A nurse is caring for a client who is in the latent phase of the first stage of labor and is in pain.
Which of the following nursing interventions are appropriate to reduce pain? (Select all that apply.)

Correct answer: C-"You should hold your newborn in your arms when you introduce him to your toddler.”

Choice A is not an answer because this approach is not suitable for dealing with regressive behaviors in toddlers. Regressive behavior, such as wanting to sleep in the crib or revert to bottle-feeding, is a normal response to the stress of a new sibling. Instead of punishment, parents should provide reassurance, comfort, and understanding. Time-outs may exacerbate feelings of insecurity rather than alleviate them.

Choice B is not an answer because While transitioning a toddler out of the crib can be a part of preparation, it should not be rushed. Doing so too early may create unnecessary stress for the toddler. The best time to make significant changes (like transitioning to a bed) is when the toddler is ready, and it should be done with care and gradual preparation, not too close to the arrival of the baby.

Choice C is the most appropriateanswer becauseIt’s important to allow the toddler to feel involved and included in the process, but holding the newborn during the introduction helps minimize feelings of jealousy and ensures the toddler doesn't feel displaced. Holding the baby allows the toddler to approach the situation more calmly, and it can also help foster a sense of love and comfort for both the toddler and the newborn.

Choice D:While it’s important to reassure the toddler that they are still loved and important, this statement might unintentionally increase anxiety or make the toddler feel less valued. Instead, the nurse should encourage a positive approach, where the toddler can learn how to be a helper and feel involved in the care of the newborn. It’s essential to focus on inclusivity rather than highlighting potential feelings of neglect.

A client who is postpartum and experiencing hypovolemic shock would have cool, clammy skin.
This is because hypovolemic shock severely limits the body’s ability to get blood
to all of its organs.

Choice B is not correct because a urinary output of 30 mL/hr is within the
normal range.
Choice C is not correct because a client experiencing hypovolemic shock would have a weak pulse, not a bounding one.
Choice D is not correct because a respiratory rate of 18/min is within the normal range, while a client experiencing hypovolemic shock would have an increased respiratory rate.