A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection and has been using an over-the-counter cream for the past 2 days to treat it. The nurse's initial response should be to:

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: Genetic changes and anomalies are not the most dangerous effect, as they are rare and not directly caused by smoking. Smoking can increase the risk of some birth defects, such as cleft lip and cleft palate, but these are not genetic changes and can be corrected by surgery. Smoking can also cause chromosomal abnormalities in the eggs, but these usually result in miscarriage or stillbirth, not live births.

Choice B reason:Maternal smoking is a significant risk factor for intrauterine growth restriction (IUGR). Nicotine and carbon monoxide from cigarettes reduce oxygen supply to the fetus, leading to lower birth weights and smaller body lengths.

Choice C reason: Fetal addiction to the substance inhaled is not the most dangerous effect, as it is not permanent and can be treated by medication and supportive care. Smoking can expose the fetus to nicotine, carbon monoxide, and other harmful chemicals, which can cross the placenta and affect the fetal brain and nervous system. Smoking can also cause withdrawal symptoms in the newborn, such as irritability, tremors, and difficulty feeding.

Choice D reason:Although prenatal exposure to smoking can affect neurodevelopment and is associated with behavioral issues, extensive central nervous system damage is not the most immediate or dangerous effect. The most critical concern remains intrauterine growth restriction.