A woman with severe preeclampsia is receiving a magnesium sulfate infusion. The nurse becomes concerned after assessment when the woman exhibits:

Choice A reason: Eating five small meals daily can help reduce heartburn in pregnancy by preventing overeating and reducing the pressure on the stomach from the growing uterus. It can also help maintain a steady blood glucose level and prevent nausea and vomiting.

Choice B reason: Lying down after each meal can worsen heartburn in pregnancy by allowing the stomach acid to reflux into the esophagus. It can also cause breathing difficulties and increase the risk of aspiration. The woman should avoid lying down for at least two hours after eating and elevate her head and chest when sleeping.

Choice C reason: Reducing the amount of fiber she consumes can cause constipation and hemorrhoids in pregnancy, which can increase the discomfort and pain. Fiber is important for maintaining a healthy digestive system and preventing gestational diabetes and preeclampsia. The woman should consume at least 25 grams of fiber per day from fruits, vegetables, whole grains, beans, and nuts.

Choice D reason: Substituting other calcium sources for milk in her diet can deprive the woman and the baby of essential nutrients, such as protein, vitamin D, and riboflavin. Milk is not a common cause of heartburn in pregnancy, unless the woman is lactose intolerant or allergic to dairy products. The woman should consume at least three servings of dairy products per day or take calcium supplements as prescribed.

Choice A reason: An FHR greater than 110 beats/min is not a sufficient indicator of fetal well-being during labor. The normal range of FHR is between 110 and 160 beats/min, but it can vary depending on the gestational age, fetal activity, and maternal factors. A high or low FHR may indicate fetal distress or compromise.

Choice B reason: Maternal pain control is not a direct measure of fetal well-being during labor. However, maternal pain can affect the FHR indirectly by causing maternal stress, anxiety, or hyperventilation, which can alter the blood flow and oxygen delivery to the fetus. Therefore, adequate pain management is important for both maternal and fetal health.

Choice C reason: The response of the FHR to UCs is the most reliable and accurate way of assessing fetal well-being during labor. UCs can cause temporary reductions in the blood flow and oxygen supply to the fetus, which can affect the FHR. A normal response of the FHR to UCs is either no change or a slight increase (acceleration), which indicates a well-oxygenated and resilient fetus. An abnormal response of the FHR to UCs is a decrease (deceleration), which indicates a compromised or hypoxic fetus.

Choice D reason: Accelerations in the FHR are not a definitive measure of fetal well-being during labor. Accelerations are transient increases in the FHR above the baseline, usually caused by fetal movement, stimulation, or UCs. Accelerations are generally reassuring and indicate a responsive and well-oxygenated fetus, but they are not always present or consistent. The absence of accelerations does not necessarily mean fetal distress, as some fetuses may have periods of sleep or reduced activity.