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?

Choice A Reason:

Instruct the client to empty their bladder: Emptying the bladder before the examination allows for better visualization and palpation of the uterus and fetal parts. A full bladder can interfere with the ability to assess the position, presentation, and engagement of the fetus accurately.

Choice B Reason:

Position the client supine with knees flexed and place a small, rolled towel under one of their hips: Positioning the client supine with knees flexed helps relax the abdominal muscles and provides better access to the uterus for palpation. Placing a small, rolled towel under one hip helps tilt the pelvis slightly, which can improve visualization and palpation of the uterine fundus.

Choice C Reason:

Palpate the fetal part positioned above the symphysis pubis: Palpating the fetal part above the symphysis pubis (typically the fetal head) allows the healthcare provider to determine the presenting part, engagement, and degree of descent of the fetus. This step provides valuable information about the fetal position and presentation.

Choice E Reason:

Palpate the fetal parts along both sides of the uterus: Palpating the fetal parts along both sides of the uterus helps the healthcare provider identify the fetal back and limbs. This step provides further confirmation of the fetal position and presentation and helps assess fetal lie and attitude.

Choice D Reason:

Palpate the fetal part positioned in the fundus: Palpating the fetal part in the fundus (typically the buttocks or head) confirms the findings from the previous steps and helps determine the presenting part and its relationship to the maternal pelvis. This step provides additional information about the fetal position, presentation, and engagement, which is crucial for assessing fetal well-being and planning for labor and delivery.

Explanation

Choice A Reason:

Placing the infant on his back with legs extended is a recommended sleeping position for infants to reduce the risk of sudden infant death syndrome (SIDS). However, it is not directly related to managing neonatal abstinence syndrome.

Choice B Reason:

Providing a stimulating environment would not be appropriate for an infant with NAS, as excessive stimulation can exacerbate symptoms such as irritability and tremors. A calm and quiet environment is preferable.

Choice C Reason:

Monitoring blood glucose levels every hour is not a routine practice for managing neonatal abstinence syndrome. While NAS can cause feeding difficulties, hypoglycemia is not typically a primary concern unless the infant is exhibiting specific symptoms.

Choice D Reason:

Initiating seizure precautions is important when caring for an infant with NAS because seizures can be a complication of withdrawal. Seizure precautions may include padding the crib, ensuring a safe environment, and being vigilant for signs of seizure activity.