Which behavior indicates to the nurse that a new mother is in the taking-hold phase

Postpartum breast engorgement occurs 48 to 72 hours after giving birth. What physiologic change influences breast engorgement?

A. An increase in blood and lymph supply to the breasts
B. An increase in estrogen and progesterone levels
C. Colostrum production increases dramatically.
D.Fluid retention in the breasts due to the intravenous fluids given during labor

1. The correct response is A. Engorgement refers to the swelling of the breast tissue as a result of an increase in blood and lymph supply to produce milk for the newborn. Estrogen and progesterone levels decrease, which allows prolactin to stimulate the glands to secrete milk. Their levels are restored when the first menses returns several weeks or months later, depending on the lactation status of the mother. Colostrum is a lemon-colored fluid secreted by both breasts immediately at birth, and within 4 to 5 days postpartum it gradually changes to transitional milk and finally mature milk by 2 weeks. Colostrum production reduces within days after childbirth as transitional and mature milk, thereby not contributing to breast engorgement.

In the taking-in maternal role phase described by Rubin (1984), the nurse would expect the woman’s behavior to be characterized as which of the following?

A. Gaining self-confidence
B. Adjusting to her new relationships
C. Being passive and dependent
D. Resuming control over her life

2. The correct response is C. According to Reva Rubin, the mother is very passive and is dependent on others to care for her for the first 24 to 48 hours after giving birth. Gaining self-confidence would characterize a mother in the taking-hold phase, during which the mother demonstrates mastery over her own body’s functioning and feels more confident in caring for her newborn. Adjustment to relationships does not occur until the third phase, letting go, when the mother begins to separate from the symbiotic relationship she and her newborn enjoyed during pregnancy and birth. Resuming control over her life would denote the second phase of taking hold, during which the mother does resume control over her life and gains self-confidence in her newborn care.

The nurse is explaining to a postpartum woman 48 hours after her giving childbirth that the afterpains she is experiencing can be the result of which of the following?

A. Abdominal cramping is a sign of endometriosis.
B. A small infant weighing less than 8 pounds
C. Pregnancies that were too closely spaced
D. Contractions of the uterus after birth

3. The correct response is D. The direct cause of afterpains is uterine contractions. Mothers experience abdominal pain secondary to contractions, especially when breast-feeding because sucking stimulates the release of oxytocin from the posterior pituitary gland, which causes uterine contractions. There is no association of afterpains with endometriosis. The small size of the newborn wouldn’t stretch her uterus, thus would not be a contributing factor to her discomfort now. Pregnancies spaced too close together can contribute to frequent stretching of the uterus, but this is not the cause of afterpains.

The nurse would expect a postpartum woman to demonstrate lochia in which sequence?

A. Rubra, alba, serosa
B. Rubra, serosa, alba
C. Serosa, alba, rubra
D. Alba, rubra, serosa

4. The correct response is B. Lochia discharge from the uterus proceeds in an orderly fashion, regardless of a surgical or vaginal birth. Its color changes from red to pink to whitish cream consistently, unless there is a complication. The correct sequence is rubra (red), then serosa (pink/brownish), and then alba (white, creamy).

The nurse is assessing Ms. Smith, who gave birth to her first child 5 days ago. What findings by the nurse would be expected?

A. Cream-colored lochia; uterus above the umbilicus
B. Bright-red lochia with clots; uterus 2 fingerbreadths below umbilicus
C. Light pink or brown lochia; uterus 4 to 5 fingerbreadths below umbilicus
D. Yellow, mucousy lochia; uterus at the level of the umbilicus

5. The correct response is C. The nurse would expect light pink or brown lochia, and the uterus should be four to five fingerbreadths below the umbilicus. Cream-colored lochia wouldn’t be seen for about 10 to 14 days after childbirth, thus it wouldn’t be observed this early in the postpartum period. The uterus would be involuting downward into the pelvis, thus it would not be above the umbilicus by this timeframe. Bright-red lochia would be observed for up to 3 days postbirth, not 5 days later unless there was a problem. The uterus descends into the pelvis at a rate of 1 cm/day, thus the fundus should be 4 to 5 cm (fingerbreadths) below the umbilicus by now.

Prioritize the postpartum mother’s needs 4 hours after giving birth by placing a number 1, 2, 3, or 4 in the blank before each need.

_________ Learn how to hold and cuddle the infant.
_________Watch a baby bath demonstration given by the nurse.
_________ Sleep and rest without being disturbed for a few hours.
_________ Interaction time (first 30 minutes) with the infant to facilitate bonding
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6. The correct answer would be:

1. Interaction time (first 30 minutes) with the infant to facilitate bonding

2. Sleep and rest without being disturbed for a few hours

3. Learn how to hold and cuddle the infant

4. Watch a baby bath demonstration given by the nurse

Immediately after childbirth in the recovery area, the nurse observes the mother’s partner’s fascination and interest in the new son. This behavior is often termed:

A. Attachment
B. Engrossment
C. Bonding
D. Temperament

7. The correct response to the question is “B” because partner’s or significant others’ developing bond with the newborn—a time of intense absorption, preoccupation, and interest—is called engrossment. Responses “A,” “C,” and “D” are incorrect since they are terms typically describing the close relationship between the mother–infant dyad, not the father.

