A pregnant client is undergoing a nipple-stimulated contraction stress test (CST). She is experiencing contractions every three minutes.

The fetal heart rate (FHR) baseline is approximately 120 beats/min with no decelerations.

How should the nurse document this test?

Choice A rationale:

While non-pharmacologic methods can promote relaxation and coping, they may not guarantee full alertness at all times.

The intensity of labor pain can vary significantly, and even non-pharmacologic methods may not completely prevent fatigue or exhaustion.

Factors such as prolonged labor, anxiety, or discomfort can still impact alertness.

Choice C rationale:

Non-pharmacologic methods often provide significant pain relief, but they may not achieve the same degree of pain control as pharmacologic options like epidural analgesia.

The level of pain relief experienced with non-pharmacologic methods can depend on individual factors, preferences, and the specific techniques used.

Choice D rationale:

While relaxation and reduced anxiety can sometimes contribute to a more efficient labor, there's no guarantee that nonpharmacologic methods will consistently lead to a more rapid labor.

The duration of labor is influenced by various factors, including the strength and frequency of contractions, the position of the fetus, and the mother's overall health and preparedness.

Choice B rationale:

Non-pharmacologic pain management techniques do not involve medications or interventions that could potentially have adverse effects on the fetus.

This makes them a safe and desirable option for many pregnant women who are concerned about the potential risks of pharmacologic pain relief.

Common non-pharmacologic techniques include:

Relaxation techniques (deep breathing, guided imagery, meditation)

Hydrotherapy (immersion in water, showers, hot or cold compresses)

Positioning and movement (walking, rocking, changing positions frequently)

Massage and touch therapy

Acupuncture and acupressure

Transcutaneous electrical nerve stimulation (TENS)

Biofeedback

Hypnosis

Continuous labor support (from a doula, partner, or other support person)

Choice A rationale:

Drug/alcohol use: While substance abuse during pregnancy can lead to adverse outcomes such as preterm labor, fetal growth restriction, and birth defects, it is not considered a primary factor in determining high-risk status for this patient. The specific substances involved (cocaine and alcohol) are indeed associated with risks, but they are not as significant as other factors in this case.

Age: The patient's age of 24 is not considered a high-risk factor for pregnancy. Advanced maternal age (typically defined as 35 years or older) is associated with increased risks for chromosomal abnormalities and other complications, but this patient falls below that age threshold.

Family history: Family history of diabetes mellitus, cancer, and neural tube defects can be relevant to pregnancy risk, but in this case, other factors outweigh their significance.

Choice B rationale:

Blood pressure: The patient's blood pressure of 108/70 mm Hg is within the normal range and does not contribute to highrisk categorization. High blood pressure (hypertension) during pregnancy can lead to preeclampsia and other complications, but this patient does not present with hypertension.

Age: As explained in Choice A, the patient's age is not a high-risk factor.

BMI: A BMI of 17 is considered underweight, which can increase the risk of certain pregnancy complications such as preterm birth and low birth weight. However, in this case, other factors are more significant in determining high-risk status.

Choice C rationale:

Family history: The patient's family history of a neural tube defect (NTD) in a close relative is a significant risk factor for NTDs in her own pregnancy. NTDs are serious birth defects that affect the brain and spinal cord, and they can have lifelong implications for the child. This factor alone warrants a high-risk categorization.

BMI: The patient's underweight BMI of 17 further contributes to her high-risk status, as it can increase the likelihood of certain complications as mentioned earlier.

Drug/alcohol abuse: The patient's admission of cocaine and alcohol use, even if occasional, is a concerning factor for pregnancy. Cocaine, in particular, is a potent vasoconstrictor that can negatively impact fetal growth and development. Alcohol consumption during pregnancy can lead to fetal alcohol spectrum disorders (FASDs), which can cause a range of physical, cognitive, and behavioral problems.

Choice D rationale:

Age: As explained previously, the patient's age is not a high-risk factor.

BMI: The patient's BMI is a contributing factor, but not the most significant one in this case.

Family history: The patient's family history is relevant, but the presence of a neural tube defect in a close relative is the most significant aspect of her family history in terms of pregnancy risk.