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. 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.
Correct Answer is C
Explanation
A. Viability of the fetus: The client reports fetal movement, indicating viability. While fetal well-being is always a consideration, the priority here is determining the cause of the bleeding.
B. The biparietal diameter: The biparietal diameter (BPD) is used to assess fetal head size and estimate gestational age, which is not relevant to the client’s bleeding.
C. Location of the placenta: The priority in evaluating third-trimester bleeding is ruling out placenta previa (where the placenta covers the cervix) or placental abruption. Ultrasound helps determine if the placenta is improperly positioned.
D. Fetal lung maturity: Fetal lung maturity is assessed when preterm delivery is being considered, typically before 37 weeks, but it is not the primary concern in assessing vaginal bleeding.
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