Which FHR finding would concern the nurse during labor?

Choice A rationale

Auscultation of the fetal heartbeat by a trained professional, typically with a Doppler device by 10 to 12 weeks of gestation, is a positive and definitive sign of pregnancy. This is an objective sign that verifies the presence of a living fetus and is completely unique to the state of being pregnant.

Choice B rationale

Verification of fetal movement, though a probable sign when felt by the examiner, is not considered a positive sign because involuntary muscle contractions, peristalsis, or movement of gas can be mistaken for fetal movement. Positive signs are objective, definitive proof of a fetus.

Choice C rationale

A positive human chorionic gonadotropin (hCG) test is a highly reliable probable sign of pregnancy, as this hormone is produced by the trophoblast. However, elevated hCG can rarely be caused by non-pregnant conditions like certain tumors, thus it is not considered a definitive, positive sign.

Choice D rationale

Palpating the uterine fundus to estimate uterine size is a probable sign of pregnancy. While suggestive of an enlarging uterus, it is subjective and can be mimicked by pelvic masses or uterine tumors like leiomyomas, failing to provide irrefutable evidence of a pregnancy.

Choice E rationale

Visualization of the fetus or embryo via ultrasound is the most conclusive and positive diagnostic sign of pregnancy. Seeing the gestational sac, fetal pole, or fetal structures unequivocally confirms the presence of an intrauterine gestation and is unique to pregnancy.

Choice A rationale

While adequate hydration is absolutely crucial during pregnancy, especially with exercise, focusing solely on "several glasses of fluid" is incomplete. The most critical nutrient to replace during aerobic exercise, like tennis, is readily available glucose from carbohydrates to prevent maternal hypoglycemia, which can harm the fetus and trigger ketosis. Fluids are vital but D addresses the immediate energy need.

Choice B rationale

Replacing sodium via salty foods is generally not necessary during moderate exercise and normal fluid intake. Excessive sodium could exacerbate dependent edema, which is common in late pregnancy, and potentially increase blood pressure in a susceptible woman. Plain water or sports drinks with small amounts of electrolytes are preferred for fluid balance.

Choice C rationale

Protein is essential for tissue growth and repair, but it is not the immediate energy source needed to fuel the high energy demands of exercise. The body relies primarily on stored glycogen and circulating glucose (carbohydrates) during physical activity; utilizing protein for energy, known as gluconeogenesis, is an inefficient and less desirable process.

Choice D rationale

Easily digested sources of carbohydrate, such as fruit or energy bars, are the most important nutritional intake before and during exercise. The metabolic demands of the fetus and physical activity increase the mother's need for glucose; consuming carbohydrates prevents maternal hypoglycemia and subsequent ketosis, which is a harmful metabolic state for the fetus.