A nurse is caring for a client who is at 40 weeks of gestation and is in labor. The client's ultrasound examination indicates that the fetus is small for gestational age (SGA). Which of the following interventions should be included in the newborn's plan of care?

A. The client’s blood does not contain the Rh factor so she produces anti- Rh antibodies that cross the placenta barrier and cause hemolysis of red blood cells in newborns: This is the correct answer. If the mother is Rh-negative and the baby is Rh-positive, the mother’s body may produce antibodies against the baby’s blood. These antibodies can cross the placenta and cause hemolysis (destruction) of the baby’s red blood cells, leading to hyperbilirubinemia.

B. The client’s anti-A and ant-B antibodies cross the placenta and cause the destruction of the fetal red blood cells: This is not correct. Anti-A and anti-B antibodies are related to the ABO blood group system, not the Rh system.

C. The client’s blood contains the Rh factor and the newborns does not, and antibodies that destroy the red blood cells are formed in the fetus: This is not correct. It is when the mother is Rh-negative and the baby is Rh-positive that there is a risk of Rh incompatibility.

D. The client has a history of receiving a transfusion with Rh-negative blood: This is not correct. A history of receiving a transfusion with Rh-negative blood would not cause Rh incompatibility in a subsequent pregnancy. Rh incompatibility is caused by a difference in Rh factor between the mother and baby.

A. Administer oxygen using a non-rebreather mask: This action might be appropriate if the fetus shows signs of distress, but it’s not the first action the nurse should take. The first action should be to change the mother’s position to improve blood flow to the fetus.
B. Increase the rate of maintenance IV infusion: This action might be appropriate in some situations, but it’s not the first action the nurse should take. The first action should be to change the mother’s position to improve blood flow to the fetus.
C. Elevate the client’s legs: This action is not likely to improve the fetal heart rate pattern. The first action should be to change the mother’s position to improve blood flow to the fetus.
D. Place the client in the lateral position: This is the correct choice. The first action the nurse should take when noticing a deceleration in the fetal heart rate that occurs after the peak of the contraction (late decelerations) is to change the mother’s position. Placing the client in the lateral position can improve uteroplacental perfusion and may correct the problem. If the decelerations continue, further interventions such as administering oxygen or increasing IV fluids may be necessary.