During auscultation of fetal heart tones (FHTs), the nurse determines that the heart rate is 136 beats per minute. The nurse's next action should be to:

a. Document the results, which are within normal range.
b. Take the maternal pulse to verify these findings as the uterine souffle.
c. Have the patient change positions and count the FHTs again.
d. Immediately notify the physician for possible fetal distress.


ANS: A
The normal fetal heart rate is between 110 and 160 beats per minute. The nurse should document the results as within the normal range. The other options are not correct.

Nursing

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