A nurse is assisting in the care of a client who is in active labor.
The nurse notes variable decelerations of the FHR. The nurse should identify which of the following as a cause of variable decelerations?

Choice A rationale

Iron (normal adult range: 60-170 µg/dL) is crucial during pregnancy to support the increased maternal blood volume and fetal red blood cell production. Iron deficiency anemia is common in pregnancy and can lead to fatigue, shortness of breath, and adverse pregnancy outcomes like preterm birth or low birth weight.

Choice B rationale

Calcium (normal range: 8.5-10.5 mg/dL) intake is vital for fetal skeletal development and maintaining maternal bone density. If maternal calcium intake is insufficient, the fetus will draw calcium from the mother's bones, potentially leading to maternal bone demineralization and increased risk of osteoporosis later in life.

Choice C rationale

Vitamin D (normal range: 30-100 ng/mL) is essential for calcium absorption and utilization, which is critical for fetal bone and tooth development. Adequate vitamin D levels also support maternal immune function and may play a role in preventing preeclampsia and gestational diabetes.

Choice D rationale

While Vitamin E (normal range: 5.5-17 µg/mL) is an important antioxidant, there is no strong evidence to recommend a significant increase in its intake during pregnancy. Excessive intake of some vitamins can be harmful; therefore, general nutritional guidelines emphasize a balanced diet to meet vitamin E needs.

Choice A rationale

Offering privacy and allowing gradual self-expression respects the adolescent's developmental stage, which often includes a need for autonomy and fear of judgment. Providing a non-threatening environment can reduce anxiety and build trust, fostering a sense of security that encourages the patient to open up when they feel ready, without feeling pressured or overwhelmed.

Choice B rationale

Encouraging immediate discussion with parents might be premature and perceived as a lack of understanding by the adolescent. Adolescents often value peer relationships and may find it difficult to express sensitive emotions to parents, especially after a traumatic event like an injury. This approach could increase their withdrawal and reluctance to communicate.

Choice C rationale

Focusing solely on physical care neglects the psychological and emotional needs of the adolescent, which are crucial for holistic recovery. Emotional distress can hinder physical healing and overall well-being. Avoiding emotional support can make the patient feel invalidated and isolated, potentially prolonging their withdrawal and emotional distress.

Choice D rationale

Assigning a withdrawn adolescent to a shared room without prior assessment or consent can exacerbate their anxiety and discomfort. While socialization is important, forcing it upon a patient who is already withdrawn can be counterproductive, potentially leading to increased stress and a further retreat into themselves rather than improving their social engagement.