A nurse is reviewing the results of a biophysical profile for a client who is at 37 weeks of gestation.
Which of the following findings indicates fetal well-being?

Choice A rationale: Trendelenburg position, where the client is placed with the head lower than the feet, is not appropriate in this scenario. This position is typically used for procedures requiring pelvic exposure or in cases of air embolism. It does not optimize uteroplacental perfusion and may actually compromise maternal respiratory function in late pregnancy due to diaphragmatic pressure from the gravid uterus. Therefore, it is not the correct position following prostaglandin insertion.

Choice B rationale: Knee-chest position is used in obstetric emergencies such as umbilical cord prolapse to relieve pressure on the cord and improve fetal oxygenation. It is not indicated for cervical ripening or for optimizing uteroplacental perfusion. Maintaining this position would be uncomfortable and unnecessary for the client, and it does not aid in medication absorption. Thus, it is not the correct intervention in this context.

Choice C rationale: Lateral tilt, specifically left lateral or side-lying tilt, is the correct position. This position reduces compression of the inferior vena cava by the gravid uterus, thereby improving venous return, cardiac output, and uteroplacental perfusion. It also facilitates optimal absorption of the vaginal prostaglandin insert by keeping the medication in place. This is the evidence-based nursing intervention following prostaglandin administration for cervical ripening.

Choice D rationale: Lithotomy position is used primarily for vaginal examinations, procedures, or delivery. It is not appropriate for maintaining medication absorption or optimizing uteroplacental perfusion. Prolonged lithotomy positioning increases maternal discomfort and risk of venous stasis. Since the client is not undergoing delivery or a procedure requiring pelvic exposure, this position is not indicated after prostaglandin insertion.

Choice A rationale

Erb-Duchenne palsy, a form of brachial plexus injury (C5-C6), primarily affects the nerves controlling the shoulder and upper arm muscles. It generally does not affect cranial nerves (such as IX and X, which control swallowing) or the muscles of the mouth, thus typically preserving the ability to suck and swallow.

Choice B rationale

The Moro (startle) reflex involves symmetrical extension and abduction of the arms followed by adduction and flexion. An injury to the brachial plexus on one side impairs the motor function of that arm, resulting in the characteristic absence of the reflex in the affected extremity, which is a key diagnostic finding.

Choice C rationale

The Babinski reflex is a normal neurological finding in infants up to about 2 years old, reflecting immature corticospinal tracts. It is a foot reflex and is unrelated to a brachial plexus injury in the neck and shoulder area; thus, its presence is not a specific finding for Erb-Duchenne palsy.

Choice D rationale

Cleft palate is a congenital craniofacial malformation resulting from incomplete fusion of the palatine shelves during fetal development. It is a structural anomaly of the mouth and is not a finding or complication associated with Erb-Duchenne palsy, which is a neuromuscular injury sustained, most commonly, during birth.