A nurse is assessing a client following an amniocentesis. Which of the following findings should the nurse recognize as complications? (Select all that apply.)

• Vitamin B12 level: A B12 level of 159 pg/mL is below normal and consistent with pernicious anemia. This condition is caused by a lack of intrinsic factor, impairing B12 absorption in the gut. The client’s vegan diet may further reduce B12 intake, worsening deficiency.
• Fatigue: Fatigue results from decreased oxygen delivery to tissues due to low hemoglobin in all anemias. In sickle cell disease, abnormally shaped RBCs impair perfusion. Iron and B12 deficiencies impair RBC production, further contributing to fatigue.
• Ferritin level: Ferritin reflects the body’s iron storage, and a level of 8 ng/mL is below the normal range. Low ferritin confirms iron depletion, a hallmark of iron deficiency anemia. This can result from dietary lack or chronic inflammation, like in rheumatoid arthritis.
• Orthostatic hypotension: Orthostatic hypotension may occur with all anemias due to reduced circulating volume and poor oxygenation. Low hemoglobin and hematocrit lead to impaired vascular tone and autonomic response, causing dizziness or lightheadedness when standing.

A. Ondansetron is used to treat nausea but is not a routine pre-epidural intervention.
B. Administering an IV fluid bolus before epidural anesthesia helps prevent hypotension caused by sympathetic blockade.
C. Epidurals can be administered earlier than 7 cm dilation based on maternal request and clinical assessment.
D. Oxygen administration is not routinely required before an epidural unless fetal distress or maternal hypoxia is present.