A nurse is calculating the estimated date of birth using Nägele's rule for a client who is pregnant and whose last menstrual cycle started June 21. Which of the following is the estimated date of delivery in the next year?

The correct answer is Choice C.

A nonstress test (NST) is a safe and noninvasive test used to check a baby’s health before birth. NSTs are a form of electronic fetal monitoring. In addition, nonstress tests are normally performed 26 to 30 weeks into pregnancy. This is because, in healthy babies, fetal heart rate increases with movement.

Nonstress test results are given as one of the following:

Reactive or Reassuring. This means the baby’s heart rate increased two or more times during the testing period.

Nonreactive. This means the baby’s heartbeat didn’t change when the baby moves, or the baby wasn’t moving much. A nonreactive result doesn’t always mean your baby has a health problem.

Based on this information, the correct answer to your question is c. Three fetal movements perceived by the client in a 20-min testing period indicate a nonreactive result, which should prompt further diagnostic testing. The other options are normal or reassuring findings for a nonstress test.

Choice A rationale: An increase in fetal heart rate to 150/min above the baseline of 140/min lasting 10 seconds in response to fetal movement within a 40-min testing period is a normal finding and indicates a reactive nonstress test. A reactive nonstress test means that the fetal heart rate increases by at least 15 beats per minute for at least 15 seconds in response to fetal movement, at least twice in a 20-min period. This shows that the fetus is well-oxygenated and has an intact central nervous system. Therefore, this finding does not indicate the need for further diagnostic testing.

Choice B rationale: No late decelerations in the fetal heart rate noted with three uterine contractions of 60 seconds in duration within a 10-min testing period is also a normal finding and indicates a negative contraction stress test. A negative contraction stress test means that there are no late decelerations in the fetal heart rate with at least three uterine contractions of 40 to 60 seconds in duration within a 10-min period. Late decelerations are a sign of uteroplacental insufficiency and fetal hypoxia, and they occur when the fetal heart rate drops below the baseline after the peak of the contraction. Therefore, this finding does not indicate the need for further diagnostic testing.

Choice C rationale: Three fetal movements perceived by the client in a 20-min testing period is an abnormal finding and indicates a nonreactive nonstress test. A nonreactive nonstress test means that the fetal heart rate does not increase by at least 15 beats per minute for at least 15 seconds in response to fetal movement, even after 40 min of testing. This may suggest that the fetus is asleep, sedated, or compromised. Therefore, this finding indicates the need for further diagnostic testing, such as a biophysical profile or a contraction stress test, to assess the fetal well-being.

Choice D rationale: Irregular contractions of 10 to 20 seconds in duration that are not felt by the client are not relevant to the nonstress test, as they do not affect the fetal heart rate or the uteroplacental perfusion. These contractions may be Braxton Hicks contractions, which are painless and irregular contractions that occur throughout pregnancy. They do not indicate labor or fetal distress. Therefore, this finding does not indicate the need for further diagnostic testing.

• Color: Consistent with genetic background

  • Interpretation: B) Sign of potential improvement
  • Rationale: The newborn’s color being consistent with their genetic background indicates a normal adjustment and is not a sign of deterioration. This suggests improvement from the initial condition of acrocyanosis.

• Axillary Temperature: 36.3°C (97.4°F)

  • Interpretation: B) Sign of potential improvement
  • Rationale: The axillary temperature is within the normal range (36.1°C to 37.2°C), which is a positive sign and suggests that the newborn is maintaining normal body temperature.

• Reflex Irritability: Cry

  • Interpretation: B) Sign of potential improvement
  • Rationale: A good cry indicates normal reflex irritability and is a positive sign of neurological and overall well-being.

• Muscle Tone: Flaccid

  • Interpretation: C) Sign of potential worsening condition
  • Rationale: Flaccid muscle tone is concerning as it might indicate a worsening condition or potential neurological issues. It is less typical for muscle tone to be flaccid after the initial adjustment period.

• Respiration Effort: Good cry

  • Interpretation: B) Sign of potential improvement
  • Rationale: A good cry indicates effective respiration and is a positive sign of the newborn’s respiratory status.

• Heart Rate: 140/min

  • Interpretation: B) Sign of potential improvement
  • Rationale: The heart rate is within the normal range for newborns (120-160/min), indicating that the cardiovascular system is functioning properly.