A nurse is caring for a client who is in active labor.
The nurse notes late decelerations in the fetal heart rate on the monitor tracing. Which of the following actions should the nurse take first?

Choice A rationale

While seizures are a serious adverse effect of ergot alkaloids, they are primarily associated with the most severe form of ergotism, which is an overdose or prolonged exposure, or in clients with severe preeclampsia/eclampsia. Methylergonovine's more common and immediate adverse effect is its potent vasoconstrictive property, leading to elevated blood pressure.

Choice B rationale

Methylergonovine is an ergot alkaloid that acts as a potent vasoconstrictor and smooth muscle contractor, primarily on the uterus to treat postpartum hemorrhage and uterine atony. Its generalized vasoconstrictive effect, however, can lead to a significant elevation in blood pressure, making hypertension (blood pressure greater than 140/90 mmHg or an increase of 20 mmHg or more) a major and frequent adverse effect.

Choice C rationale

Methylergonovine's potent vasoconstrictive action typically causes an increase in peripheral vascular resistance, which often results in bradycardia (heart rate less than 60 beats/min) as a reflex response to the elevated blood pressure. Tachycardia (heart rate greater than 100 beats/min) is not a typical adverse effect of this medication.

Choice D rationale

Methylergonovine acts mainly on the smooth muscle of the uterus and blood vessels; it does not typically cause water retention. Water retention is more commonly associated with conditions like preeclampsia or medications such as glucocorticoids. The adverse effects of methylergonovine center around vasoconstriction and uterine cramping.

Choice A rationale

Instructing the client to be NPO (nil per os), or nothing by mouth, is not typically required before an amniocentesis procedure. The client can usually eat and drink normally. Fasting is more commonly associated with procedures involving general anesthesia or those where there is a risk of aspiration, neither of which is routine for an amniocentesis. Clients may be asked to empty their bladder before the procedure to avoid puncturing it.

Choice B rationale

For an Rh-negative client undergoing an amniocentesis, there is a risk of fetomaternal hemorrhage during the procedure, which can lead to the mother's immune system producing Rh antibodies that attack the fetus's red blood cells in the current or future pregnancies. Therefore, administering Rh(D) immune globulin (RhoGAM) after the procedure is essential to prevent Rh sensitization. The standard dose is administered within 72 hours of the procedure.

Choice C rationale

Positioning the client in a left lateral position is typically used to promote optimal uteroplacental perfusion or during the second stage of labor. For an amniocentesis, the client is usually positioned in a supine position with a wedge placed under the right hip to slightly tilt the uterus and prevent vena cava compression, providing the provider with a clear anatomical view for ultrasound guidance.

Choice D rationale

The insertion site on the client's abdomen is cleaned with an antiseptic solution, such as povidone-iodine or chlorhexidine, to reduce the risk of introducing bacteria into the sterile field or uterus. Irrigating the site with sterile water is an inappropriate action for skin preparation as it is not a primary antiseptic and may interfere with the effectiveness of the chosen antiseptic solution.