A nurse is planning care for a client in the postpartum unit.
What goals should the nurse identify for the client to accomplish during the taking-in phase of postpartum adjustment?
The client will demonstrate proper bathing of the infant.
The client will verbalize appropriate car seat safety.
The client will have adequate nutritional intake.
The client will identify necessary family roles.
The Correct Answer is C
Choice A rationale
While demonstrating proper bathing of the infant is an important skill for new mothers, it is not typically a primary goal during the taking-in phase. This phase is characterized by the mother’s need to review her birth experience and begin to process her new role.
Choice B rationale
Verbalizing appropriate car seat safety is important, but it is not a primary goal during the taking-in phase. This phase is more focused on the mother’s internal processing of her birth experience.
Choice C rationale
This is the correct answer. Having adequate nutritional intake is a key goal during the taking-in phase. Good nutrition is essential for healing and recovery after childbirth, as well as for breastfeeding.
Choice D rationale
Identifying necessary family roles is an important part of adjusting to parenthood, but it is not a primary goal during the taking-in phase. This phase is more about the mother’s personal adjustment and recovery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Terbutaline, a medication used to suppress preterm labor, can cause heart palpitations as an adverse effect. This is due to its action as a beta-adrenergic agonist, which can increase heart rate.
Choice B rationale
Bradycardia, or a slow heart rate, is not a typical adverse effect of terbutaline. Terbutaline is more likely to cause tachycardia, or a fast heart rate.
Choice C rationale
Hot flashes are not a common adverse effect of terbutaline. They are more commonly associated with hormonal changes, such as those that occur during menopause.
Choice D rationale
Shortness of breath is not a typical adverse effect of terbutaline. However, if it occurs, it could indicate a serious condition like pulmonary edema and should be reported immediately.
Correct Answer is D
Explanation
Choice A rationale
A previous delivery at 37 weeks gestation does not necessarily indicate a risk for preterm delivery. Preterm delivery is defined as delivery before 37 weeks of gestation.
Choice B rationale
A previous delivery of a newborn weighing 2.5 kg (5.5 lb) does not indicate a risk for preterm delivery. Low birth weight can be a result of preterm delivery, but it can also be due to other factors such as intrauterine growth restriction.
Choice C rationale
A previous reactive non-stress test does not indicate a risk for preterm delivery. A reactive non-stress test is a positive sign of fetal well-being.
Choice D rationale
A previous cervical cerclage indicates a risk for preterm delivery. Cervical cerclage is a procedure performed to prevent preterm birth in women with a history of preterm birth and who have a short cervix.
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