, focusing on the behavior rather than the mother's perceived fatigue.

Choice D rationale

While observing the infant's behavior during feeding is important for a comprehensive assessment, the immediate and most critical action is to intervene with the unsafe practice of bottle propping. Observing further without addressing the identified risk delays necessary education and intervention to ensure infant safety.