A pregnant client late in the second trimester comes to the emergency department with a report of painless, bright red vaginal bleeding.
The client states, "It started all of a sudden and now it seems to have stopped.”. What action is the priority for this client on admission?

Choice A rationale

Lanolin cream is used to treat or prevent sore, cracked nipples by providing a moisturizing barrier. It is not an effective measure for treating breast engorgement, which is caused by venous and lymphatic stasis and milk accumulation, leading to painful swelling. Treatment focuses on relief of swelling and efficient milk removal.

Choice B rationale

Encouraging the mother to wear a firm-fitting, supportive bra or apply breast binding provides compression to the breasts. This compression helps to inhibit milk production by mechanically interfering with milk removal and reducing local circulation, which alleviates the swelling and discomfort associated with engorgement.

Choice C rationale

Decreasing fluid intake to an extremely low level (<500 mL/24 hours) is ineffective and potentially detrimental to the mother's overall hydration status. Engorgement is a local breast issue involving fluid shifts and milk stasis, and systemic hydration levels do not directly resolve the breast swelling.

Choice D rationale

Discontinuing breastfeeding will worsen engorgement because the breasts will become fuller and the pressure will increase, leading to more discomfort. The appropriate management for engorgement is frequent and effective milk removal, typically through continued nursing or pumping, along with local comfort measures.

Choice A rationale

The "taking in" phase immediately follows birth and typically lasts 1-2 days. During this period, the mother is largely passive and dependent, focusing on her own needs for rest and nourishment, and reliving the birth experience. She is often content to let others provide care for the infant while she rests and recovers.

Choice B rationale

The "letting go" phase is the final phase, occurring once the mother has settled at home, and involves the mother moving forward as a family unit. This phase involves relinquishing the previous childless lifestyle and adapting to her new role, including accepting the infant's increasing independence and addressing relationship changes with her partner.

Choice C rationale

The "taking hold" phase usually begins on the second or third day and lasts for several weeks. The mother becomes more independent and actively focused on the newborn's needs, exhibiting a strong interest in learning and taking charge of infant care. Asking multiple questions about care is a hallmark of this phase.

Choice D rationale

Early parenting is a broader, less specific term than the Reva Rubin's three-stage framework. While the behavior is certainly a part of early parenting, the phases ("taking in," "taking hold," and "letting go") specifically describe the mother's psychological adjustment to her new role and are the correct terminology for this specific behavioral stage.