The practical nurse (PN) administers digoxin to a 9-month-old infant with an apical heart rate of 160 beats/minute.
Which apical heart rate indicates that the therapeutic effect of the medication has been achieved?

Choice A rationale

An acceleration is a visually apparent abrupt increase in the fetal heart rate above the baseline. For a 38-week fetus, an acceleration is defined as an increase of 15 beats per minute or more above the baseline, lasting 15 seconds or more but less than 2 minutes. The given finding of 10 seconds does not meet this criterion.

Choice B rationale

While fetal movement often accompanies accelerations, documenting "fetal movement" alone is insufficient. The nonstress test specifically assesses the fetal heart rate response to movement, and the critical finding to document relates to the FHR pattern itself, not just the presence of movement.

Choice C rationale

A positive tracing in obstetrics typically refers to a positive contraction stress test, which indicates late decelerations and is an abnormal finding. This terminology is not applicable to a nonstress test, where the terms "reactive" or "nonreactive" are used to describe the findings.

Choice D rationale

A nonreactive pattern on a nonstress test for a 38-week fetus is defined by the absence of two or more accelerations (15 bpm above baseline for at least 15 seconds) within a 20-minute period. The observed FHR increases lasting only 10 seconds do not meet the duration criteria for reactivity.

Choice A rationale

Preterm birth can be a complication of gestational diabetes due to polyhydramnios or preeclampsia, but macrosomia carries a higher risk of birth trauma and neonatal complications. Prematurity can lead to respiratory distress syndrome and other developmental challenges.

Choice B rationale

Macrosomic newborn is the greatest risk to the fetus if euglycemia is not maintained. High maternal glucose levels lead to excessive fetal insulin production, resulting in increased fat deposition and growth. This can cause birth injuries, hypoglycemia, and respiratory distress in the neonate.

Choice C rationale

Low birth weight is typically associated with maternal malnutrition or placental insufficiency, not poorly controlled gestational diabetes. Uncontrolled gestational diabetes usually leads to fetal overgrowth (macrosomia) due to constant glucose supply.

Choice D rationale

Cleft palate is a congenital anomaly primarily linked to genetic and environmental factors during early fetal development, not directly or primarily to poorly controlled gestational diabetes. Metabolic imbalances of diabetes are not a primary cause of such structural malformations.