Health Promotion and Maintenance
33. A client, who is gravida 4, para 3 at 39 weeks' gestation, has no identified prenatal risk factors and is in early labor. The client declines electronic fetal monitoring (EFM), stating that she delivered her second baby at home without a monitor and everything went well. What is the most appropriate way for the nurse to handle this situation?
. Explain that she will need to be on the monitor for about 20 minutes to assess fetal well-being. If the initial tracing is reassuring, the baby may be monitored intermittently.
. Insist that the fetal monitor be used because there are not enough staff members to adequately monitor her using any other method.
. Request a change in assignment because of the responsibility if anything were to happen to her baby during labor.
. Tell her that it is her decision, although continuous EFM is the only effective way to monitor infant well-being during labor.
Test-Taking Tip
Watch out for the word "only." The choice with that absolute word is usually wrong.
Content Area: Maternity, Antepartum; Integrated Process: Communication and Documentation; Cognitive Level: Application; Client Need/Subneed: Health Promotion and Maintenance/Ante/Intra/Postpartum and Newborn Care
Health Promotion and Maintenance
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Answer 1 is correct because studies have shown that intermittent monitoring is a safe and effective method for monitoring fetal well-being for a low-risk pregnancy. This client fits the criteria for intermittent monitoring. In addition, the use of intermittent monitoring may depend on the hospital's policy and procedure. Answer 2 is incorrect because the client has the right to refuse any medical procedure and it is inappropriate to tell clients there are not enough staff members to care for them during labor. Answer 3 is incorrect because changing assignments does not deal with the underlying problem—the client's desire to avoid electronic fetal monitoring. Answer 4 is incorrect because, although the nurse is acknowledging the client's decision-making rights, continuous EFM is not the only effective way to monitor infant well-being during labor; and the statement could be perceived by the client as manipulating her into accepting the electronic fetal monitoring.