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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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A decrease in fetal heart rate during monitoring: A decrease in fetal heart rate (deceleration) is not a reassuring sign and suggests fetal distress, which is not considered reactive.
B. The presence of at least two fetal heart rate accelerations during 20 minutes of monitoring: A reactive NST is defined as at least two fetal heart rate accelerations of 15 beats per minute lasting at least 15 seconds within a 20-minute period, indicating fetal well-being.
C. A rise in fetal heart rate of at least 15/min from baseline lasting for at least 15 seconds: While this is part of the criteria for determining accelerations, the key aspect of a reactive NST is the presence of at least two such accelerations within a 20-minute period.
D. The absence of fetal heart rate accelerations during monitoring: The absence of accelerations in a 40-minute period is classified as a nonreactive NST, which may indicate fetal hypoxia or other concerns requiring further evaluation.
Correct Answer is D
Explanation
A. Increase the rate of maintenance IV infusion. Increasing IV fluids may help improve placental perfusion, but it is not the first action. Repositioning the client takes priority to improve blood flow before considering IV adjustments.
B. Administer oxygen using a nonrebreather mask. Oxygen is beneficial in improving fetal oxygenation, but positioning the client laterally should be done first to optimize blood flow before oxygen administration.
C. Elevate the client’s legs. Elevating the legs may be helpful in cases of hypotension, but this scenario describes late decelerations, which are related to uteroplacental insufficiency.
D. Place the client in the lateral position. Late decelerations are caused by uteroplacental insufficiency, leading to fetal hypoxia. The first action is to reposition the client to the lateral position, which improves blood flow to the placenta and enhances fetal oxygenation.
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