A nurse is caring for a client who is having a nonstress test. The fetal heart rate (FHR) baseline is 145 bpm, there is moderate variability, but there have been no accelerations or fetal movement. Which of the following actions should the nurse complete next?
Choices:

Choice A rationale

Intrauterine growth restriction (IUGR) is an indication for a contraction stress test. It assesses fetal response to uterine contractions, identifying potential placental insufficiency.

Choice B rationale

A normal biophysical profile indicates no need for a contraction stress test. It assesses fetal well-being, and normal results suggest no immediate concerns.

Choice C rationale

Placental abruption is a contraindication for a contraction stress test. Inducing contractions can exacerbate placental separation, risking maternal and fetal health.

Choice D rationale

Decreased fetal movements warrant a contraction stress test. It evaluates fetal response to contractions, detecting possible hypoxia or compromised fetal condition.

Choice E rationale

Post-term pregnancy (>42 weeks) is an indication for a contraction stress test. It assesses placental function and fetal well-being as prolonged gestation increases risks.

Choice A rationale: Performing a sterile vaginal examination (SVE) is important for assessing cervical dilation and effacement, but it does not address the immediate concern of a Category 3 fetal heart rate tracing, which indicates fetal distress and requires prompt intervention.

Choice B rationale: Placing the client in a side-lying position can improve uteroplacental blood flow and oxygenation to the fetus by relieving compression on the inferior vena cava and enhancing venous return, thereby reducing fetal distress observed in Category 3 tracings.

Choice C rationale: Applying oxygen at 10 L/min via a venturi mask increases maternal oxygenation, which can enhance oxygen delivery to the fetus. This intervention is crucial in addressing fetal distress and improving fetal oxygenation, as observed in Category 3 fetal heart rate tracings.

Choice D rationale: Initiating a bolus of primary IV fluids can improve maternal blood volume and circulation, thereby enhancing uteroplacental perfusion and fetal oxygenation. This intervention is important in managing Category 3 fetal heart rate tracings and reducing fetal distress.

Choice E rationale: Increasing the oxytocin infusion to 13 mu/min is not appropriate as it can lead to hyperstimulation of the uterus, reducing uteroplacental blood flow and exacerbating fetal distress. In Category 3 tracings, the oxytocin infusion should be discontinued to reduce contractions.