A nurse is caring for a client who is pregnant.

The client’s vital signs are as follows: Temperature 37.2°C (98.9°F), Pulse rate 80/min, Respiratory rate 16/min, Blood Pressure 120/69 mm Hg. What should the nurse monitor next?

Choice A rationale
Terbutaline is a beta-adrenergic agonist that works by relaxing the smooth muscles of the uterus, thereby reducing uterine contractions. It is commonly used in cases of tachysystole and recurrent late decelerations to decrease uterine activity and improve fetal oxygenation. Terbutaline’s mechanism of action involves stimulating beta-2 adrenergic receptors, which leads to an increase in cyclic AMP and subsequent relaxation of uterine smooth muscle.
Choice B rationale
Oxytocin is a hormone that stimulates uterine contractions and is typically used to induce or augment labor. Administering oxytocin in a situation where there is already tachysystole and recurrent late decelerations would exacerbate the problem by increasing uterine contractions, potentially leading to further fetal distress.
Choice C rationale
Misoprostol is a prostaglandin analog used to ripen the cervix and induce labor. Similar to oxytocin, it would not be appropriate in this scenario as it would increase uterine contractions, worsening the tachysystole and late decelerations.
Choice D rationale
Magnesium sulfate is primarily used as a tocolytic to prevent preterm labor and as a neuroprotective agent for the fetus in cases of preeclampsia. While it has some uterine relaxation properties, it is not the first-line treatment for reducing uterine activity in the context of tachysystole and late decelerations.

Choice A rationale
Category I tracings are normal and indicate no fetal hypoxia or acidemia. They include a baseline heart rate of 110-160 bpm, moderate variability, and no late or variable decelerations.
Choice B rationale
Category II tracings are indeterminate and include any of the following: baseline heart rate changes, minimal or marked variability, absence of accelerations, or periodic decelerations. A baseline heart rate of 175 bpm with moderate variability and absent accelerations fits this category.
Choice C rationale
Category III tracings are abnormal and indicate possible fetal hypoxia or acidemia. They include absent variability with recurrent late or variable decelerations, bradycardia, or a sinusoidal pattern.
Choice D rationale
Category IV is not a standard classification in fetal heart rate monitoring. The correct categories are I, II, and III6.