You are evaluating the fetal monitor tracing of your client, who is in active labor.

Suddenly, you see the FHR drop from its baseline of 125 down to 80. You reposition the mother, increase intravenous (IV) fluid, and perform a vaginal exam.

The cervix has not changed.

Five minutes have passed, and the fetal heart rate remains in the 80s.

What additional nursing measures should you take?

Choice A rationale

A gravida 3, para 2 woman with a history of a very short previous labor (4 hours) is a grand multipara who has demonstrated rapid labor progression in the past. Multiparas, especially those with a history of precipitous labor (less than 3 hours), are at risk for rapid progression in subsequent labors. She should be advised to come to the hospital or birth center as soon as regular contractions begin to ensure a safe delivery in a controlled setting.

Choice B rationale

A gravida 1, para 0 (primigravida) generally has a longer labor duration, with the active phase often lasting many hours (normal range 6 to 18 hours). Even living 40 minutes away, she will likely have sufficient time to travel safely to the hospital once a clear pattern of regular, strong contractions has been established. This client is not the highest priority to leave immediately compared to others with a faster labor history.

Choice C rationale

A gravida 2, para 1 whose first labor lasted 16 hours has a history of a relatively long labor. Although her second labor is expected to be shorter than her first, the historical data suggests she will likely have many hours before delivery. Therefore, she does not need to rush to the hospital as soon as labor begins and can remain at home longer, following standard guidelines for hospital admission.

Choice D rationale

A gravida 2, para 1 who lives 10 minutes away has the advantage of close proximity to the hospital. While multiparas generally labor faster, her proximity allows for a slightly more relaxed approach to the initial phase of labor. She can wait until contractions are stronger, closer together (e.g., 5 minutes apart for 1 hour), or until her membranes rupture, before coming to the facility.

Step 1 is: Subtract 3 months from the month of the last menstrual period (LMP) and add 7 days to the day of the LMP.

Step 2 is: The LMP month is 10 (October). Subtract 3 months: 10 minus 3 equals 7 (July).

Step 3 is: The LMP day is 14. Add 7 days: 14 plus 7 equals 21.

Step 4 is: Naegele's rule also requires adjusting the year forward by one year because the calculation crosses the calendar year boundary, which is 2023 plus 1 equals 2024.

Step 5 is: The estimated due date (EDD) is July 21, 2024.