After the nurse provides instructions to a postpartum woman about postpartum blues, which statement would indicate understanding of it? I will

A. Need to take medication daily to treat the anxiety and sadness.”
B. “Call the OB support line only if I start to hear voices.”
C. “Contact my doctor if I become dizzy and fell nauseated.”
D. “Feel like laughing 1 minute and crying the next minute.”

8. The correct response to this question is “D” because emotional lability is typical of postpartum blues which is usually self-limiting. Response “A” is incorrect since postpartum blues don’t require any medication to treat. Response “B” is incorrect since this behavior would indicate postpartum psychosis and not merely the “blues.” Response “C” would indicate a physical condition, such as infection, not a mental disorder.

Case study
1. A new nurse assigned to the postpartum mother–baby unit makes a comment to the oncoming shift that, a 25-year-old primipara patient, seems lazy and shows no initiative in taking care of herself or her baby. The nurse reported that this new mother talks excessively about her labor and birth experience and seems preoccupied with herself and her needs, not her newborn’s care. She wonders if something is wrong with this mother because she seems so self-centered and has to be directed to do everything.

a. Is there something “wrong” with Ms. Griffin’s behavior? Why or why not?
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No, this is typical behavior for a new mother within the first 2 days after giving birth.
b. What maternal role phase is being described by the new nurse?
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This behavior is characteristic of Reva Rubin’s taking-in phase, which covers the first 48 hours after childbirth. The new mother is typically focused on her own needs for rest, food, and comfort. New mothers in this phase tend to be passive and take directions/suggestions well from staff. Preoccupation with themselves rather than their newborns is normal during this phase. Their needs must be met before they can begin to care for others.
c. What role can the nurse play to support the mother through this phase?
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The nurse can be supportive through this early phase by providing a restful, quiet environment to facilitate her recovery from childbirth. Providing her with simple guidance and suggestions of how she can care for herself and her newborn will assist the new mother in expanding her focus. Praising her for her accomplishments in care will reinforce it.

Case study
Mrs. Lenhart, a primipara, gave birth to a healthy baby boy yesterday. Her partner seemed elated at the birth, calling their friends and family on his cell phone minutes after the birth. He passed out cigars and praised his wife for her efforts. Today, when the nurse walked into their room, her partner seemed very anxious around his new son and called for the nurse whenever the baby cried or needed a diaper change. He seemed standoffish when asked to hold his son, and he spent time talking to other fathers in the waiting room, leaving his wife alone in the room.

a. Would you consider Mr. Lenhart’s paternal behavior to be normal at this time?
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Yes, inexperienced first-time fathers are anxious around their newborns because this is a new experience for them and many do not know how to handle or care for their newborns yet. Paternal attachment is a gradual process that occurs over weeks and months.
b. What might Mr. Lenhart be feeling at this time?
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He is probably feeling overwhelmed with this tiny baby and, although he probably wants to help, he is anxious about how or what to do without appearing awkward.
c. How can the nurse help this new father adjust to his new role?
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The nurse can help new fathers adjust to their role by taking time to listen to their concerns and demonstrating how they can become involved in the care of their newborn. Staying in the room and physically supporting the father as he tries out his new role will provide encouragement for him to become involved. The nurse can slowly introduce fathers to the care needs of their newborn and encourage their participation. This supportive role by the nurse can help reduce role strain and enhance family adjustment.

The term that describes the return of the uterus to its prepregnant state is 

A deviated fundus to the right side of the abdomen would indicate a 

Is the following statement True or False?
The drop in maternal blood volume after birth leads to a similar drop in hematocrit.

b. False
Despite the decrease in blood volume, the hematocrit level remains relatively stable and may even increase, reflecting the predominant loss of plasma.

For the woman who is not breast-feeding her newborn, which measure would be most appropriate to relieve engorgement?

a. Warm showers
b. Nipple stimulation
c. Ice to the breasts
d. Manually expressing milk

c. Ice to the breasts
For the woman who is not breast-feeding,measures to relieve engorgement include applying ice to the breasts for 15 to 20 minutes every other hour. Warm showers promote the let-down reflex are encouraged for the woman who is breast- feeding and experiencing engorgement. Any stimulation of the breasts, such as nipple stimulation or manual milk expression, is to be avoided for the woman who is not breast-feeding.

Lochia typically begins as lochia serosa.

________ or swelling of the breast tissue occurs usually 2 to 4 days after birth.

The postpartum period begins with the birth of the newborn.

_________ refers to the uterine contractions that occur after birth.

Profuse diaphoresis is common during the early postpartum period.

The postpartum woman commonly exhibits bradycardia.

Fathers or partners go through three stages in their role development process: ________, reality, and transition to mastery.

Lochia _______ occurs from postpartum days 10 to 14.

Cardiac output quickly returns to nonpregnant values after birth.

The uterus returns to its normal size through a process called _________.

Which behavior indicates to a nurse that a new mother is in the taking hold face?

Which behavior would the postpartum woman demonstrate during the taking

What is the taking

Which phase is commonly seen in a new mother shortly after delivery?