At her first prenatal visit, a woman and the nurse are discussing fetal development.The client asks, "When will we be able to hear the baby's heartbeat?" The nurse should reply, The fetal heartbeat can be heard with a Doppler at:

Choice A rationale

Blood returning to the right atrium from the pulmonary system is consistent with adult circulation, not fetal circulation. In fetal circulation, blood bypasses the lungs via the ductus arteriosus and foramen ovale since the fetus receives oxygenated blood from the placenta, not the lungs.

Choice B rationale

Blood is returning to the placenta via the umbilical arteries. In fetal circulation, deoxygenated blood is carried from the fetus to the placenta through the umbilical arteries. This is consistent with normal fetal circulation as the placenta is responsible for gas exchange.

Choice C rationale

Blood being shunted to the right side from the left side of the heart is incorrect. In fetal circulation, there is a right-to-left shunt through the foramen ovale, allowing blood to bypass the non-functioning fetal lungs and go directly into systemic circulation.

Choice D rationale

A right-to-left shunt is not seen between the umbilical arteries. Instead, the shunts in fetal circulation are the ductus venosus, ductus arteriosus, and foramen ovale, which help reroute blood away from the fetal lungs and liver.

Choice A rationale: Administer IV fluids with electrolytes: This is crucial to rehydrate the client and correct electrolyte imbalances caused by excessive vomiting, a common complication of hyperemesis gravidarum.

Choice B rationale: Offer small, frequent meals high in protein: Small, frequent meals can help manage nausea and vomiting by preventing the stomach from becoming empty, while high-protein foods can provide necessary nutrients and energy.

Choice C rationale: Administer antiemetics as prescribed: Antiemetics can help control nausea and vomiting, improving the client's ability to tolerate oral intake and maintain hydration and nutrition.

Choice D rationale: Encourage the client to increase oral fluid intake immediately: While increasing oral fluid intake is beneficial, it may not be immediately feasible due to the severity of nausea and vomiting in hyperemesis gravidarum. Hence, initial IV fluid therapy is prioritized.

Choice E rationale: Perform continuous fetal monitoring: Continuous fetal monitoring is not typically necessary in the early stages of pregnancy, especially at 11 weeks of gestation. The primary focus should be on stabilizing the mother's condition to support overall pregnancy health.