A nurse is placing a fetal spiral electrode (FSE) on baby "A" for a client in labor with twins.

The nurse reviews the client's history.

Which of the following is a contraindication for FSE placement?

Choice A rationale

Counting fetal movements for two hours after a meal or during periods of increased fetal activity is recommended because maternal glucose levels rise post-prandially, providing energy to the fetus and often leading to increased movement. This specific timeframe allows for an adequate period to monitor and establish a baseline of fetal well-being, as healthy fetuses typically exhibit predictable periods of wakefulness and sleep.

Choice C rationale

Maintaining a daily log is crucial for tracking trends in fetal movement over time. A significant decrease, or a notable change from the established baseline, can be an early indicator of potential fetal distress, such as placental insufficiency or hypoxia. Promptly reporting these changes to a healthcare provider enables timely intervention and further diagnostic testing, such as a biophysical profile or non-stress test.

Choice D rationale

Performing the kick count at the same time each day is essential for consistency in data collection. This practice minimizes the influence of diurnal variations in both maternal and fetal activity levels, providing a more reliable and comparable baseline for assessment. A consistent approach helps the healthcare provider accurately evaluate the fetus’s well-being and identify any deviations from the established pattern.

Choice B rationale

Counting for only five minutes is an insufficient amount of time to accurately assess fetal movement. Fetal sleep cycles can last for twenty to forty minutes, so a five-minute window may not capture a period of activity. This brief duration does not provide an adequate representation of overall fetal well-being, potentially missing subtle signs of distress or variations in the baby’s typical movement pattern.

Choice E rationale

The supine or side-lying position is generally recommended for kick counts. Standing can increase maternal heart rate and blood pressure, potentially altering placental blood flow and fetal oxygenation. It can also be more difficult to detect subtle fetal movements due to muscle tension and gravitational effects. Lying down promotes comfort and allows the mother to focus on the movements.

Choice F rationale

Fetal kick counts are typically recommended to begin around 28 weeks of gestation, not at 15 weeks. At 15 weeks, fetal movements, known as quickening, are often sporadic and not yet strong enough to be consistently and reliably felt by the mother. The fetus's size and nervous system development are not mature enough to establish a consistent pattern of movement until the third trimester.

Choice A rationale

This is a significant indicator of human trafficking because the trafficker exerts control by preventing the victim from communicating freely. The presence of a third party, often the trafficker, during medical interviews or conversations prevents the victim from disclosing their situation and seeking help without fear of reprisal.

Choice B rationale

Tattoos, piercings, and marijuana use are not definitive signs of human trafficking. These are personal choices and lifestyle factors that are common in various populations and do not, in themselves, indicate exploitation. Basing a suspicion of trafficking on these alone can lead to inaccurate conclusions and misidentification of victims.

Choice C rationale

This is a key sign of human trafficking. A victim living with their employer and not possessing their own identification documents like a license or passport signifies a lack of autonomy and control. The trafficker holds these documents to restrict the victim's movement, prevent them from leaving, and maintain total control over their life.

Choice D rationale

A client being alone and having no support system present is not a direct indicator of human trafficking. Many individuals may present alone to a healthcare setting for various reasons, such as privacy, independence, or lack of local family/friends. While it can be a factor, it is not a primary sign on its own.

Choice E rationale

Living alone and outside of the city area is not a sign of human trafficking. Many individuals choose to live in more rural or isolated locations for personal or financial reasons. This living situation does not inherently suggest that a person is being exploited or held against their will.

Choice F rationale

Providing scripted or rehearsed answers is a common sign of a human trafficking victim. This behavior suggests that the person has been coached by their trafficker on what to say to avoid detection and maintain the narrative. It indicates a lack of spontaneity and genuine communication, signaling a controlled environment.