A nurse is performing a nonstress test (NST) for a client who is at 28 weeks of gestation and has intrauterine growth restriction (IUGR).

The nurse observes that the fetal heart rate (FHR) does not accelerate with fetal movement after 20 minutes of monitoring.

Which of the following tests should the nurse anticipate to be ordered next for this client? (Select all that apply.)

The nurse should instruct the client to brush her nipple with her palm for 2 minutes.

This will stimulate the release of oxytocin and cause uterine contractions.The fetal heart rate (FHR) will be monitored for any signs of fetal distress, such as decelerations.

Choice A is wrong because fasting is not required for a CST.Fasting may be necessary for other tests that involve anesthesia or sedation.

Choice B is wrong because drinking orange juice will not induce contractions.Orange juice may be given to increase fetal activity before a nonstress test (NST), which measures the FHR response to fetal movement.

Choice D is wrong because lying on the back can compress the inferior vena cava and reduce blood flow to the uterus and the fetus.The client should lie on her side during the test to prevent supine hypotension syndrome.

Normal ranges for FHR are 110 to 160 beats per minute, with moderate variability and no decelerations.Normal ranges for uterine contractions are less than five in a 10-minute period, lasting less than 90 seconds each.

Explain the purpose, procedure, and possible outcomes of the test to the client.This is because the nurse should always obtain informed consent from the client before performing any procedure, and provide education and reassurance about the test.

Choice A is wrong because applying conduction gel to the client’s abdomen is not the first action the nurse should take.The nurse should first explain the test and obtain consent from the client before applying any equipment.

Choice B is wrong because instructing the client to press a button when she feels fetal movement is part of the nonstress test procedure, but not the first action.The nurse should first educate the client about the test and its purpose.

Choice D is wrong because activating a vibroacoustic stimulation device to wake up the fetus is not necessary for a nonstress test.This device may be used if the fetal heart rate is nonreactive, but only after explaining the test and obtaining consent from the client.