During her prenatal exam at 26-weeks gestation, a client expresses feeling faint while lying supine on the examination table.
Which action should the practical nurse (PN) implement?

Choice A rationale

Elevating the head of the examination table would not effectively alleviate supine hypotensive syndrome. This condition occurs due to compression of the vena cava by the gravid uterus, reducing venous return to the heart. While elevating the head might provide some comfort, it does not directly address the underlying circulatory compromise.

Choice B rationale

Assisting the client to a lateral position, particularly the left lateral position, is the most effective intervention. This maneuver displaces the gravid uterus off the inferior vena cava, increasing venous return to the heart, thereby improving cardiac output and uteroplacental perfusion, which alleviates symptoms of faintness and dizziness.

Choice C rationale

Placing the examination table in Trendelenburg position involves lowering the head and raising the foot of the bed. This position would further exacerbate vena caval compression in a pregnant client, potentially worsening supine hypotensive syndrome and increasing the risk of aspiration, making it an contraindicated intervention.

Choice D rationale

Stepping out of the room to notify the healthcare provider (HCP) before addressing the immediate physiological distress is inappropriate. The PN should first implement immediate interventions to stabilize the client's condition, such as repositioning, and then promptly inform the HCP about the event and the interventions performed.

The correct answer is Choice D.

Choice A rationale: This choice incorrectly counts four pregnancies. Scientifically, gravida includes all confirmed pregnancies, but only those that actually occurred. The client has had one miscarriage, one fetal demise, and is currently pregnant—totaling three pregnancies. Counting four would imply an additional pregnancy that did not occur. Overestimating gravida can lead to inaccurate obstetric records and misinterpretation of reproductive history, which may affect clinical decision-making and risk assessment.

Choice B rationale: This choice undercounts the total number of pregnancies by only including two. It likely omits either the miscarriage or the current pregnancy. Scientifically, all pregnancies are counted in gravida, regardless of gestational age or outcome. Miscarriages and fetal demises are included. Underreporting gravida can lead to incomplete obstetric history, which may compromise prenatal care and risk evaluation during labor and delivery.

Choice C rationale: This choice significantly underestimates the gravida by counting only one pregnancy. It may reflect a misunderstanding that only the current or viable pregnancies are included. However, from a clinical standpoint, gravida includes all pregnancies, including those that ended in miscarriage or fetal demise. Accurate gravida documentation is essential for assessing maternal risk factors and planning appropriate obstetric care.

Choice D rationale: This is the correct interpretation. The client has had three pregnancies: one miscarriage at 16 weeks, one fetal demise at 31 weeks, and the current pregnancy at 39 weeks. Scientifically, gravida includes all pregnancies regardless of outcome. This total of three pregnancies makes her gravida 3. Accurate documentation of gravida is crucial for understanding reproductive history and guiding prenatal and intrapartum care.