A nurse is reinforcing teaching to a student nurse about Apgar scores in newborns.
Which of the following statements by the student demonstrates effective reinforcement?

Choice A rationale

Active peer interaction generally indicates healthy social development and positive self-esteem in adolescents. Engagement with peers often provides opportunities for validation, belonging, and the development of social skills, all of which contribute positively to an individual's self-perception and confidence, rather than signaling struggles with self-esteem.

Choice B rationale

Isolation and negative body image are significant warning signs of self-esteem issues. Isolation indicates a withdrawal from social engagement, potentially due to feelings of inadequacy or fear of judgment. A negative body image reflects dissatisfaction with one's physical appearance, often leading to feelings of shame, anxiety, and low self-worth, which are central to poor self-esteem.

Choice C rationale

Choosing healthy foods is typically associated with positive health behaviors and a sense of self-care, which can be indicative of a healthy self-image and good self-esteem. Individuals with high self-esteem are more likely to prioritize their well-being and make choices that benefit their physical and mental health.

Choice D rationale

Frequent tantrums are more characteristic of younger children struggling with emotional regulation rather than adolescents with self-esteem issues. While adolescents can exhibit emotional outbursts, prolonged and frequent tantrums are less specific to self-esteem and more indicative of broader emotional or behavioral dysregulation issues in this age group.

Choice A rationale

Repositioning the client to a left lateral position aims to improve uteroplacental perfusion by alleviating compression of the inferior vena cava by the gravid uterus. This enhances venous return to the mother's heart, increasing cardiac output and ultimately improving blood flow and oxygen delivery to the placenta and fetus, which can resolve late decelerations caused by uteroplacental insufficiency.

Choice B rationale

Documenting findings is a crucial nursing responsibility, but it is not the immediate intervention for addressing late decelerations. Scientific principles dictate that physiological stabilization takes precedence over documentation when fetal well-being is compromised. Documentation would follow after initial interventions are implemented to improve the fetal status.

Choice C rationale

Adjusting fetal monitor sensors might be necessary if the tracing is poor quality, but it does not directly address the physiological cause of late decelerations. Late decelerations reflect uteroplacental insufficiency, not merely a monitoring artifact. Addressing the underlying physiological compromise is the priority before troubleshooting equipment.

Choice D rationale

Inserting a fetal scalp electrode provides a more accurate assessment of fetal heart rate by directly monitoring the fetus. However, this is an invasive procedure and is typically considered after initial conservative measures, such as maternal repositioning and oxygen administration, have been attempted without resolution of the late decelerations.