A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

Choice A Reason:

"You didn't report any symptoms of GBS during your pregnancy." This response is incorrect because GBS infection in pregnant women often does not present with noticeable symptoms. Additionally, GBS screening is not based on symptoms but rather on the presence of the bacteria in the genital or gastrointestinal tract.

Choice B Reason:

"Your previous deliveries were all negative for GBS." This response is incorrect because GBS status can change between pregnancies. A negative result in previous pregnancies does not guarantee a negative result in subsequent pregnancies. Screening closer to the delivery date is necessary to determine the current GBS status.

Choice C Reason:

"There was no indication of GBS in your earlier prenatal testing." This response is incorrect because routine prenatal testing typically does not include GBS screening unless there are specific risk factors or symptoms present. GBS screening is specifically done closer to delivery to determine colonization status at that time.

Choice D Reason:

"We need to know if you are positive for GBS at the time of delivery." This response is appropriate. Group B streptococcus (GBS) screening is typically performed around the 35th to 37th week of pregnancy because colonization status can change over time. A negative result earlier in the pregnancy does not necessarily mean that the client will remain negative at the time of delivery. Therefore, it is essential to screen closer to delivery to determine if the client is colonized with GBS and if prophylactic measures are needed to reduce the risk of transmission to the newborn during labor and delivery.

Explanation

Choice A Reason:

A weight gain of 4 kg (10 lb) since the positive pregnancy test, especially at 12 weeks of gestation, may be considered excessive. Typically, during the first trimester, a weight gain of around 1-2 kg (2-4.5 lb) is recommended for women with a normal pre-pregnancy weight. However, individual weight gain recommendations may vary based on factors such as pre-pregnancy weight, height, and medical history.

Choice B Reason:

The client reports that they eat prunes to help manage their constipation. Eating prunes to manage constipation is a healthy dietary choice during pregnancy and does not necessarily indicate a need for a referral to a dietitian. However, it is important to ensure that the client's overall diet is well-balanced and meets their nutritional needs during pregnancy.

Choice C Reason:

The client reports that they take a multivitamin daily. Taking a multivitamin daily is a positive behavior that supports adequate intake of essential vitamins and minerals during pregnancy. While it is important to ensure that the client's prenatal vitamin provides adequate nutrition, this finding alone does not indicate a need for a referral to a dietitian.

Choice D Reason:

The client reports that they are nauseous most mornings. Nausea during pregnancy, particularly in the morning (commonly known as morning sickness), is a common symptom experienced by many pregnant women and does not necessarily indicate a need for a referral to a dietitian. However, the nurse may provide education and support to help manage nausea and ensure adequate nutritional intake despite symptoms.