A nurse is caring for a client who is at 37 weeks of gestation and received a provider order for group B streptococcus beta-hemolytic culture.
Which of the following statements should the nurse include in the teaching?

Choice A rationale

Sequential compression devices (SCDs) are applied preoperatively to promote venous return and prevent venous stasis in the lower extremities, significantly reducing the risk of deep vein thrombosis (DVT) and subsequent pulmonary embolism (PE), which are critical concerns during and after major surgery like a cesarean birth. Prophylaxis should commence before the operation for maximal effect.

Choice B rationale

An indwelling urinary catheter is typically inserted prior to the cesarean section, after the client receives regional anesthesia, to ensure the bladder is empty during the procedure, preventing injury to the bladder by the surgeon and maintaining a clear surgical field. It is not delayed until immediately following the procedure.

Choice C rationale

Oxytocin is a uterotonic agent administered post-delivery of the placenta (not prior to the procedure) via continuous IV infusion to stimulate uterine contractions, which is crucial for preventing postpartum hemorrhage by promoting myometrial contraction and vessel constriction.

Choice D rationale

The surgical timeout, a critical patient safety measure that verifies the correct patient, procedure, and surgical site, is performed by the entire surgical team immediately prior to the incision, typically after the client enters the operating room and is prepped, not while they are in the preoperative holding area.

Choice A rationale: Trendelenburg position, where the client is placed with the head lower than the feet, is not appropriate in this scenario. This position is typically used for procedures requiring pelvic exposure or in cases of air embolism. It does not optimize uteroplacental perfusion and may actually compromise maternal respiratory function in late pregnancy due to diaphragmatic pressure from the gravid uterus. Therefore, it is not the correct position following prostaglandin insertion.

Choice B rationale: Knee-chest position is used in obstetric emergencies such as umbilical cord prolapse to relieve pressure on the cord and improve fetal oxygenation. It is not indicated for cervical ripening or for optimizing uteroplacental perfusion. Maintaining this position would be uncomfortable and unnecessary for the client, and it does not aid in medication absorption. Thus, it is not the correct intervention in this context.

Choice C rationale: Lateral tilt, specifically left lateral or side-lying tilt, is the correct position. This position reduces compression of the inferior vena cava by the gravid uterus, thereby improving venous return, cardiac output, and uteroplacental perfusion. It also facilitates optimal absorption of the vaginal prostaglandin insert by keeping the medication in place. This is the evidence-based nursing intervention following prostaglandin administration for cervical ripening.

Choice D rationale: Lithotomy position is used primarily for vaginal examinations, procedures, or delivery. It is not appropriate for maintaining medication absorption or optimizing uteroplacental perfusion. Prolonged lithotomy positioning increases maternal discomfort and risk of venous stasis. Since the client is not undergoing delivery or a procedure requiring pelvic exposure, this position is not indicated after prostaglandin insertion.