A nurse in a clinic is caring for a client who is in her second trimester of pregnancy. The client expresses concern about preparing her 2-year-old child for a new sibling. Which of the following is an appropriate response by the nurse?

Choice A rationale:

Instructing the client to maintain scheduled mealtimes is essential for a postpartum client with type 1 diabetes mellitus who is breastfeeding. Consistent and balanced meals help stabilize blood glucose levels, especially in diabetic clients who need to manage their insulin.

Choice B rationale:

Checking blood glucose levels every 8 hours is not appropriate for a postpartum client with type 1 diabetes mellitus. Diabetic clients typically need to monitor their blood glucose more frequently, especially after meals and during breastfeeding.

Choice C rationale:

Instructing the client to take more insulin with each meal than she did prior to pregnancy is not accurate advice. The insulin requirements may change during pregnancy, but it is essential to follow the healthcare provider's guidance on adjusting insulin doses after delivery.

Choice D rationale:

Limiting carbohydrate intake to 30 grams per day is not suitable for a breastfeeding postpartum client with type 1 diabetes mellitus. Carbohydrates are a crucial source of energy, and breastfeeding mothers usually require more carbohydrates to support lactation and energy needs. Restricting carbohydrates to such a low level could be harmful.

Choice A rationale:

Requesting that the provider insert an intrauterine pressure catheter is not the immediate action the nurse should take when the umbilical cord is palpated during a vaginal examination. The priority is to relieve pressure on the cord and improve fetal oxygenation.

Choice B rationale:

Exerting continuous upward pressure on the presenting part is the correct action when the nurse palpates the umbilical cord during a vaginal examination. This manoeuvre is called "vaginal elevation,”. helps lift the presenting part off the umbilical cord, reducing the risk of cord compression and fetal distress until the provider can take further action.

Choice C rationale:

Initiating oxytocin via continuous IV infusion is not appropriate when the umbilical cord is palpated during a vaginal examination. Oxytocin can cause uterine contractions, potentially further compromising the cord and fetus.

Choice D rationale:

Placing the client in the left-lateral position is not the best immediate action for cord palpation. While the left-lateral position is useful for relieving pressure on the vena cava in cases of supine hypotensive syndrome, the priority here is to relieve cord compression, and upward pressure on the presenting part is more effective.