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    Hesi RN Med Surg Proctored Exam(ICHS)

    When teaching a gravid client how to perform kick (fetal movement) counts, which instruction should the nurse include?

    Explanation & Rationale

    A. Count the movements once daily, for one hour, before breakfast: Kick counts are most effective when performed at a consistent time, usually when the fetus is most active, often after meals in the evening. Counting only before breakfast may not capture optimal fetal activity and could delay recognition of decreased movements. B. Exercise for 15 minutes before starting the counting to help increase fetal movement: Light activity may temporarily alter fetal movement patterns, but vigorous exercise is not recommended as it can mask fetal movements. Kick counts are more reliable when the mother is resting in a quiet environment rather than immediately after exercise. C. If 10 kicks are not felt within one hour, drink orange juice and count for another hour: This is the recommended instruction. If the fetus does not exhibit 10 movements within an hour, maternal glucose intake (such as orange juice) can stimulate fetal activity, and counting should continue for another hour. Persistent decreased movement warrants contacting the healthcare provider, as it may indicate fetal compromise. D. Avoid caffeinated drinks for 24 hours before conducting the kick test: Caffeine can cross the placenta and may slightly increase fetal activity, but it is not necessary to avoid it for 24 hours prior. Kick counts are intended to monitor baseline fetal activity, and moderate caffeine intake does not significantly impact the reliability of the test.

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