A nurse is caring for a client at 35 weeks of gestation who has preeclampsia with severe features and is scheduled for an immediate induction of labor after the manifestations worsened. The client is upset because the provider has disregarded their birth plan. Which of the following considerations should the nurse implement for the client?
Antenatal steroid administration
Expectant management protocols
Method of birth
Shared decision-making
The Correct Answer is D
A. Antenatal steroid administration: Antenatal steroids (e.g., betamethasone) are used to enhance fetal lung maturity in preterm pregnancies (<34 weeks). At 35 weeks, steroids are generally not indicated.
B. Expectant management protocols: Expectant management (delaying delivery with close monitoring) is considered in mild preeclampsia but is not appropriate in severe preeclampsia due to the risk of maternal and fetal complications.
C. Method of birth: The method of birth (vaginal vs. C-section) is determined based on maternal and fetal conditions. While important, it is not the key consideration in addressing the client's concern about their birth plan.
D. Shared decision-making: Shared decision-making ensures that the client feels heard and involved in their care plan, even in urgent situations. The nurse should acknowledge the client's concerns, explain the rationale for induction, and explore possible accommodations for their birth plan.
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Correct Answer is D
Explanation
A. Increase the client's IV fluid infusion rate. While increasing IV fluids can improve placental perfusion, the priority intervention for late decelerations is repositioning the client to relieve uteroplacental insufficiency.
B. Palpate the client's uterus. Uterine palpation helps assess for tachysystole (excessive contractions), which could contribute to late decelerations. However, this is not the priority intervention.
C. Administer oxygen to the client. Oxygen administration (8-10 L/min via face mask) improves fetal oxygenation, but repositioning the client should be done first to relieve pressure on the placenta.
D. Turn the client onto her side. Repositioning the client to the left or right lateral position improves uteroplacental circulation and reduces compression of the inferior vena cava, increasing blood flow to the fetus.
Correct Answer is D
Explanation
A. "I will need to eat 600 more calories per day because I am pregnant." Pregnant clients with diabetes require careful calorie management. The recommended increase is about 300 kcal/day, not 600, to support fetal growth while maintaining glycemic control.
B. "I will plan my diet based on the results of urine glucose testing." Urine glucose testing is not a reliable indicator of blood glucose control because it does not reflect real-time fluctuations. Clients should base dietary adjustments on blood glucose monitoring.
C. "I can continue with the same diet as before pregnancy as long as it is well balanced." Pregnancy alters insulin needs, requiring dietary modifications to maintain blood glucose control. Carbohydrate intake must be carefully regulated to prevent hyperglycemia.
D. "Diet and insulin needs change during pregnancy." Hormonal changes in pregnancy increase insulin resistance, necessitating adjustments in diet and insulin therapy to maintain optimal blood glucose levels.
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