A nurse is assessing a client who is 12 hours postpartum and received spinal anesthesia for a cesarean birth.
Which of the following findings requires immediate intervention by the nurse?

Choice A rationale

Nausea and vomiting are common discomforts of pregnancy, particularly in the first trimester. While they can be distressing, they are not typically indicative of an immediate life-threatening condition for the mother or fetus at 14 weeks gestation. Hyperemesis gravidarum, a more severe form, would warrant closer attention, but the description here is general.

Choice B rationale

Painless vaginal bleeding in the second or third trimester (28 weeks gestation) is a concerning sign and could indicate placenta previa or placental abruption, both of which can lead to significant maternal and fetal hemorrhage and compromise fetal oxygenation. This client requires immediate assessment to determine the cause and ensure prompt intervention if necessary.

Choice C rationale

A cough and fever at 38 weeks gestation could indicate an infection, such as influenza or pneumonia. While these conditions can be serious for a near-term pregnant woman and potentially affect the fetus, they are generally less immediately life-threatening than significant vaginal bleeding in the second or third trimester and would be addressed after the client with potential placental issues.

Choice D rationale

Missed period and vaginal spotting can be early signs of pregnancy or a threatened abortion. While it warrants investigation, it is generally not an immediate emergency requiring triage before a client with painless vaginal bleeding at 28 weeks gestation, which carries a higher risk of acute complications.

Choice A rationale

Encouraging a hands-and-knees position can help rotate a fetus in an occiput posterior position or relieve back pain during labor. However, in hypotonic uterine dysfunction where contractions are weak and ineffective, this positional change alone is unlikely to augment labor significantly.

Choice B rationale

Providing a comfortable environment with dim lighting can reduce anxiety and promote relaxation, which might indirectly support labor progress. However, it does not directly address the issue of weak and ineffective uterine contractions characteristic of hypotonic dysfunction.

Choice C rationale

Administering oxytocin is the typical intervention for hypotonic uterine dysfunction after ruling out fetopelvic disproportion. Oxytocin is a synthetic hormone that stimulates uterine contractions, increasing their frequency, duration, and intensity to facilitate labor progress. It acts on the oxytocin receptors in the uterus, leading to smooth muscle contraction.

Choice D rationale

Preparing for an amniotomy (artificial rupture of membranes) might be considered to augment labor if the membranes are intact. However, since the woman's membranes have already ruptured, this intervention is not applicable in this situation. Amniotomy can sometimes stimulate or augment labor by releasing prostaglandins.