A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

Choice A Reason:

"Do your contractions feel further apart?" This question does not directly assess the effectiveness of the hands-and-knees position in rotating the baby or relieving discomfort associated with occipitoposterior position. It focuses on the timing of contractions rather than the impact of the position change.

Choice B Reason:

"Are you feeling relief from your pelvic pressure?" Pelvic pressure is more associated with the descending fetus and the overall labor process. The hands-and-knees position is mainly intended to alleviate back pain caused by the fetus's occipitoposterior position, rather than pelvic pressure.

Choice C Reason:

"Has your back labor improved?" The hands-and-knees position is often used to help alleviate back labor, a common issue with a fetus in the occipitoposterior position. The pressure from the fetal head on the mother's spine can cause significant back pain, and the hands-and-knees position can help by shifting the fetal position slightly and relieving some of this discomfort.

Choice D Reason:

"Does that lessen your suprapubic pain?" Suprapubic pain is more related to the pressure of the descending fetus on the bladder and the lower uterus. While the hands-and-knees position may alleviate some discomfort, it is primarily aimed at relieving back labor caused by the occipitoposterior position, not suprapubic pain.

Explanation

Choice A Reason:

While asking the client can provide some information, it relies on self-reporting, which may not always be accurate. Clients might forget doses, misunderstand instructions, or provide inaccurate information, whether intentional or unintentional. Therefore, this method is not the most reliable way to assess medication adherence.

Choice B Reason:

Digoxin can affect the heart rate, so checking the apical pulse is important for monitoring potential side effects, such as bradycardia. However, the pulse rate alone does not provide direct evidence of whether the client is taking the medication consistently or correctly. The pulse can be influenced by various factors and may not accurately reflect medication adherence.

Choice C Reason:

Checking the serum medication level provides an objective measurement of whether the client is taking digoxin as prescribed. This is a direct indicator of medication adherence and is particularly important for a medication like digoxin, which requires precise dosing to avoid toxicity or subtherapeutic effects.

Choice D Reason:

Assessing kidney function is crucial when managing a client on digoxin because impaired kidney function can lead to digoxin toxicity. However, this assessment does not directly measure whether the client is taking the medication as prescribed. It's more about ensuring the safe use of the drug rather than evaluating adherence.