After examining and treating a client who has been raped, discharge instructions from the emergency department (ED) would include which of the following?

Choice A reason:
Administering oxygen using a non-rebreather mask is a subsequent step if initial measures do not improve fetal heart rate decelerations. It can help increase the amount of oxygen available to the fetus. Oxygen administration is a supportive measure that can be used if there are signs of fetal distress. In the scenario described, where the fetal heart rate slows after the start of a contraction with the lowest rate occurring after the peak, it suggests late decelerations, which are often associated with uteroplacental insufficiency. Administering oxygen can help increase the fetal oxygen reserve and is a common intervention during labor when there are concerns about fetal well-being.

Choice B reason:
Increasing the rate of maintenance IV infusion is typically considered when there is a concern for maternal hypotension or dehydration, which may not be the immediate cause of the observed fetal heart rate pattern. Increasing the rate of an IV infusion can help improve maternal hydration and blood pressure, which in turn can enhance placental perfusion. However, this intervention is more indirect and may not provide the immediate response needed to address fetal heart rate decelerations. It is typically considered after more direct interventions, such as repositioning the mother, have been attempted.

Choice C reason:
Elevating the client's legs can help improve venous return to the heart, potentially increasing maternal cardiac output and blood flow to the placenta. While this can be beneficial, it is not the primary intervention for late decelerations. Repositioning the mother to improve uteroplacental circulation is generally the first step.
Choice D reason:
Placing the client in the lateral position is often the first action taken when late decelerations are observed. This position helps improve uteroplacental blood flow and can quickly address potential issues related to fetal oxygenation. This position helps to relieve pressure on the inferior vena cava and aorta, which can be compressed by the gravid uterus, especially in the supine position. Relieving this pressure helps to improve uteroplacental circulation and can quickly address the cause of late decelerations, which is often related to compromised blood flow to the placenta.

Choice A Reason
Increased urine output is not a direct indicator of the effectiveness of nitroglycerin for angina pectoris. Nitroglycerin is a vasodilator used primarily to relieve chest pain by improving blood flow to the heart muscle, not to influence urine production.

Choice B Reason
Asking the client if their chest pain has been relieved is the most direct method of evaluating the effectiveness of nitroglycerin. Relief of chest pain indicates that the medication is working as intended, reducing the ischemia that causes angina.

Choice C Reason
While taking the client's blood pressure is important, especially since nitroglycerin can cause hypotension, it is not the primary method for evaluating the effectiveness of the medication in relieving angina. Blood pressure measurements are more of a safety check to monitor for adverse effects.

Choice D Reason
Ambulation and assessing for the absence of dyspnea can be part of an overall evaluation of the client's cardiovascular status, but they are not specific to evaluating the effectiveness of nitroglycerin for angina relief. Dyspnea may be a symptom of heart failure or other conditions, not specifically angina pectoris.