A patient at 24 weeks of gestation says she has a glass of wine with dinner every evening. The nurse will counsel her to eliminate all alcohol intake because:

Choice A reason: This is not the correct action, as the rate is not within normal limits. A normal FHR at 30 weeks of gestation is between 110 and 160 beats/min. A rate of 82 beats/min is considered bradycardia (slow heart rate), which can indicate fetal distress or hypoxia (low oxygen).

Choice B reason: This is not the first action, but it may be necessary after confirming the FHR. The nurse should first rule out the possibility of a maternal-fetal heart rate confusion, which can occur when the maternal heart rate is mistakenly counted as the FHR. This can happen if the Doppler or the electronic fetal monitor is placed too close to the maternal pulse or if the maternal heart rate is unusually slow².

Choice C reason: This is the correct action, as it can help differentiate between the maternal and the fetal heart rate. The nurse should assess the woman's radial pulse at the same time as listening to the FHR and compare the rates and rhythms. If the rates are the same or very close, it is likely that the nurse is hearing the maternal heart rate instead of the FHR. If the rates are different, it is likely that the nurse is hearing the FHR and that the fetus has bradycardia.

Choice D reason: This is not the correct action, as it may cause unnecessary anxiety or distress for the woman. The nurse should not allow the woman to hear the heartbeat until the FHR is confirmed and the cause of the bradycardia is determined. The nurse should also explain the situation to the woman and provide reassurance and support.

Choice A reason: Vibroacoustic stimulation is a technique that uses sound to stimulate the fetus and elicit a response. It is sometimes used in conjunction with the nonstress test (NST), not the CST. The NST measures the fetal heart rate (FHR) in response to fetal movement, while the CST measures the FHR in response to uterine contractions.

Choice B reason: A negative CST result means that the FHR does not show any late decelerations during at least three contractions in a 10-minute period. Late decelerations are decreases in the FHR that begin after the peak of a contraction and return to the baseline after the contraction ends. They indicate uteroplacental insufficiency, which means that the placenta is not delivering enough oxygen and nutrients to the fetus. A negative CST result is reassuring and suggests that the fetus is well-oxygenated and can tolerate labor².

Choice C reason: The CST is not an invasive test, as it does not involve inserting any instruments or devices into the uterus or the fetus. However, it does require stimulating contractions, either by giving the pregnant woman oxytocin (a hormone that causes uterine contractions) or by having her rub her nipples (which also releases oxytocin). The contractions can be uncomfortable and may trigger preterm labor in some cases.

Choice D reason: The CST is not more effective than the NST if the membranes have already been ruptured. In fact, the CST is contraindicated (not recommended) in women who have ruptured membranes, as it can increase the risk of infection and bleeding. The NST is a safer and simpler alternative to the CST, as it does not require stimulating contractions. However, the NST may not be as reliable as the CST in detecting fetal compromise.