A nurse is providing education to a third-trimester pregnant client regarding how to perform fetal kick counts at home. Which statement made by the client indicates a need for further teaching?

Appeared in: NORCET 10 Mains

Explanation

Lying flat on the back (supine position) during the third trimester is contraindicated for performing fetal kick counts.
This position can cause the heavy uterus to compress the inferior vena cava, a major blood vessel that returns blood from the lower body to the heart.
Compression of the vena cava can lead to supine hypotensive syndrome, characterized by a drop in the mother's blood pressure.
This maternal hypotension reduces blood flow to the uterus and placenta, potentially causing fetal distress.
The correct position for counting fetal kicks is lying on the left side (left lateral recumbent), which promotes maximum blood flow to the fetus.

Option B: This is a correct statement. Placing hands on the abdomen is the direct way for the mother to feel and count the baby's movements.
Option C: This is a correct statement. Fetal activity varies, with periods of sleep and wakefulness. Counting when the baby is typically active (e.g., after meals or in the evening) makes the process more efficient and provides a better assessment of well-being.
Option D: This is a correct and crucial safety instruction. A common guideline is the 'count to 10' method, where feeling fewer than 10 distinct movements within a 2-hour period is a warning sign.

Clinical Relevance

Nursing practice connection: Use the key finding related to The core concept tested is the correct procedure for performing fetal kick counts, a method of antenatal fetal surveillance, and the nurse's role in patient education to guide bedside assessment, documentation, and the next nursing action.
Patient education on fetal kick counts is a critical nursing responsibility that empowers the mother to participate in monitoring her baby's health.
Recognizing decreased fetal movement is often the first sign of fetal compromise. Prompt reporting allows for timely intervention, such as a nonstress test (NST) or biophysical profile (BPP), which can be life-saving.
What if the client says she feels fewer than 10 kicks in 2 hours? The nurse should instruct her to immediately contact her healthcare provider or go to the hospital for evaluation. She should not wait or try to 'wait it out'.

How to Approach the Question

First, identify the question type. This is a 'negative' question, asking you to find the statement that is INCORRECT or indicates a 'need for further teaching'.
Read the stem carefully: A third-trimester client is being taught about fetal kick counts.
Evaluate each option based on standard, safe obstetric practices for the third trimester.
Option A mentions lying flat on the back. Recall the physiological changes in late pregnancy. The supine position is known to cause vena cava compression (supine hypotension). This is an unsafe practice.
Option B mentions placing a hand on the abdomen. This is the logical way to feel kicks.
Option C mentions counting when the baby is active. This is a practical and recommended approach.

Concept Tested & Keywords

Concept Tested: The core concept tested is the correct procedure for performing fetal kick counts, a method of antenatal fetal surveillance, and the nurse's role in patient education.
Stem keywords: fetal kick counts, third-trimester, pregnant client, further teaching
Lead-in keywords: indicates a need for further teaching
Clinical cues: Age/sex group narrows the expected diagnosis, intervention, or normal reference range.
Clinical cues: The care setting changes urgency, monitoring level, and the expected nursing action.

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur pp. 40-48, 39-47

E6 Obstetrics Williams p. 68-91

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