A nurse is caring for a client who is 6 hours postpartum. The client is Rh-negative and her newborn is Rh-positive. The client asks why an indirect Coombs test was ordered by the provider. Which of the following is an appropriate response by the nurse?

Choice A reason:
In the case of a client with painless, bright red vaginal bleeding at 38 weeks of gestation, the priority is to stabilize the client's condition. Initiating IV access is crucial as it allows for rapid administration of fluids or blood products to address potential hypovolemia and to prepare for the possibility of an emergency cesarean section if needed. The client's low blood pressure and elevated heart rate suggest that she may be experiencing hypovolemia, which can quickly lead to hypovolemic shock if not treated promptly.

Choice B reason:
While obtaining informed consent is important before any surgical procedure, it is not the immediate priority. The priority is to stabilize the client, and consent can be obtained concurrently with other stabilizing actions or by another member of the healthcare team.

Choice C reason:
Inserting an indwelling urinary catheter is a supportive measure that can be necessary during labor or before surgery to keep the bladder empty, reducing the risk of bladder injury during a cesarean section and monitoring urine output as an indicator of renal perfusion. However, it is not the first priority in the presence of significant vaginal bleeding.

Choice D reason:
Preparing the abdominal and perineal areas is part of the preoperative procedure for a cesarean section. This action would follow after the client has been stabilized and a decision for surgery has been made.

The correct answer is choice A. Uteroplacental insufficiency.

Choice A rationale:

Late decelerations on a fetal monitor strip are typically indicative of uteroplacental insufficiency. This condition occurs when the placenta is not delivering enough oxygen to the fetus, often due to issues like placental abruption, preeclampsia, or post-term pregnancy.

Choice B rationale:

Maternal bradycardia refers to a slow heart rate in the mother, which is not directly related to late decelerations in the fetal heart rate. Late decelerations are specific to fetal distress due to placental issues.

Choice C rationale:

Umbilical cord compression usually causes variable decelerations, not late decelerations. Variable decelerations are abrupt decreases in fetal heart rate that can occur at any time during a contraction.

Choice D rationale:

Fetal head compression typically results in early decelerations, which are gradual decreases in fetal heart rate that mirror the contractions. These are generally not concerning and are considered a normal response to labor.