A nurse is collecting data during an admission assessment of a client who is pregnant with twins.

The client has a healthy 5-year-old child that was delivered at 38 weeks, and tells the nurse that she does not have any history of abortion or fetal demise.

The nurse would document the GTPAL for this client as:

Choice A rationale

Cocaine is a stimulant that typically causes fetal tachycardia (an elevated fetal heart rate) due to its sympathomimetic effects, increasing maternal and subsequently fetal heart rate and blood pressure. It does not usually lead to fetal bradycardia.

Choice B rationale

Prolonged umbilical cord compression can lead to fetal bradycardia because it restricts oxygenated blood flow to the fetus. The baroreceptors in the fetus respond to decreased oxygen by slowing the heart rate in an attempt to conserve oxygen and maintain perfusion to vital organs.

Choice C rationale

Fetal anemia, a decrease in red blood cell count, can lead to fetal tachycardia as the heart attempts to compensate for reduced oxygen-carrying capacity by increasing cardiac output. Bradycardia is not a typical initial response to fetal anemia.

Choice D rationale

Terbutaline is a tocolytic medication used to relax the smooth muscle of the uterus and prevent preterm labor. Its side effects often include maternal and fetal tachycardia due to its beta-adrenergic agonist activity.

Choice A rationale

Elevating the mother's legs may help with venous return and circulation, but it does not directly address a soft and boggy uterus, which indicates uterine atony and a risk for hemorrhage. The immediate priority is to promote uterine contraction.

Choice B rationale

A soft and boggy uterus indicates uterine atony, a primary cause of postpartum hemorrhage. Massaging the fundus stimulates the uterine muscles to contract, which helps to compress the blood vessels at the placental site and reduce bleeding. This is the most appropriate initial intervention to address uterine atony.

Choice C rationale

Encouraging the mother to void is important in the postpartum period as a full bladder can displace the uterus and interfere with its ability to contract. However, in the presence of a soft and boggy uterus, the immediate priority is to directly stimulate uterine contraction through fundal massage before addressing bladder emptying.

Choice D rationale

Pushing on the uterus to express clots without first ensuring the uterus is firm is contraindicated. A soft, atonic uterus is more susceptible to inversion if pressure is applied. Fundal massage should be performed first to encourage uterine contraction and firmness before attempting to express any clots.