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: Woman shorter than 62 inches or 157 cm should not restrict her weight gain during pregnancy, as she may have a higher risk of delivering a low birth weight infant. She should follow the recommended weight gain guidelines based on her pre-pregnancy body mass index (BMI).

Choice B reason: Woman in early adolescence should not restrict her weight gain during pregnancy, as she is still growing and developing herself. She may need more calories and nutrients than an adult woman to support her own health and the fetal growth.

Choice C reason: Woman who was 30 lbs overweight before pregnancy should restrict her weight gain during pregnancy, as she may have a higher risk of developing gestational diabetes, hypertension, or preeclampsia. She should aim for a lower weight gain range than a woman with a normal BMI.

Choice D reason: Woman pregnant with twins should not restrict her weight gain during pregnancy, as she needs more energy and nutrients to support the growth of two fetuses. She should aim for a higher weight gain range than a woman with a singleton pregnancy.