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 ["C"]
Explanation
The correct answers are choices C, D, and E.
Choice A rationale:
Constipation is not a sign of labor. It is more commonly associated with pregnancy rather than the onset of labor.
Choice B rationale:
Weight gain is not a sign of labor. In fact, weight gain often stops as labor approaches.
Choice C rationale:
Bloody show is a sign of labor. It is the discharge of the mucus plug that seals the cervix during pregnancy.
Choice D rationale:
Lightening, or the baby dropping into the pelvis, is a sign of labor.
Choice E rationale:
Backache can be a sign of labor, as the muscles and joints stretch and shift in preparation for childbirth.
Correct Answer is B
Explanation
The correct answer is choice B.
Choice A rationale:
Stimulating the infant to cry is important, but it is not the first action to be taken.
Choice B rationale:
Clearing the respiratory tract is the first action to be taken to ensure the newborn can breathe properly.
Choice C rationale:
Drying the infant off and covering the head is done after the respiratory tract is cleared.
Choice D rationale:
Cutting the umbilical cord is done after the infant is stabilized.
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