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.)

Abiophysical profile (BPP)is a test that combines a nonstress test with an ultrasound to assess fetal well-being.Aumbilical artery Doppler velocimetryis a test that measures the blood flow in the umbilical cord to detect fetal growth restriction.Both of these tests are indicated for a client who has a nonreactive nonstress test (NST), which means that the fetal heart rate does not accelerate with fetal movement after 20 minutes of monitoring.

Choice B is wrong because acontraction stress test (CST)is a test that stimulates uterine contractions to evaluate how the fetal heart rate responds to stress.It is not recommended for clients who have intrauterine growth restriction (IUGR) because it can compromise fetal oxygenation.

Choice D is wrong because anamniocentesisis a test that obtains amniotic fluid for genetic testing, fetal lung maturity, or infection.It is not used to assess fetal well-being or growth.

Choice E is wrong because afetal kick countis a method of monitoring fetal movement at home by counting how many times the fetus kicks in a certain period of time.It is not a test that can be ordered by a health care provider.

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.