A nurse is caring for a client who is in labor and is receiving epidural analgesia.
Which of the following changes in the FHR should the nurse report to the provider?

Choice A rationale

At 10 weeks of gestation, the external genitalia of the fetus are not yet fully differentiated or large enough to be reliably visualized and identified as male or female on an ultrasound. Fetal sex determination is typically more accurate later in pregnancy, usually after 16-20 weeks, when anatomical structures are more developed and distinct.

Choice B rationale

While some major structural congenital anomalies might be detectable at 10 weeks, a comprehensive and detailed assessment for a wide range of congenital anomalies is usually performed during the anomaly scan, which is typically conducted between 18 and 22 weeks of gestation. Fetal development is still ongoing at 10 weeks.

Choice C rationale

An ultrasound performed in the first trimester, particularly around 10 weeks, is highly accurate for estimating gestational age and, consequently, the expected delivery date. This is because fetal growth is very consistent during this period, allowing for precise measurements such as crown-rump length to determine gestational age within a small margin of error.

Choice D rationale

Assessment of amniotic fluid volume, often quantified using the amniotic fluid index (AFI) or deepest vertical pocket, is more commonly performed in the second and third trimesters of pregnancy. At 10 weeks, the amniotic fluid volume is relatively small, and its adequacy is not typically a primary focus of an early ultrasound unless there are specific concerns.

Choice A rationale

Dark and concentrated urine in an infant indicates inadequate hydration, which can be a sign of insufficient milk intake during breastfeeding. Well-hydrated infants, receiving adequate breast milk, typically produce urine that is pale yellow and dilute, not dark and concentrated. This reflects proper kidney function and fluid balance.

Choice B rationale

After effective breastfeeding, the breasts should feel softer and less engorged, not firm. The firmness before feeding is due to milk accumulation within the mammary glands. As the infant removes milk, the pressure decreases, leading to a softer breast texture, indicating successful milk transfer.

Choice C rationale

A tugging sensation during breastfeeding is a normal and expected physiological sign. This sensation results from the baby's effective latch and negative pressure creation, which draws milk from the milk ducts into the baby's mouth. It signifies proper milk ejection and efficient feeding.

Choice D rationale

Two to three wet diapers in a 24-hour period for a 5-day-old infant is indicative of insufficient fluid intake. A well-hydrated newborn at this age, receiving adequate breast milk, should typically have six to eight wet diapers per 24 hours, reflecting sufficient hydration and milk transfer.