A nurse is caring for a patient who is 7 days postpartum and calls the clinic to report pain and redness in her left calf. Besides seeing her provider, which interventions should the nurse suggest?

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.

Choice A rationale
While it is important to monitor a client’s temperature regularly, especially if they have a fever, simply checking the client’s temperature in 4 hours is not an adequate response to a temperature of 38.9°C (102°F) in a woman who is at 38 weeks of gestation and in early labor with ruptured membranes. This could indicate an infection, which could be dangerous for both the mother and the baby.
Choice B rationale
Administering glucocorticoids intramuscularly is not typically the first-line treatment for a fever in a pregnant woman. Glucocorticoids are often used to accelerate fetal lung maturity in preterm labor, but they are not typically used to treat infections or fevers.

Choice C rationale
Preparing the client for an emergency cesarean section may be necessary if the client’s condition worsens or if there are other complications, but it is not the immediate response to a fever. The first step would be to identify and treat the cause of the fever, which could be an infection.
Choice D rationale
Administering acetaminophen orally is an appropriate nursing action for a client with a fever. Acetaminophen can help to reduce the client’s fever and make her more comfortable. However, it is also important to identify and treat the underlying cause of the fever, which could be an infection.