A nurse is performing a physical examination of a term newborn upon admission to the nursery.
In which order should the nurse perform the following assessments?

Choice A rationale

Administering oxygen via nasal cannula at 2 L/min might marginally increase fetal oxygenation, but it does not address the primary issue of hypotension causing decreased placental perfusion. The fundamental problem is reduced blood flow to the placenta, necessitating interventions that increase maternal circulating volume and blood pressure to improve perfusion.

Choice B rationale

Administering a lactated Ringer's 500 mL bolus directly addresses hypotension by expanding the maternal intravascular volume. This increased circulating volume raises blood pressure, thereby improving placental perfusion and oxygen delivery to the fetus. Lactated Ringer's is an isotonic solution, effective for rapid volume expansion.

Choice C rationale

Placing the client in a knee-chest position is typically used to alleviate cord compression or prolapse by shifting the fetus, not for treating hypotension. This position can actually worsen hypotension by trapping blood in the lower extremities and reducing venous return to the heart, further compromising placental blood flow.

Choice D rationale

Monitoring the client's blood pressure every 30 minutes is a crucial assessment but is not an immediate intervention for acute hypotension with decreased placental perfusion. While ongoing monitoring is essential, immediate actions are required to correct the underlying cause of hypotension and restore adequate blood flow to the placenta.

Choice A rationale

Avoiding sterile vaginal examinations is not a primary action for uterine atony and large vaginal bleeding. While excessive or repeated vaginal examinations can potentially introduce infection or dislodge clots, the immediate priority for uterine atony is to address the lack of uterine tone to prevent further blood loss.

Choice B rationale

Obtaining a specimen for a Kleihauer-Betke test is used to quantify the amount of fetal red blood cells in the maternal circulation, typically after a significant feto-maternal hemorrhage or trauma. While potentially useful in specific situations, it is not an immediate, primary intervention for acute uterine atony and bleeding.

Choice C rationale

Performing a fundal massage is the most immediate and critical action for uterine atony. Uterine atony is the leading cause of postpartum hemorrhage, characterized by a boggy, relaxed uterus that cannot effectively constrict blood vessels at the placental site. Manual massage stimulates uterine contractions, promoting vasoconstriction and reducing blood loss.

Choice D rationale

Assessing for abdominal tenderness is an important assessment, but it is not the primary intervention for acute uterine atony with large vaginal bleeding. Abdominal tenderness could indicate other complications such as uterine rupture or hematoma, which require different immediate interventions after addressing the atony.