A nurse is caring for a postpartum client who is breastfeeding their newborn and reports that their nipples have become sore and cracked.
Which of the following statements should the nurse make?

Choice A rationale

Fetal heart rate (FHR) accelerations occurring with fetal movement signify a healthy autonomic nervous system and adequate fetal oxygenation. These accelerations, typically 15 beats per minute (bpm) above baseline for 15 seconds in a fetus beyond 32 weeks, indicate a reactive nonstress test, reflecting good fetal well-being.

Choice B rationale

Late decelerations are a concerning finding, indicating uteroplacental insufficiency and potential fetal hypoxia. They are characterized by a gradual decrease in FHR that begins after the peak of the contraction and returns to baseline after the contraction ends, signifying a non-reassuring fetal status.

Choice C rationale

Variable decelerations are abrupt decreases in FHR, often indicative of umbilical cord compression. While not always pathological, frequent or severe variable decelerations can compromise fetal oxygenation and require further assessment, thus not indicating a reactive nonstress test.

Choice D rationale

Minimal variability in FHR, defined as an amplitude range of 5 bpm or less, suggests a compromised fetal central nervous system or a sleeping state. Persistent minimal variability can be a sign of fetal hypoxia or acidosis, and it does not meet the criteria for a reactive nonstress test. Normal variability is 6-25 bpm.

Choice A rationale

Consuming milk with iron supplements significantly inhibits iron absorption due to the high calcium content in milk. Calcium competes with iron for absorption sites in the small intestine, forming insoluble complexes that reduce the bioavailability of iron. This would counteract the intended therapeutic effect of the iron supplementation, leading to suboptimal iron levels.

Choice B rationale

Doubling an iron dose can lead to iron toxicity, which is dangerous, especially during pregnancy. Excessive iron intake can cause gastrointestinal distress, liver damage, and metabolic acidosis. Adhering to the prescribed dosage is crucial for safe and effective supplementation, preventing adverse effects while achieving therapeutic iron levels.

Choice C rationale

Maintaining adequate fiber intake (normal range 25-30 grams daily) is crucial during iron supplementation. Iron often causes constipation due to its effect on gastrointestinal motility. Dietary fiber adds bulk to stool, promoting regular bowel movements and alleviating constipation, which is a common and uncomfortable side effect of iron therapy.

Choice D rationale

Vitamin K is essential for blood coagulation, but taking 100 milligrams daily during pregnancy without a specific medical indication is excessive and potentially harmful. The normal recommended daily allowance for vitamin K during pregnancy is much lower, around 90 micrograms. High doses could interfere with anticoagulant medications or have unknown fetal effects.