The nurse receives a call at the provider's office with a patient asking what her estimated due date is. The last menstrual period was on 10/14/2023.

Using Naegele's rule, the nurse determines that the EDD is:

Choice A rationale

The normal baseline fetal heart rate (FHR) range for a term fetus is defined as 110 to 160 beats/min over a 10-minute segment, excluding periodic or episodic changes. A rate of 135 beats/min falls within this established normal range, indicating an appropriate balance between the fetal sympathetic and parasympathetic nervous systems.

Choice B rationale

Fetal bradycardia is defined as a baseline FHR of less than 110 beats/min for a duration of 10 minutes or longer. A rate of 135 beats/min is significantly higher than this definition and thus does not meet the criteria for bradycardia.

Choice C rationale

Fetal tachycardia is defined as a baseline FHR of greater than 160 beats/min for a duration of 10 minutes or longer. A rate of 135 beats/min is below this threshold and does not meet the criteria for fetal tachycardia.

Choice D rationale

Fetal hypoxia, a state of inadequate oxygen supply at the tissue level, is typically manifested by non-reassuring FHR patterns, such as late decelerations, absent or minimal variability, or sustained bradycardia. A normal baseline rate of 135 beats/min does not suggest hypoxia.

Choice A rationale

Telling the woman to push immediately upon full dilation is often discouraged as it does not allow for a period of rest or passive descent, which is beneficial for both maternal and fetal well-being, especially if the urge to push is not yet overwhelming. Pushing should ideally be driven by the woman's involuntary urge, often called 'laboring down' or delayed pushing. This conserves maternal energy and may improve fetal oxygenation by reducing the number of sustained pushing efforts.

Choice B rationale

Sustained, closed-glottis pushing, where the woman holds her breath and pushes for 10-15 seconds, increases intrathoracic and intra-abdominal pressure. This can lead to decreased venous return to the heart, resulting in reduced maternal cardiac output and blood pressure. Consequently, this diminishes blood flow to the placenta and can cause fetal hypoxia or nonreassuring fetal heart rate patterns, making it a generally unfavorable pushing technique.

Choice C rationale

While an epidural can provide effective pain relief, it may slow the progress of the second stage of labor by reducing the woman's urge and ability to spontaneously push, especially with dense motor blockade. Furthermore, the timing of the epidural placement, particularly initiating it during the second stage, is not a primary measure to enhance fetal descent, which relies more on gravity and effective pushing efforts.

Choice D rationale

Encouraging upright positions like squatting or having the head of the bed up utilizes the force of gravity to assist fetal descent and rotation through the pelvis. These positions also promote uterine contractility and allow for optimal maternal-pelvic alignment. Squatting, in particular, increases the capacity of the pelvic outlet by 10.