A nurse is caring for a client who is about to undergo an amniotomy. What is the priority nursing action following this procedure?

Choice A rationale: Conducting a non-stress test twice per week is a common practice for pregnant women who are at high risk, and this client is considered high risk due to her history of gestational diabetes and the fact that her two previous newborns weighed over
4.5 kg. A non-stress test is a simple, noninvasive test that checks the baby’s heart rate and response to movement. It’s called a “non- stress” test because it causes no stress to the baby. The test usually takes about 20 to 30 minutes. The mother lies on her left side, and a belt with a sensor that can detect the baby’s heartbeat is placed around her abdomen. The baby’s heart rate is expected to increase with each movement, and this is a sign that the baby is healthy and getting enough oxygen. If the baby’s heart rate does not increase with movement, it may mean that the baby is not getting enough oxygen, which could be a sign of a problem.

Choice B rationale: Monitoring blood glucose levels once daily is crucial for this client due to her history of gestational diabetes and current elevated fasting blood glucose level. Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. It may precede development of type 2 DM. Self-monitoring of blood glucose levels in gestational diabetes is considered a cornerstone of management to improve maternal and neonatal prognosis. It allows pregnant women to evaluate their individual response to therapy and assess whether glycemic targets are being achieved. This can help prevent complications related to gestational diabetes, such as macrosomia (a high birth weight), hypoglycemia in the newborn, and pre- eclampsia in the mother.

Choice C rationale: Referring the client to a dietitian for nutritional counseling is an important step in managing her gestational diabetes. Diet plays a crucial role in managing blood glucose levels during pregnancy. A dietitian can provide a personalized meal plan that includes the right amount of carbohydrates, protein, and fat for the client. The meal plan will also take into account the client’s food preferences, lifestyle, and weight gain goals during pregnancy. Nutritional counseling can help the client understand how different foods affect her blood glucose levels and how to make healthy food choices that will benefit both her and her baby.

Choice D rationale: Instructing the client to refrain from physical activity is not a recommended action. Physical activity is generally beneficial for pregnant women, including those with gestational diabetes. Regular physical activity can help lower blood glucose levels, reduce insulin resistance, and manage weight gain during pregnancy. However, the type and intensity of physical activity should be appropriate for the client’s fitness level and pregnancy stage, and any physical activity should be done under the guidance of a healthcare provider.

Choice E rationale: Increasing caloric intake to support fetal growth is not necessarily a recommended action for this client. While it’s true that pregnant women need additional calories to support fetal growth, this must be balanced with the need to manage blood glucose levels in the case of gestational diabetes. Consuming too many calories, particularly in the form of carbohydrates, can lead to high blood glucose levels. Instead, the focus should be on consuming a balanced diet that includes a variety of nutrients to support fetal growth.

The correct answer is choice A. Drink 48 to 64 ounces of water daily.

Choice A rationale:

Drinking 48 to 64 ounces of water daily is recommended to help maintain hydration and support overall health during pregnancy, especially for those with mild preeclampsia.

Choice B rationale:

While protein intake is important, the recommended amount for pregnant women is generally higher than 40 to 90 grams per day. The exact amount can vary based on individual needs, but typically, pregnant women are advised to consume around 71 grams of protein daily.

Choice C rationale:

Limiting intake of whole grains, raw fruits, and vegetables is not recommended. These foods are rich in essential nutrients and fiber, which are beneficial for both the mother and the baby.

Choice D rationale:

Avoiding salting of foods during cooking can help manage blood pressure, but it is not the primary focus of dietary recommendations for preeclampsia. Reducing overall sodium intake is more important.