Question

A nurse is caring for a client who is at 35 wks of gestation and is undergoing a NST that reveals a variable deceleration in the FHR. Which of the following actions should the nurse take?

a. Administer oxygen to the client.
b. Encourage the client to push.
c. Perform a cesarean section immediately.
d. Document the finding as normal.

Answer 1

The correct action for a nurse when an NST reveals variable decelerations in FHR at 35 weeks of gestation is to administer oxygen to the client and take other supportive measures to improve fetal oxygenation.

Step-by-step explanation:

When caring for a client at 35 weeks of gestation with a non-stress test (NST) that reveals variable decelerations in the fetal heart rate (FHR), the appropriate action for the nurse to take is: a. Administer oxygen to the client. This action can help increase the oxygen supply to the fetus potentially resolving the variable decelerations, which can indicate that the fetus is experiencing stress or that the umbilical cord is being compressed. The nurse should also change the mother's position, often to the left lateral side, to improve circulation and check the mother's hydration status. Documentation of the finding, encouragement of pushing, or performing a cesarean section should not be the immediate course of action without a proper assessment by the healthcare provider and further indications for those interventions.