A nurse is preparing to measure the fundal height of a client whose fetus is 28 weeks gestation. To perform the procedure, the nurse should place the client?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

The correct position for measuring fundal height is supine with the head on a pillow and knees slightly flexed.
This position, also known as the dorsal recumbent position, relaxes the abdominal muscles, which is essential for accurate palpation of the uterine fundus.
Flexing the knees prevents the abdominal muscles from tensing, allowing the examiner to get a precise measurement from the symphysis pubis to the top of the fundus.
It is also important to have the client empty her bladder before the procedure to avoid elevation of the uterus, which would lead to an inaccurate reading.

Option A: A standing position causes the abdominal muscles to tense to maintain posture. Gravity also affects the position of the uterus, both of which would lead to an inaccurate measurement.
Option B: The Trendelenburg position (head down, feet up) causes the abdominal organs to shift upward against the diaphragm. This would make it very difficult to locate the fundus and would be uncomfortable for the pregnant client.
Option C: Elevating the head of the bed to 45 degrees (a semi-sitting or Semi-Fowler's position) can cause the abdomen to compress, shortening the vertical distance and leading to an inaccurately low fundal height measurement.

Clinical Relevance

Nursing practice connection: Use the key finding related to Client positioning for fundal height measurement to guide bedside assessment, documentation, and the next nursing action.
Accurate fundal height measurement is a crucial, non-invasive screening tool for monitoring fetal growth, estimating gestational age, and detecting potential complications like IUGR or polyhydramnios.
A discrepancy of more than 2-3 cm from the expected gestational week measurement should prompt the nurse to report the finding for further investigation, often an ultrasound.
Patient comfort and safety are paramount. Before placing the client supine, the nurse should ask her to empty her bladder. During the measurement, the nurse should be vigilant for signs of supine hypotensive syndrome (dizziness, pallor, nausea).

How to Approach the Question

First, identify the key procedure in the question: 'measure the fundal height'.
Recall the primary goal of this procedure: to obtain an accurate measurement of uterine size.
Consider what anatomical factor is most likely to interfere with this measurement. The tension of the abdominal muscles is the main obstacle.
Evaluate each option based on how it affects abdominal muscle tension.
Eliminate the standing position, as it requires abdominal muscle tone for posture.
Eliminate the Trendelenburg and semi-Fowler's positions, as they alter the natural placement of the uterus and abdominal contents, leading to inaccuracy.

Concept Tested & Keywords

Concept Tested: Client positioning for fundal height measurement
Stem keywords: fundal height, measure, 28 weeks gestation, procedure
Lead-in keywords: place the client
Clinical cues: 28 weeks gestation: This is a point in pregnancy where fundal height measurement is a routine and important part of prenatal assessment to monitor fetal growth.

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E6 Comprehensive Textbook of Community Health Nursing for BSc Nursing Students Part 2 — Subpart A (pp 1-275 of 550) p. 199-201

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 15-23

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.