A breastfeeding woman, 6 weeks postdelivery, must go into the hospital for a hemorrhoidectomy. Which of the following is the best intervention regarding infant feeding?

Correct Answer: D

Rationale: In this scenario, the most appropriate intervention regarding infant feeding when a breastfeeding woman needs to undergo a hemorrhoidectomy is to have the baby bottle-fed milk that the mother has stored (Option D). This choice is the best because it ensures that the infant continues to receive the benefits of breastmilk while the mother is temporarily unable to breastfeed due to the surgery. Option A, weaning the baby to formula, is not recommended as it can disrupt the established breastfeeding relationship, reduce the mother's milk supply, and deprive the baby of the unique nutrients and antibodies found in breastmilk. Option B, having the baby stay in the hospital room with the mother, may not be feasible during the postoperative period when the mother may not be able to care for the infant adequately due to her recovery needs. Option C, having the woman pump and dump her milk for two weeks, is unnecessary and can lead to a decrease in the mother's milk supply as breastfeeding works on a supply-demand basis. It also unnecessarily deprives the infant of valuable breastmilk. Educationally, this scenario highlights the importance of considering the well-being of both the mother and the infant in situations where breastfeeding may be temporarily interrupted. It emphasizes the need for healthcare providers to support breastfeeding mothers in maintaining their milk supply and providing breastmilk to their infants even during times of medical interventions.

Correct Answer: C

Rationale: The priority nursing diagnosis for a woman who is PP1 from a spontaneous vaginal delivery with significant postpartum hemorrhage is C) Fluid volume deficit related to blood loss. This is the correct answer because postpartum hemorrhage can lead to a rapid loss of blood volume, potentially resulting in hypovolemic shock and other serious complications. Replenishing the lost fluids is crucial to stabilize the woman's condition and prevent further complications. Option A) Alteration in comfort related to afterbirth pains is important but not the priority in this situation. Pain management is essential, but addressing fluid volume deficit takes precedence due to the potential life-threatening consequences of hemorrhage. Option B) Risk for altered parenting related to grand multiparity is not a priority in the immediate postpartum period. While it is important to support new mothers in their parenting journey, addressing a physiological issue like fluid volume deficit is more urgent. Option D) Risk for sleep deprivation related to mothering role is also not the priority in this scenario. While fatigue and sleep deprivation can impact the new mother's well-being, addressing the physical health issue of fluid volume deficit is more critical for her immediate recovery and safety. In an educational context, understanding the hierarchy of nursing priorities is crucial for providing effective and efficient care. By prioritizing the most critical needs of the patient, nurses can ensure that life-threatening issues are addressed promptly, leading to better patient outcomes. In the case of postpartum hemorrhage, identifying and managing fluid volume deficit is a priority to stabilize the woman's condition and prevent complications.

Correct Answer: D

Rationale: The correct answer is D) Are there many stairs in your home? Postpartum care after a cesarean delivery involves considering the physical limitations of the mother. Asking about stairs at home is crucial as climbing stairs can be challenging post-cesarean and can impact the mother's recovery. This question helps assess the client's potential mobility challenges and the need for additional support or modifications at home to ensure a safe and smooth transition post-discharge. A) Asking about previous anesthesia history is important but not as immediately relevant to post-discharge care after a cesarean delivery. B) Inquiring about allergies is essential for medical safety but is not directly related to discharge planning in this context. C) Asking about scarring propensity is not as critical as assessing the client's immediate environment and physical challenges post-cesarean delivery. Educationally, this question highlights the importance of tailoring discharge planning to the individual needs of postpartum mothers, considering their specific circumstances and potential challenges to optimize their recovery and ensure a successful transition to home care.

Correct Answer: C

Rationale: In this scenario, option C, "She may have a hidden laceration," is the most appropriate conclusion for the nurse to make about the client. This is because despite the client having a spontaneous vaginal delivery over an intact perineum, the persistence of severe perineal pain (level 9 on a 10-point scale) one hour after taking ibuprofen could indicate a hidden laceration that was not initially detected during the assessment. Option A, "She should be assessed by her doctor," could be considered less urgent compared to the potential of a hidden laceration causing the severe pain. Option B, "She should have a sitz bath," might provide some relief but does not address the underlying cause of the severe pain. Option D, "She needs a narcotic analgesic," is not the first-line treatment for postpartum perineal pain and should be avoided unless absolutely necessary due to potential side effects and risks. From an educational perspective, it is crucial for nurses to understand the significance of persistent severe pain postpartum, especially in the context of perineal discomfort. This case highlights the importance of thorough assessment, including the possibility of hidden lacerations, to ensure appropriate and timely interventions for postpartum clients. Early detection and management of complications can significantly impact the client's recovery and overall postpartum experience.

Correct Answer: D

Rationale: The appropriate response by the nurse is option D) Women who have implants are often able exclusively to breastfeed. This response is correct because breast implants do not typically interfere with a woman's ability to breastfeed. Breast augmentation surgery usually does not affect the function of the mammary glands responsible for milk production. Option A is incorrect because breast implants do not inherently contaminate breast milk with toxins. Option B is incorrect as it inaccurately suggests that women who need breast implants lack sufficient glandular tissue for breastfeeding. Option C is also incorrect as babies can usually latch onto the nipples of women with breast implants without significant difficulty. Educationally, it is crucial for healthcare providers to have accurate information about the impact of breast augmentation on breastfeeding to provide appropriate support and guidance to women. Understanding that breast implants generally do not impede breastfeeding can help alleviate concerns and encourage women who have had breast augmentation surgery to confidently pursue breastfeeding if they choose to do so.