A practical nurse is assigned to assist in the care of a laboring client at 42-weeks gestation with maternal intrapartum fever, chorioamnionitis. Four hours after admission, the practical nurse observes fetal heart rate decelerations occurring after the peak of contractions.
Which action should the practical nurse take?

Choice A rationale

While postpartum depression is a serious concern, immediately jumping to a question about suicidal thoughts can be alarming and may shut down communication unless other specific warning signs are present. A more gentle and open-ended approach is generally preferred initially to build rapport and gather information.

Choice B rationale

While it is true that many new mothers experience challenges with bonding, simply stating this without further exploration can minimize the client's feelings and prevent her from elaborating. It does not provide an opportunity for the client to express the depth or specifics of her emotional experience.

Choice C rationale

Focusing on the husband's bonding shifts the attention away from the client's expressed feelings and needs. While partner involvement is important, the immediate priority is to address the client's own emotional state and her perceived lack of bonding with her baby.

Choice D rationale

Encouraging the client to talk about her feelings provides an open-ended opportunity for her to express her concerns, explore the contributing factors, and feel heard. This therapeutic communication technique allows the nurse to gather more specific data and assess for potential postpartum mood disorders or other issues, promoting a client-centered approach.

Choice A rationale

Preterm birth can be a complication of gestational diabetes due to polyhydramnios or preeclampsia, but macrosomia carries a higher risk of birth trauma and neonatal complications. Prematurity can lead to respiratory distress syndrome and other developmental challenges.

Choice B rationale

Macrosomic newborn is the greatest risk to the fetus if euglycemia is not maintained. High maternal glucose levels lead to excessive fetal insulin production, resulting in increased fat deposition and growth. This can cause birth injuries, hypoglycemia, and respiratory distress in the neonate.

Choice C rationale

Low birth weight is typically associated with maternal malnutrition or placental insufficiency, not poorly controlled gestational diabetes. Uncontrolled gestational diabetes usually leads to fetal overgrowth (macrosomia) due to constant glucose supply.

Choice D rationale

Cleft palate is a congenital anomaly primarily linked to genetic and environmental factors during early fetal development, not directly or primarily to poorly controlled gestational diabetes. Metabolic imbalances of diabetes are not a primary cause of such structural malformations.