A nurse is collecting data from a client who has hyperemesis gravidarum. Which of the following findings should the nurse anticipate?

(A) Maternal temperature 36.3°C (101°F):
While maternal temperature elevation can indicate infection, in this scenario, the sudden gush of vaginal fluid takes precedence as it could be indicative of premature rupture of membranes. However, assessing maternal temperature is important for ruling out maternal infection, but it is not the priority manifestation compared to assessing fetal well-being.

(B) Amniotic fluid with meconium noted:
While the presence of meconium in the amniotic fluid is concerning, assessing fetal heart tones is the priority. Meconium-stained amniotic fluid can indicate fetal distress, but the immediate concern is to determine if the fetus is experiencing any compromise or distress by assessing the fetal heart rate.

(C) Fetal heart tones 98/min:
In this scenario, the priority is to assess the well-being of the fetus. Fetal heart tones provide critical information about fetal status, indicating whether the baby is experiencing any distress or compromise. A fetal heart rate of 98 beats per minute (bpm) is within the normal range for a fetus at 34 weeks of gestation. However, any abnormalities or significant deviations from the normal fetal heart rate range may indicate fetal distress, requiring immediate intervention.

(D) Foul-smelling vaginal discharge:
Foul-smelling vaginal discharge can indicate infection, such as chorioamnionitis, which is a concern during pregnancy. However, in this scenario, assessing fetal well-being takes precedence as it is essential to ensure timely interventions to assess and manage any fetal distress.

(A) Assist the client to empty her bladder:
Emptying the bladder is an essential intervention, especially in laboring women with epidural anesthesia, as a full bladder can contribute to hypotension. However, in this scenario, the priority is to address the hypotension directly with fluid administration. After stabilizing the client's blood pressure, assisting with bladder emptying would be appropriate.

(B) Place the client in knee-chest position:
The knee-chest position is not typically indicated for managing hypotension. While this position can increase venous return to the heart and potentially increase blood pressure, it is not the initial intervention for hypotension associated with epidural anesthesia. Intravenous fluid administration is the primary intervention to increase blood pressure in this situation.

(C) Administer methylergonovine IM:
Methylergonovine is a medication used to prevent or treat postpartum hemorrhage by causing uterine contractions. It is not indicated for the management of hypotension associated with epidural anesthesia during labor. Administering methylergonovine in this situation could potentially exacerbate hypotension and should be avoided.

(D) Give a bolus of lactated Ringer's:
The client's blood pressure is low (80/40 mm Hg), indicating hypotension. Hypotension can be a common side effect of epidural anesthesia during labor. Administering a bolus of intravenous fluids, such as lactated Ringer's solution, is the initial intervention to address hypotension. Fluid administration helps increase intravascular volume, improving blood pressure and perfusion to vital organs.