Screening at 24 weeks of gestation reveals that a pregnant woman has gestational diabetes mellitus (GDM). In planning her care, the nurse and the woman mutually agree that an expected outcome is to prevent injury to the fetus as a result of GDM. The nurse identifies that the fetus is at greatest risk for:

Choice A reason: This is not the correct action, as the rate is not within normal limits. A normal FHR at 30 weeks of gestation is between 110 and 160 beats/min. A rate of 82 beats/min is considered bradycardia (slow heart rate), which can indicate fetal distress or hypoxia (low oxygen).

Choice B reason: This is not the first action, but it may be necessary after confirming the FHR. The nurse should first rule out the possibility of a maternal-fetal heart rate confusion, which can occur when the maternal heart rate is mistakenly counted as the FHR. This can happen if the Doppler or the electronic fetal monitor is placed too close to the maternal pulse or if the maternal heart rate is unusually slow².

Choice C reason: This is the correct action, as it can help differentiate between the maternal and the fetal heart rate. The nurse should assess the woman's radial pulse at the same time as listening to the FHR and compare the rates and rhythms. If the rates are the same or very close, it is likely that the nurse is hearing the maternal heart rate instead of the FHR. If the rates are different, it is likely that the nurse is hearing the FHR and that the fetus has bradycardia.

Choice D reason: This is not the correct action, as it may cause unnecessary anxiety or distress for the woman. The nurse should not allow the woman to hear the heartbeat until the FHR is confirmed and the cause of the bradycardia is determined. The nurse should also explain the situation to the woman and provide reassurance and support.

Choice A reason: Limiting time spent wearing a wet bathing suit is a good preventive measure, as it can reduce the moisture and warmth that can promote the growth of bacteria and fungi in the genital area. The nurse should advise the 15-year old to change into dry clothes as soon as possible after swimming or bathing.

Choice B reason: Not douching is a good preventive measure, as it can preserve the natural balance of the vaginal flora and pH. The nurse should explain to the 15-year old that douching can wash away the protective mucus and lactobacilli that prevent infections, and it can also introduce harmful substances or microorganisms into the vagina.

Choice C reason: Wearing nylon undergarments is not a good preventive measure, as it can trap heat and moisture in the genital area and create a favorable environment for infections. The nurse should recommend the 15-year old to wear cotton or breathable fabrics that can absorb sweat and allow air circulation.

Choice D reason: Using floral scented bath salts is not a good preventive measure, as it can irritate the genital mucosa and alter the vaginal pH. The nurse should caution the 15-year old to avoid using any products that contain perfumes, dyes, or chemicals in the genital area, as they can cause allergic reactions or infections.

Choice E reason: Decreasing sugar intake is a good preventive measure, as it can lower the risk of yeast infections. The nurse should educate the 15-year old that sugar can feed the growth of Candida albicans, which is a common cause of vaginal candidiasis. The nurse should also encourage the 15-year old to eat a balanced diet that includes probiotics, such as yogurt, to maintain a healthy vaginal flora.

Choice F reason: Avoiding tight-fitting jeans is a good preventive measure, as it can prevent friction and pressure on the genital area. The nurse should suggest the 15-year old to wear loose or comfortable clothing that can reduce the risk of skin irritation or injury, which can lead to infections.