(Select all that apply) A nurse is performing a nonstress test (NST) for a client who is at 32 weeks of gestation and has gestational diabetes mellitus.
The nurse uses vibroacoustic stimulation to elicit fetal movement and acceleration of FHR.
What are the indications for using this method?
The fetus is in a breech presentation
The fetus has not moved for 40 minutes.
The baseline FHR variability is minimal.
The client has a history of stillbirth.
The test result is nonreactive after 40 minutes.
Correct Answer : E
The test result is nonreactive after 40 minutes. Vibroacoustic stimulation (VAS) is the application of a vibratory sound stimulus to the abdomen of a pregnant woman to induce fetal heart rate (FHR) accelerations. VAS is typically used during a nonstress test (NST) to elicit fetal movement and reactivity when the baseline FHR variability is minimal or the test result is nonreactive after 40 minutes. VAS can shorten the testing time and reduce the incidence of non-reactive cardiotocography.
Choice A is wrong because the fetus’s presentation does not affect the use of VAS.
Choice B is wrong because VAS is not indicated for a fetus that has not moved for 40 minutes, unless the NST result is also nonreactive.
Choice C is wrong because minimal baseline FHR variability is not a sufficient indication for VAS, unless the NST result is also nonreactive.
Choice D is wrong because a history of stillbirth does not affect the use of VAS.
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Correct Answer is D
Explanation
Notify the provider and prepare for delivery.Oligohydramnios is a condition where the amniotic fluid volume is less than expected for gestational age and it is associated with maternal and fetal complications.
The nonstress test (NST) is a method of fetal surveillance that measures the fetal heart rate response to fetal movement.A reactive NST is defined as at least two accelerations of 15 beats per minute or more above the baseline, lasting 15 seconds or more, within a 20-minute period.
A nonreactive NST indicates fetal hypoxia or acidosis and requires further evaluation.An acoustic stimulator can be used to elicit fetal movement and accelerations, but it should not be repeated more than once in a 10-minute period.
Therefore, choice A is wrong because repeating the acoustic stimulation after 1 minute is too soon and may cause fetal distress.
Choice B is wrong because documenting the finding as a nonreactive NST is not enough to address the situation.Choice C is wrong because performing a contraction stress test (CST) is contraindicated in oligohydramnios because it may cause umbilical cord compression and fetal compromise.
The CST involves inducing uterine contractions with oxytocin or nipple stimulation and monitoring the fetal heart rate for signs of intolerance.
A negative CST means that there
Correct Answer is A
Explanation
Place the device over the fetal back for 3 seconds.This is because vibroacoustic stimulation (VAS) is the application of a vibratory sound stimulus to the abdomen of a pregnant woman to induce fetal heart rate (FHR) accelerations.The presence of FHR accelerations reliably predicts the absence of fetal metabolic acidemia.VAS is typically used during a nonstress test (NST) to assess fetal well-being.The device should be placed over the fetal back for 3 seconds, as this is the optimal duration and location to elicit a fetal response.
Choice B is wrong because holding the device firmly against the maternal abdomen for 10 seconds may be too long and too strong for the fetus, and may cause discomfort or distress.
Choice C is wrong because moving the device around the maternal abdomen until fetal movement is detected may not be effective or efficient, as the device may not reach the optimal location or duration to stimulate the fetus.
Choice D is wrong because applying the device intermittently over the fundus for 15 seconds may not target the fetal auditory system, which is located near the fetal back, and may also be too long and too strong for the fetus.
Normal ranges for FHR are between 110 and 160 beats per minute, and FHR accelerations are defined as an increase of at least 15 beats per minute above baseline for at least 15 seconds.
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