A nurse is caring for a 30-year-old female client at 30 weeks of gestation in the labor and delivery unit. The client is gravida 2, para 1, and presents with low back pain and abdominal cramping for two days.

Exhibits

 

Complete the following sentence by using the lists of options.
The nurse should recommend to first address the client's

_____

, followed by the client's

______

.

Condition: Placenta previa

2 actions:

• Reinforce bed rest and maintain IV access
• Prepare for an emergency cesarean birth

2 parameters:

• Fetal heart rate
• Maternal oxygen saturation

Rationale for correct condition: Placenta previa is indicated by painless, bright red vaginal bleeding in the third trimester, without abdominal pain or uterine tenderness. The fetal heart rate shows abnormalities with minimal variability, which can occur due to placental issues. Fundal height consistent with gestational age and absence of contractions support this diagnosis. Diagnosing this early is crucial as it poses significant risks to both the mother and fetus. The client’s history of bleeding and current symptoms align with placenta previa more than other conditions.

Rationale for actions: Reinforcing bed rest helps minimize bleeding and maintains stability. IV access is crucial for fluid management and potential blood transfusion. Preparing for an emergency cesarean birth ensures prompt delivery if maternal or fetal status deteriorates, preventing severe complications. Administering broad-spectrum antibiotics isn’t directly indicated as there's no sign of infection. Methotrexate is inappropriate here as it treats ectopic pregnancies, not placental issues. Encouraging ambulation might exacerbate bleeding, worsening the condition.

Rationale for parameters: Monitoring fetal heart rate assesses fetal well-being and detects distress early. Maternal oxygen saturation is vital to ensure adequate oxygen delivery to both mother and fetus. WBC count isn't immediately relevant unless there's an infection concern. Urine output doesn’t directly indicate placental health. Uterine contractions are irrelevant since there are no signs of preterm labor or irritability.

Rationale for incorrect conditions: Abruptio placentae usually involves painful bleeding with uterine tenderness or contractions. Preterm labor is characterized by regular contractions leading to cervical changes, absent here. Uterine rupture often involves severe pain, sudden fetal distress, and maternal shock, none of which are present.

Choice A rationale

Placing the client in the knee-chest position is not appropriate for managing hypotension. This position is typically used for cord prolapse to relieve pressure on the umbilical cord, not for hypotension due to an epidural infusion.

Choice B rationale

Giving a bolus of lactated Ringer's solution can help increase the client's blood pressure by expanding the intravascular volume. This is a common and effective intervention for hypotension caused by epidural anesthesia.

Choice C rationale

Administering methylergonovine IM is inappropriate in this context because it is used to manage postpartum hemorrhage by stimulating uterine contractions, not for treating hypotension.

Choice D rationale

Assisting the client to empty her bladder might help in some situations but is not an immediate intervention for hypotension. The primary concern with epidural-induced hypotension is to restore adequate blood pressure quickly.