A nurse is reviewing the results of a fetal non-stress test (NST) for a client who is at 32 weeks of gestation.

The nurse notes that there are no accelerations of the fetal heart rate (FHR) during the 20-minute test.

Which of the following actions should the nurse take next? (Select all that apply.).

“The NST can be affected by my smoking or medication use.” This statement indicates an understanding of the teaching because smoking and medication use can alter the fetal heart rate response and cause false-negative or false-positive results.

Some possible explanations for the other choices are:

• Choice A is wrong because the NST cannot detect chromosomal abnormalities in the baby.

The NST only measures the fetal heart rate and movement, not the genetic makeup of the baby.To detect chromosomal abnormalities, other tests such as amniocentesis or chorionic villus sampling are needed.

• Choice B is wrong because the NST does not cause contractions or discomfort for the mother or the baby.The NST is a non-invasive and painless procedure that does not put any stress on the fetus.The only discomfort that may occur is from having a belt around the abdomen and a button to press when feeling fetal movement.

• Choice D is wrong because the NST cannot measure the amount of amniotic fluid around the baby.

The NST only monitors the fetal heart rate and movement, not the volume of fluid in the uterus.To measure the amount of amniotic fluid, other tests such as ultrasound or amniotic fluid index are needed.

Perform a biophysical profile (BPP).A BPP is a test that combines a non-stress test (NST) with an ultrasound to evaluate the fetal well-being.A BPP is indicated when an NST is non-reactive, meaning that there are no accelerations of the fetal heart rate (FHR) with fetal movements.A BPP measures five parameters: fetal movement, fetal tone, fetal breathing, amniotic fluid volume and FHR reactivity.

A BPP can help detect fetal hypoxemia or distress and guide further management.

Choice A is wrong because repeating the NST after 24 hours may delay the diagnosis and treatment of fetal compromise.A non-reactive NST requires further evaluation with a BPP or a contraction stress test (CST).

Choice B is wrong because performing a CST may not be safe for a fetus with a non-reactive NST.

A CST involves inducing uterine contractions with oxytocin or nipple stimulation and monitoring the FHR response.A CST can cause fetal distress or placental abruption if the fetus is already hypoxic.

Choice D is wrong because applying an acoustic vibration device to the abdomen may not elicit FHR accelerations if the fetus is hypoxic or asleep.An acoustic stimulation test (AST) is sometimes used to augment an NST, but it is not a substitute for a BPP.

Choice E is wrong because administering oxygen via face mask to the client may not improve the FHR reactivity if the cause of fetal compromise is not maternal hypoxia.Oxygen administration may also have adverse effects on maternal and fetal hemodynamics.