Practice Quiz

CPM Certified Professional Midwife

Category - Prenatal

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A client at 32 weeks’ gestation complains of easy fatigability. During the history taking, the client tells the midwife that she has been frequently awakened from sleep almost every night for the past week due to the activity of the fetus. The client also reports shortness of breath every time she sleeps flat in bed. Which of the following instructions given by the midwife is the least appropriate when managing the client’s sleeping problems?
  1. Sleep on two pillows, or on a couch with an armrest.
  2. Sleep in a modified Sims’ position, with the top leg forward.
  3. Schedule a rest period during the afternoon.
  4. When sitting or lying down, rest with the knees sharply bent.
Explanation
Answer: D - The least appropriate instruction is to keep the client’s knees sharply bent when sitting or lying down. This position can increase the risk of venous stasis below the knee. The client should not lie in a supine position as it increases the risk of supine hypotension. The client may instead sleep on two pillows or on a couch with an arm rest. Sleeping in a modified Sims’ position, with the top leg forward, allows the weight of the fetus to rest on the bed. A rest period during the afternoon may alleviate fatigue.
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