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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 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?

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

A nurse is caring for a client who is in the first stage of labor. The client is stating that her pain level is 8/10 during her contractions but does not want an epidural. The nurse assists with a position change and offers Fentanyl for pain relief. The client requests the offered pain medication. What action should the nurse perform first?

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?

A client has received MSAFP test result. The client is requesting additional testing to determine whether the fetus has a chromosomal abnormality.

Which of the following antenatal tests would the nurse anticipate the provider will order?

The nurse is caring for a client at 39 weeks gestation who arrived to OB triage with a complaint of decreased fetal movement.

The client was placed on external fetal monitors for an ordered non-stress test.

The client was encouraged to drink some cold water and juice.

She reported she had not had anything to eat or drink yet for the day.

The nurse observes the following tracing.

How should the nurse document the non-stress test results?

The nurse is caring for a client immediately after epidural. Which of the following findings should the nurse report to the anesthesia provider?

A nurse is caring for a client at term in labor.

The client states, “I can’t do this anymore.”. She reports rectal pressure and increasing nausea. SVE (sterile vaginal exam) performed: 9 cm, 100% effaced, +1 station.

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 labor and delivery nurse tells her client she has completed stage 1 of labor. Which of the following statements by the student nurse indicates confusion about the stages of labor?