A nurse is assessing a postpartum woman.
Which behavior would the nurse interpret as an indication that the woman is entering the taking-hold phase of the postpartum period?
She did her perineal care independently.
She is eager to talk about her birth experience.
She has not asked for anything for pain all day.
She sits and rocks her infant for long intervals.
The Correct Answer is A
The correct answer is choice A. She did her perineal care independently.
Choice A rationale:
Taking the initiative for caring for her newborn independently while managing her own postpartum needs marks the taking-hold phase of infant bonding.
Choice B rationale:
Being eager to talk about her birth experience is more associated with the taking-in phase, not the taking-hold phase.
Choice C rationale:
Not asking for anything for pain all day is not a specific indicator of the taking-hold phase.
Choice D rationale:
Sitting and rocking her infant for long intervals is not a specific indicator of the taking-hold phase.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is choice A.
Choice A rationale:
Evaluating the firmness of the uterus (fundus) is the first action the nurse should take when a client’s blood pressure drops postpartum. A soft or “boggy” uterus can indicate uterine atony, a leading cause of postpartum hemorrhage, which can lead to hypotension.
Choice B rationale:
Obtaining a type and crossmatch is important if the client needs a blood transfusion, but it is not the first action the nurse should take.
Choice C rationale:
Administering oxytocin infusion can help contract the uterus and control bleeding, but the nurse should first assess the uterus.
Choice D rationale:
Initiating oxygen therapy can help if the client is hypoxic, but the nurse should first assess the uterus.
Correct Answer is D
Explanation
The correct answer is choice D.
Choice A rationale:
Washing the cord daily with mild soap and water is not recommended as it can delay healing and increase the risk of infection.
Choice B rationale:
Applying petroleum jelly to the cord stump is not recommended as it can create a moist environment that promotes bacterial growth.
Choice C rationale:
The diaper should be folded down to keep the cord stump dry and exposed to air, which promotes healing.
Choice D rationale:
Giving a sponge bath until the cord stump falls off is recommended to keep the area dry and prevent infection.
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