A nurse is reinforcing teaching with a client who is in labor and requires an internal fetal scalp electrode. Which of the following statements should the nurse make?

A. Acrocyanosis. Acrocyanosis, or bluish discoloration of the hands and feet, is a normal finding in newborns during the first 24 to 48 hours after birth. It occurs due to immature circulation and peripheral vasoconstriction, especially in response to cold exposure. This does not require immediate intervention.
B. Blood glucose level 60 mg/dL (greater than 40 to 45 mg/dL). A blood glucose level of 60 mg/dL is within the normal range for a newborn. Hypoglycemia in neonates is typically defined as blood glucose below 40 to 45 mg/dL. Since this value is normal, it does not require reporting.
C. Crossed eyes. Intermittent eye crossing or misalignment (strabismus) is common in newborns due to weak extraocular muscles. This usually resolves as the eye muscles strengthen within the first few months of life. Persistent strabismus beyond 3 to 6 months of age requires further evaluation, but it is not a concern at 22 hours old.
D. Temperature 36°C (96.8°F). A newborn's normal temperature range is 36.5°C to 37.5°C (97.7°F to 99.5°F). A temperature of 36°C (96.8°F) indicates mild hypothermia, which increases the risk of cold stress, hypoglycemia, and respiratory distress. The nurse should report this finding and initiate warming measures, such as skin-to-skin contact, warm blankets, or a radiant warmer.

A. "This will allow us to monitor your baby's temperature." An internal fetal scalp electrode is used to monitor the fetal heart rate (FHR), not the baby's temperature. Fetal temperature is not typically monitored continuously unless there is concern for infection, such as chorioamnionitis.
B. "This will allow us to monitor your baby's heart rate." A fetal scalp electrode provides continuous, accurate fetal heart rate monitoring by detecting electrical signals from the fetal heart. It is used when external monitoring is ineffective due to maternal obesity, excessive fetal movement, or difficulty obtaining a clear FHR tracing.
C. "This will allow us to monitor your baby's blood pressure." Fetal blood pressure is not measured with a fetal scalp electrode. Blood pressure monitoring in a fetus is typically done through invasive methods in specific high-risk situations, such as umbilical artery catheterization in a neonatal intensive care unit (NICU) setting.
D. "This will allow us to monitor your baby's oxygen level." A fetal scalp electrode does not measure oxygen levels. Fetal oxygenation is assessed indirectly through FHR patterns, umbilical cord blood gases after birth, or fetal scalp blood sampling in certain cases of suspected fetal distress.