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A nurse is educating a client about a contraction stress test.

Which of the following is correct regarding the contraction stress test?

A nurse is caring for a client who is at 39 weeks of gestation and is in active labor. The nurse locates the fetal heart tones above the client’s umbilicus at midline. The nurse should suspect that the fetus is in which of the following positions?

During the delivery, which fetal position would be considered optimal for a vaginal birth?

A nurse is caring for a 29-year-old female client who is 35 weeks gestation in the triage area of the maternity ward. The client presents with complaints of decreased fetal movement. Below are the exhibits relevant to the case:

History and Physical

The client is a 29-year-old female, gravida 2 para 1, at 35 weeks gestation. She has a history of an uncomplicated spontaneous vaginal birth three years ago of a 7 lb 4 oz infant. The client has no significant medical, social, or surgical history.

Nurses Notes

The client arrived at triage with complaints of decreased fetal movement over the past 24 hours. She reports feeling anxious and concerned about the well-being of her baby. The client denies any contractions, vaginal bleeding, or fluid leakage. She states that she has been feeling generally well otherwise. The client’s partner is present and supportive. The nurse notes that the client appears visibly worried but is cooperative and responsive to questions.

Vital Signs

• Temperature: 98.6°F (37°C)
• Pulse: 82 beats per minute
• Respiratory Rate: 18 breaths per minute
• Blood Pressure: 120/80 mmHg
• Oxygen Saturation: 98% on room air

Physical Examination Results

Upon physical examination, the client’s abdomen is soft and non-tender. Fundal height measures consistent with 35 weeks gestation. Fetal heart tones are auscultated at 140 beats per minute with a Doppler. No signs of uterine contractions are noted. There is no evidence of vaginal bleeding or fluid leakage. The client’s extremities are without edema, and deep tendon reflexes are normal.

Provider’s Prescriptions

1. Non-stress test (NST) to assess fetal well-being.
2. Ultrasound to evaluate fetal movement and amniotic fluid index.
3. Continuous fetal heart rate monitoring.
4. Encourage the client to rest and monitor fetal movements.
5. Follow-up appointment in 1 week or sooner if symptoms persist or worsen.

Diagnostic Results

• Non-stress test (NST): Reactive, indicating normal fetal heart rate patterns with adequate accelerations.
• Ultrasound: Normal amniotic fluid index, fetal movements observed, no abnormalities detected.

Medical History

The client has no significant medical history. She had an uncomplicated spontaneous vaginal birth three years ago. There are no known allergies, and she is not on any medications.

What is the most appropriate next step in the management of this client?

The nurse preceptor is teaching about the physiology of the fetal heart rate (FHR) pattern. Which statement by the student indicates a lack of understanding?

A nurse on the labor and delivery unit is caring for a client following a vaginal examination by the provider which is documented as -2 station. Which of the following interpretations of this finding should the nurse make?

The nurse is caring for a client in labor at term. The nurse reviews the external monitor tracing below. The nurse identifies that the deceleration pattern seen indicates which of the following?

A nurse is caring for a client in active labor.

The nurse identifies tachysystole and late decelerations with each contraction.

The nurse performs intrauterine resuscitation interventions, including repositioning the client, initiating an IV fluid bolus, and applying oxygen.

After the stated interventions, the nurse continues to observe tachysystole and recurrent late decelerations.

Which medication does the nurse anticipate administering to reduce uterine activity?

A client who is 32 weeks gestation and has gestational diabetes calls the provider’s office to report decreased fetal movement over the last several hours. The provider advises her to report to OB triage for further testing.

What test should you anticipate the provider will order?

A nurse is caring for a client who is having a nonstress test.

The fetal heart rate (FHR) baseline is 130 bpm, there is moderate variability, but there have been no accelerations or fetal movement.

Which of the following actions should the nurse complete next?

The nurse is caring for a client. Which of the following findings would the nurse report to the anesthesia provider?