The nurse caring for a woman hospitalized for hyperemesis gravidarum should expect that initial treatment will involve:

Choice A reason: Normal weight women should gain 11.5 to 16 kg during pregnancy, according to the Institute of Medicine (IOM) guidelines. This is based on the body mass index (BMI) of 18.5 to 24.9 before pregnancy.

Choice B reason: Underweight women should gain 12.5 to 18 kg during pregnancy, according to the IOM guidelines. This is based on the BMI of less than 18.5 before pregnancy. Underweight women are at risk of having low birth weight infants, so they need to gain more weight to support fetal growth and development.

Choice C reason: Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale, according to the IOM guidelines. This is because adolescents are still growing themselves and need extra nutrients and calories to meet their own needs and those of the fetus.

Choice D reason: In twin gestations, the weight gain recommended for a single fetus pregnancy should not be simply doubled. The IOM guidelines suggest that women with twin gestations should gain 16.5 to 24.5 kg if they have a normal weight before pregnancy, 14 to 22.5 kg if they are overweight, and 11 to 19 kg if they are obese.

Choice E reason: Obese women should gain at least 7 to 11.5 kg during pregnancy, according to the IOM guidelines. This is based on the BMI of 30 or more before pregnancy. Obese women are at risk of having complications such as gestational diabetes, preeclampsia, and cesarean delivery, so they need to limit their weight gain to avoid further complications.

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.