A nurse is caring for a client during a nonstress test (NST). At the end of a 30min period of observation, the nurse notes the following findings: The fetal heart rate baseline is 120/min with minimal variability and no accelerations. There are two decelerations of 15 /min in the fetal heart rate during a period of fetal movement, each lasting 20 seconds. Which of the following
interpretations of these findings should the nurse make?
A.
A reactive test
B.
A negative test
C.
A positive test
D.
A nonreactive test
The correct answer and Explanation is :
The correct answer is D. A nonreactive test.
Explanation:
A Nonstress Test (NST) is a common prenatal test used to assess fetal well-being by monitoring the fetal heart rate (FHR) in response to fetal movements. The test is considered “reactive” when the FHR shows accelerations in response to fetal movements, indicating good fetal oxygenation and neurological function.
Here’s a breakdown of the findings and their implications:
- Fetal Heart Rate Baseline: The baseline FHR of 120/min is within the normal range (110-160 bpm). This baseline rate alone does not indicate a problem, but it is only one part of the NST evaluation.
- Minimal Variability: Minimal variability in the FHR means that the fluctuations in the FHR are less than 5 beats per minute. While this can be a normal finding at times, it can also indicate fetal distress or an issue with fetal oxygenation, especially if accompanied by other abnormal findings.
- No Accelerations: In a reactive NST, we expect to see at least two accelerations in the FHR of 15 beats per minute or more above the baseline, each lasting at least 15 seconds, within a 20-minute period. The absence of these accelerations is a key factor in determining a nonreactive result.
- Decelerations During Fetal Movement: The presence of decelerations (a decrease in the FHR) during fetal movements could be concerning, depending on their pattern. In this case, the decelerations are 15 beats per minute lasting 20 seconds each. These may suggest possible umbilical cord compression or other issues affecting fetal oxygenation, especially if they occur during movements when accelerations are expected.
Interpretation of the Findings:
The NST is considered nonreactive if it does not meet the criteria for reactivity: there should be at least two accelerations in the FHR of 15 beats per minute above the baseline, each lasting 15 seconds or more, within a 20-minute observation period. Since there are no accelerations noted in this case and the presence of decelerations could indicate a problem, the findings do not meet the criteria for a reactive test.
Therefore, the nurse should interpret these findings as a nonreactive NST. This result would typically prompt further evaluation and monitoring to determine the cause and to ensure the well-being of the fetus.