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A 30-year-old multiparous woman has a boy who is 2 1/2 years old and now an infant girl.

She tells the nurse, "I don't know how I'll ever manage both children when I get home.”. Which suggestion would best help this woman alleviate sibling rivalry?

Realize that the regression in habits and behaviors in the older child is a typical reaction and that he needs extra love and attention at this time.

Tell the older child that he is a big boy now and should love his new sister.

Ask friends and relatives not to bring gifts to the older sibling because you do not want to spoil him.

Let the older child stay with his grandparents for the first 6 weeks to allow him to adjust to the newborn.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The regression in habits and behaviors, like a return to thumb-sucking or wetting the bed, is a common manifestation of sibling rivalry and is the older child's unconscious attempt to regain parental attention by acting like the infant. The best approach is to affirm the older child's need for extra love and attention and acknowledge that these feelings are typical, validating his emotional response to the newborn's presence and minimizing punitive reactions.

Choice B rationale

Telling the older child he is a "big boy" and instructing him to "love his new sister" invalidates his complex emotional response to the change, which often includes feelings of resentment or displacement. This statement creates an unrealistic expectation and can intensify feelings of inadequacy or hostility toward the newborn, rather than alleviating the underlying causes of sibling rivalry which require emotional support.

Choice C rationale

Asking friends and relatives not to bring gifts for the older sibling removes a crucial opportunity to help the older child feel included and valued amidst the focus on the newborn. Bringing the older child gifts, especially those "from the baby," helps mitigate feelings of being overlooked and reinforces the message that he is still important to the family, thereby reducing rivalry.

Choice D rationale

Allowing the older child to stay away from the home for 6 weeks during the newborn period may intensify the child's feeling of being displaced or abandoned by the parents. Rather than promoting adjustment, this absence can create further distance and difficulty reintegrating the older child into the new family dynamic, increasing the risk of more severe sibling rivalry upon return. —.

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Correct Answer is A

Explanation

Choice A rationale

A hemoglobin level less than 10 g/dL post-delivery indicates anemia, potentially due to excessive blood loss during birth, with the normal range for postpartum women being around 11-15 g/dL. Significant anemia can cause fatigue, dizziness, and insufficient oxygen-carrying capacity, elevating the risk of complications and requiring further investigation or intervention like iron supplementation or possibly a transfusion, thereby preventing the standard 24 to 48-hour early discharge.

Choice B rationale

An episiotomy healing site that is dry, approximated, and only exhibits slight redness and edema suggests normal, uncomplicated wound healing, which is an expected finding in the immediate postpartum period. This finding does not signify infection or dehiscence, which are complications that would warrant extended hospitalization, thus this condition would not impede an early discharge, provided other criteria are met.

Choice C rationale

Voids of 200 to 300 mL per void are within the expected, adequate range for a postpartum woman, demonstrating satisfactory bladder emptying and function. Normal postpartum void volumes vary but this quantity shows the woman is avoiding urinary retention, a common complication after birth that can lead to infection or uterine displacement, thus this finding would support, not prevent, early discharge.

Choice D rationale

A birth occurring at 38 weeks of gestation is classified as a term birth, as term is generally defined as 37 weeks 0 days through 41 weeks 6 days gestation. Term newborns are typically physiologically mature and less prone to adaptation issues than preterm infants, and therefore, being 38 weeks pregnant at delivery is a normal circumstance that supports, rather than prevents, an early postpartum discharge. —.

A. Excessive uterine bleeding. B. A ruptured bladder. C. Urinary tract infection. D. Bladder wall atony.

Correct Answer is A

Explanation

Choice A rationale

A distended bladder displaces the uterus superiorly and laterally, most commonly to the right, as described. This displacement physically impedes the uterus from contracting effectively (uterine atony), preventing the compression of blood vessels at the placental site. The most serious consequence of this inability to contract is excessive uterine bleeding or postpartum hemorrhage.

Choice B rationale

A ruptured bladder is extremely rare in the immediate postpartum period solely due to simple distention. While prolonged, severe distention can lead to complications, the immediate and most common danger is compromised uterine contractility, not a structural rupture of the bladder wall.

Choice C rationale

A urinary tract infection (UTI) is a potential consequence of bladder distention because urinary stasis promotes bacterial growth. However, a UTI develops over time and is not the immediate or most serious risk compared to acute postpartum hemorrhage from uterine atony.

Choice D rationale

Bladder wall atony (loss of muscle tone) can result from overdistention and may hinder the bladder from emptying properly. While true, this is a cause or complication of the distention itself, but the resulting uterine atony and subsequent hemorrhage pose a more immediate and serious threat to maternal stability. —.

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A 30-year-old multiparous woman has a boy who is 2 1/2 years old and now an infant girl. She tells the nurse, "I don't know how I'll ever manage both children when I get home.”. Which suggestion would best help this woman alleviate sibling rivalry?

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What could prevent early discharge of a postpartum woman?

Correct Answer is A

Explanation

Correct Answer is A

Explanation

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A 30-year-old multiparous woman has a boy who is 2 1/2 years old and now an infant girl.

She tells the nurse, "I don't know how I'll ever manage both children when I get home.”. Which suggestion would best help this woman alleviate sibling rivalry?