The nurse is providing discharge teaching to a client with angina pectoris who is prescribed metoprolol 50 mg PO daily. Which information should the nurse include in the teaching?

Choice A reason:
Administering oxygen using a non-rebreather mask is a subsequent step if initial measures do not improve fetal heart rate decelerations. It can help increase the amount of oxygen available to the fetus. Oxygen administration is a supportive measure that can be used if there are signs of fetal distress. In the scenario described, where the fetal heart rate slows after the start of a contraction with the lowest rate occurring after the peak, it suggests late decelerations, which are often associated with uteroplacental insufficiency. Administering oxygen can help increase the fetal oxygen reserve and is a common intervention during labor when there are concerns about fetal well-being.

Choice B reason:
Increasing the rate of maintenance IV infusion is typically considered when there is a concern for maternal hypotension or dehydration, which may not be the immediate cause of the observed fetal heart rate pattern. Increasing the rate of an IV infusion can help improve maternal hydration and blood pressure, which in turn can enhance placental perfusion. However, this intervention is more indirect and may not provide the immediate response needed to address fetal heart rate decelerations. It is typically considered after more direct interventions, such as repositioning the mother, have been attempted.

Choice C reason:
Elevating the client's legs can help improve venous return to the heart, potentially increasing maternal cardiac output and blood flow to the placenta. While this can be beneficial, it is not the primary intervention for late decelerations. Repositioning the mother to improve uteroplacental circulation is generally the first step.
Choice D reason:
Placing the client in the lateral position is often the first action taken when late decelerations are observed. This position helps improve uteroplacental blood flow and can quickly address potential issues related to fetal oxygenation. This position helps to relieve pressure on the inferior vena cava and aorta, which can be compressed by the gravid uterus, especially in the supine position. Relieving this pressure helps to improve uteroplacental circulation and can quickly address the cause of late decelerations, which is often related to compromised blood flow to the placenta.

Choice A Reason
Monitoring for hypoglycemia at 1200 is not optimal because it is well past the peak action time of insulin aspart, which occurs approximately 45–90 minutes after administration. By noon, the insulin's effects are waning, and the risk of hypoglycemia is lower compared to the peak action period.

Choice B Reason
Monitoring at 1000 might still catch the tail end of the peak action time, but it is not the most likely time for hypoglycemia to occur. The nurse could miss the initial signs of hypoglycemia if monitoring starts two hours after administration.

Choice C Reason
0900 is the most appropriate time for the nurse to monitor for hypoglycemia. Insulin aspart has a rapid onset of action, peaking in about 45–90 minutes, and the effects last for 3–5 hours. Monitoring one hour after administration aligns with the start of the peak action time, when hypoglycemia is most likely to occur.

Choice D Reason
Monitoring at 1100 is less ideal because it is nearing the end of the peak action period. While there is still a risk for hypoglycemia, the highest risk would have been earlier, closer to the peak action time.