In a prenatal clinic, a nurse is caring for a group of clients.

Which client should the nurse identify as having a contraindication for a contraction stress test?

Choice A rationale
Asking when the client last ate meat is not relevant for assessing dietary intake in a client who adheres to a vegan diet. Vegans do not consume meat or any other animal products.
Choice B rationale
While vitamin C is an important nutrient, it is not typically a concern for vegans as it is abundant in fruits and vegetables. Therefore, asking about vitamin C supplementation may not provide the most useful information about the client’s dietary intake.
Choice C rationale
Protein intake is a key concern for individuals following a vegan diet, as many sources of protein are animal-based. Vegans can get protein from foods like lentils, chickpeas, beans, tofu, and nuts. Therefore, asking about daily protein intake can provide valuable information about the client’s dietary habits and nutritional status.
Choice D rationale
Shellfish are not part of a vegan diet, so asking if the client has considered eating shellfish would not be relevant or appropriate.

Choice A rationale
Administering oxygen helps improve oxygenation to the fetus and is the priority intervention for late decelerations. Oxytocin is commonly used for induction and augmentation of labor. Its influence is indirect via increased uterine activity, mostly due to increased frequency of contractions or baseline pressure (hypertonus). Increase in duration or amplitude of contractions can also lead to FHR changes. The FHR changes associated with oxytocin infusion may be caused by compression of the cord with contractions or by the reduction in placental perfusion due to increased intrauterine basal pressure and frequent contractions cutting off the blood supply to the placenta. Therefore, administering oxygen can help improve the oxygen supply to the fetus.
Choice B rationale
Instructing the client to bear down and push with contractions is not the appropriate action when the fetus is experiencing persistent late decelerations. This action is more associated with the active phase of labor and not with managing fetal distress.
Choice C rationale
Amnioinfusion is a procedure where a saline solution is instilled into the uterus during labor if there is low amniotic fluid, or thick meconium is present. It is not typically used in response to late decelerations in the FHR.
Choice D rationale
Placing the client in a supine position is not the correct action. The supine position can exacerbate a condition known as supine hypotensive syndrome, where the gravid uterus compresses the inferior vena cava, reducing venous return to the heart and cardiac output. This can potentially worsen fetal distress.