A nurse is assisting in the care of a client who is 3 hours postpartum and reports complete saturation of their perineal pad in the past 30 minutes. Which of the following actions is the highest priority?

(A) Assist the client to empty her bladder:
Emptying the bladder is an essential intervention, especially in laboring women with epidural anesthesia, as a full bladder can contribute to hypotension. However, in this scenario, the priority is to address the hypotension directly with fluid administration. After stabilizing the client's blood pressure, assisting with bladder emptying would be appropriate.

(B) Place the client in knee-chest position:
The knee-chest position is not typically indicated for managing hypotension. While this position can increase venous return to the heart and potentially increase blood pressure, it is not the initial intervention for hypotension associated with epidural anesthesia. Intravenous fluid administration is the primary intervention to increase blood pressure in this situation.

(C) Administer methylergonovine IM:
Methylergonovine is a medication used to prevent or treat postpartum hemorrhage by causing uterine contractions. It is not indicated for the management of hypotension associated with epidural anesthesia during labor. Administering methylergonovine in this situation could potentially exacerbate hypotension and should be avoided.

(D) Give a bolus of lactated Ringer's:
The client's blood pressure is low (80/40 mm Hg), indicating hypotension. Hypotension can be a common side effect of epidural anesthesia during labor. Administering a bolus of intravenous fluids, such as lactated Ringer's solution, is the initial intervention to address hypotension. Fluid administration helps increase intravascular volume, improving blood pressure and perfusion to vital organs.

(A) Reposition the newborn every 2 to 3 hr:
Repositioning the newborn every 2 to 3 hours helps ensure uniform exposure to the phototherapy lights, maximizing the effectiveness of the treatment. This prevents uneven distribution of light and reduces the risk of pressure ulcers or skin breakdown from prolonged immobility.

(B) Monitor the newborn's blood glucose level every 2 hr:
Monitoring the newborn's blood glucose level every 2 hours is not directly related to phototherapy for hyperbilirubinemia. While monitoring blood glucose levels may be necessary for certain newborns, especially those at risk for hypoglycemia, it is not a routine intervention during phototherapy.

(C) Give the newborn 30 ml of distilled water after each feeding:
Giving the newborn distilled water after each feeding is not indicated during phototherapy for hyperbilirubinemia. Breast milk or formula is sufficient for hydration, and providing additional water can interfere with adequate feeding and potentially lead to electrolyte imbalances.

(D) Apply a water-based ointment to the newborn's skin every 4 to 6 hr:
Applying a water-based ointment to the newborn's skin is not typically recommended during phototherapy. Ointments can create a barrier on the skin, reducing the effectiveness of the phototherapy treatment by blocking light absorption.