A nurse in a provider's office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. The nurse should recognize that which of the following is the most common risk factor for abruption?

Choice A rationale
This is correct because blood pressure 80/56 mm Hg is the nurse's priority finding. It indicates hypotension, which is a common and serious complication of epidural analgesia. Hypotension can compromise the maternal and fetal perfusion and oxygenation, leading to fetal distress and acidosis. The nurse should immediately administer oxygen, fluids, and vasopressors as prescribed, and monitor the fetal heart rate and variability.

Choice B rationale
This is incorrect because temperature 38.2°C (100.8°F) is not the nurse's priority finding. It indicates a fever, which could be a sign of infection or dehydration. The nurse should assess the client for other signs of infection, such as chills, malaise, or foul-smelling discharge, and administer antipyretics and antibiotics as prescribed. The nurse should also ensure adequate hydration and cooling measures for the client.

Choice C rationale
This is incorrect because the client reports weakness of the lower extremities is not the nurse's priority finding. It indicates a side effect of epidural analgesia, which blocks the nerve impulses from the lower spinal segments. The nurse should assess the client's motor and sensory function, and adjust the epidural infusion rate as prescribed. The nurse should also assist the client with positioning and mobility, and prevent pressure ulcers and nerve injuries.

Choice D rationale
This is incorrect because the client reports profuse itching is not the nurse's priority finding. It indicates a side effect of opioid epidural analgesia, which stimulates the histamine receptors in the skin. The nurse should assess the client's skin condition, and administer antihistamines as prescribed. The nurse should also provide comfort measures, such as cool compresses, lotion, or massage, for the client.

Choice A rationale
Preparing the abdominal and perineal areas is not the priority nursing action for a client who has a large amount of painless, bright red vaginal bleeding. This may indicate placenta previa, a condition where the placenta covers the cervical opening, which can cause life-threatening hemorrhage for both the mother and the fetus. The priority is to stabilize the client's hemodynamic status and prevent hypovolemic shock.

Choice B rationale
Initiating IV access is the priority nursing action for a client who has a large amount of painless, bright red vaginal bleeding. This allows the nurse to administer fluids and blood products as needed to maintain the client's blood pressure and perfusion. It also provides a route for administering medications such as tocolytics, which can inhibit uterine contractions and reduce bleeding.

Choice C rationale
Inserting a Foley catheter is not the priority nursing action for a client who has a large amount of painless, bright red vaginal bleeding. This may increase the risk of infection and trauma to the lower urinary tract. It is also contraindicated in placenta previa, as it may dislodge the placenta and worsen the bleeding.

Choice D rationale
Administering oxygen via face mask is not the priority nursing action for a client who has a large amount of painless, bright red vaginal bleeding. This may be beneficial to improve the oxygenation of the mother and the fetus, but it does not address the underlying cause of the bleeding or the potential hypovolemia. Oxygen therapy should be initiated after securing IV access and fluid resuscitation.