Women's Health/Disorders and Childbearing Health Promotion

A nurse is teaching breast care to a client who is breastfeeding. Which statement by the client indicates that the teaching has been effective?

"I should air-dry my nipples after each feeding." Rationale: Air-drying nipples after feedings limits irritation and disruption of skin integrity.The application of soap to breast tissue may result in drying and cracking. Plastic liners trap moisture against tissue and may cause skin breakdown. Wearing a brassiere continuously, except while bathing, is recommended for 2 to 3 weeks after delivery to provide support to breast tissue structures.

Before discharge, a breastfeeding postpartum client and the nurse discuss methods of birth control. The client asks the nurse, "When will I begin to ovulate again?" How should the nurse respond?

"Ovulation may occur before you begin to menstruate." Rationale: If the client is breastfeeding, ovulation and fertility may occur before menstruation resumes. It is the nurse's responsibility to answer the client's questions rather than putting the client off. Ovulation may occur while a woman is breastfeeding because the process of follicular maturation begins when the prolactin level decreases. Declining to answer by claiming that every woman is different evades the question; there are general guidelines that the nurse can share with the client.

A woman is being prepared for a contraction stress test (CST). What should the nurse explain to the woman before the test?

"The fetal heart rate will be monitored for about 20 minutes before the test begins." Rationale: The fetal heart rate (FHR) is measured for about 20 minutes before the CST to determine baseline variability and to detect any FHR alterations without induced stress. The test involves monitoring the fetal heart rate during three to five uterine contractions over a 10-minute period. A urine sample is unnecessary. The semi-Fowler position with a left-sided tilt is the position of choice.

A client who is scheduled for an amniocentesis says, "I'm glad this test will be able to tell whether my baby is well." How should the nurse respond?

"This test is useful in detecting potential defects caused by chromosomal errors." Rationale: Amniocentesis has proved useful in detecting potential defects resulting from chromosomal and metabolic errors, such as Down syndrome, Tay-Sachs disease, hemophilia, thalassemia, and neural tube defects. Stating that research has shown that this is an excellent test is false reassurance and may stop further communication. Amniocentesis can identify many fetal defects, but even if none is detected, this does not guarantee a healthy newborn, because there are other factors that are required for a positive outcome. An amniocentesis does not detect congenital defects; the test can detect chromosomal anomalies, inherited errors of metabolism, and other disorders for which marker genes are known.

A client who has just begun breastfeeding complains that her nipples feel very sore. What should the nurse encourage the mother to do? Select all that apply.

-Apply cool packs to her breasts to reduce the discomfort. -Take the analgesic medication prescribed to limit the discomfort. -Assume a different position when breastfeeding to adjust the infant's sucking. Rationale: Applying cool packs to the breasts to reduce the discomfort may provide relief after a feeding. Analgesics may eventually be necessary. Altering the breastfeeding position may ensure that the entire nipple and as much of the areola as possible are in the infant's mouth. When the infant is latched on the nipple correctly and a finger is used to release suction at the end of a feeding, trauma to the nipple is reduced. Soreness is common; it usually occurs at the beginning of a feeding and is temporary, lasting till the nipples become accustomed to the infant's sucking. Nursing mothers should be encouraged to expose their nipples to air several times a day. Discontinuing feeding for several days will result in engorgement, which will increase the discomfort.

A nurse is caring for a postpartum client. Where does the nurse expect the fundus to be located if involution is progressing as expected 12 hours after birth?

1 cm above the umbilicus Rationale: Twelve hours after birth the uterus is 1 cm above the umbilicus, and each succeeding day it descends one fingerbreadth. Therefore the uterus should be 2 cm below the umbilicus on the second postpartum day. A uterus 3 cm above the umbilicus indicates that the bladder is full. The uterus is 3 cm below the umbilicus on the fourth postpartum day because the uterus descends one fingerbreadth per day.

On her first visit to the prenatal clinic a woman is to have a pelvic examination. What information should the nurse include when discussing the examination?

A rectal examination may be performed after the pelvic examination. Rationale: A rectal examination is usually is conducted to palpate any masses or detect abnormalities in the rectum; it is performed after the vaginal examination to avoid contamination. Gloves are changed between vaginal and rectal examinations. The client should be encouraged to ask questions of both the health care provider and the nurse so that nursing care and treatment plans based on client needs can be developed. The client may be unable to relax and will feel powerless if told that she must do so. Douching or vaginal irrigation is contraindicated unless specifically prescribed; there are no data to indicate that there will be a biopsy.