A nurse is providing teaching to an antepartum client who has a new diagnosis of genital herpes simplex virus 2 (HSV-2). Which of the following information should the nurse include?

Explanations

Fetal presentation The fetus is in a left occiput anterior (LOA) vertex presentation, which is the most favorable position for vaginal birth. LOA allows for optimal alignment of the fetal head with the maternal pelvis, facilitating descent and rotation during labor. Malpresentations such as breech or transverse would be unfavorable, but vertex LOA is considered ideal. Therefore, this finding is favorable for vaginal delivery at 42 weeks gestation.

Cervical findings The cervix is described as closed and thick, which is unfavorable for vaginal birth. At 42 weeks, the cervix should ideally be effaced and dilated to allow for labor progression. A closed, thick cervix indicates that the cervix has not ripened, which may necessitate induction with cervical ripening agents such as prostaglandins or mechanical methods. Thus, this finding is not favorable for vaginal birth readiness.

Uterine contraction pattern The client reports only occasional mild uterine contractions, which is not favorable for vaginal birth at 42 weeks. Effective labor requires regular, strong contractions that cause progressive cervical dilation and effacement. Occasional mild contractions are insufficient to initiate or sustain active labor. At this post-term stage, the absence of an adequate contraction pattern suggests that induction may be required. Therefore, this finding is not favorable.

FHR The fetal heart rate is 150/min, which falls within the normal baseline range of 110 to 160 beats per minute. This indicates adequate fetal oxygenation and no evidence of tachycardia or bradycardia. A normal FHR is a favorable finding for vaginal birth, as it reflects reassuring fetal status. Continuous monitoring remains important, but this specific finding supports safe progression toward vaginal delivery.

Choice A rationale

Instructing the client to be NPO (nil per os), or nothing by mouth, is not typically required before an amniocentesis procedure. The client can usually eat and drink normally. Fasting is more commonly associated with procedures involving general anesthesia or those where there is a risk of aspiration, neither of which is routine for an amniocentesis. Clients may be asked to empty their bladder before the procedure to avoid puncturing it.

Choice B rationale

For an Rh-negative client undergoing an amniocentesis, there is a risk of fetomaternal hemorrhage during the procedure, which can lead to the mother's immune system producing Rh antibodies that attack the fetus's red blood cells in the current or future pregnancies. Therefore, administering Rh(D) immune globulin (RhoGAM) after the procedure is essential to prevent Rh sensitization. The standard dose is administered within 72 hours of the procedure.

Choice C rationale

Positioning the client in a left lateral position is typically used to promote optimal uteroplacental perfusion or during the second stage of labor. For an amniocentesis, the client is usually positioned in a supine position with a wedge placed under the right hip to slightly tilt the uterus and prevent vena cava compression, providing the provider with a clear anatomical view for ultrasound guidance.

Choice D rationale

The insertion site on the client's abdomen is cleaned with an antiseptic solution, such as povidone-iodine or chlorhexidine, to reduce the risk of introducing bacteria into the sterile field or uterus. Irrigating the site with sterile water is an inappropriate action for skin preparation as it is not a primary antiseptic and may interfere with the effectiveness of the chosen antiseptic solution.