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Question:

The nurse cares for four clients in labor on the maternity unit. Which of the following patients should the nurse see FIRST?

A A primigravida at thirty-nine weeks gestation whose fetal heartbeat is 147 with minimal variation and dips twenty beats at a time, independent of contractions.
explanation

It is normal to feel increased pressure with the transition phase of labor. A fetal heartbeat of 160 plus or minus five beats describes good variation. A fetal heartbeat that dips during a contraction before returning to baseline “at its conclusion” perfectly describes early decelerations. The correct answer, however, describes variable decelerations (unrelated to contractions) which are due to cord compression.

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