The nurse is assessing the client's transition to the taking-hold phase after an uncomplicated vaginal birth.
Which behavior by the mother best indicates this transition is occurring?

Choice A rationale

Clear fluid oozing from a pilonidal sinus is unrelated to congenital hip dysplasia and more associated with other conditions like pilonidal cysts.

Choice B rationale

A positive hip click can indicate hip instability but is not definitive for congenital hip dysplasia.

Choice C rationale

Erythema toxicum is a benign, self-limiting skin condition and does not relate to hip dysplasia.

Choice D rationale

Limited abduction of the hip is a key sign of congenital hip dysplasia, indicating restricted movement due to abnormal hip joint development. .

Choice A rationale

A red, tender area on the breast could indicate mastitis, an infection of the breast tissue. This requires prompt medical attention to prevent complications and provide appropriate treatment, often involving antibiotics.

Choice B rationale

A temperature of 100.8°F is considered a fever and could indicate an infection. Postpartum clients are at risk of infections, including endometritis, and should report any fever to their healthcare provider for further evaluation.

Choice C rationale

Burning on urination could indicate a urinary tract infection (UTI). UTIs are common postpartum due to catheter use and trauma during delivery. This symptom should be reported for evaluation and treatment if necessary.

Choice D rationale

Increased lochia rubra can indicate postpartum hemorrhage or retained placental fragments. Any significant change in bleeding pattern should be reported to ensure timely management and prevent serious complications.