A nurse is providing care to a client who is receiving an epidural block with an opioid analgesic.

Which of the following findings should the nurse monitor as a potential adverse effect of the medication?

Choice A rationale
Administering oxygen helps improve oxygenation to the fetus and is the priority intervention for late decelerations. Oxytocin is commonly used for induction and augmentation of labor. Its influence is indirect via increased uterine activity, mostly due to increased frequency of contractions or baseline pressure (hypertonus). Increase in duration or amplitude of contractions can also lead to FHR changes. The FHR changes associated with oxytocin infusion may be caused by compression of the cord with contractions or by the reduction in placental perfusion due to increased intrauterine basal pressure and frequent contractions cutting off the blood supply to the placenta. Therefore, administering oxygen can help improve the oxygen supply to the fetus.
Choice B rationale
Instructing the client to bear down and push with contractions is not the appropriate action when the fetus is experiencing persistent late decelerations. This action is more associated with the active phase of labor and not with managing fetal distress.
Choice C rationale
Amnioinfusion is a procedure where a saline solution is instilled into the uterus during labor if there is low amniotic fluid, or thick meconium is present. It is not typically used in response to late decelerations in the FHR.
Choice D rationale
Placing the client in a supine position is not the correct action. The supine position can exacerbate a condition known as supine hypotensive syndrome, where the gravid uterus compresses the inferior vena cava, reducing venous return to the heart and cardiac output. This can potentially worsen fetal distress.

Choice A rationale
While it’s true that there may not have been any indication of GBS in earlier prenatal testing, this does not explain why the test was not conducted earlier. GBS can come and go in the body, so a negative test earlier in pregnancy does not guarantee that the woman will still be GBS-negative later in pregnancy.
Choice B rationale
Even if previous deliveries were all negative for GBS, this does not mean that the woman will not have GBS in this pregnancy. GBS can come and go in the body, so each pregnancy is considered separately.
Choice C rationale
GBS is usually asymptomatic in adults, so the woman would not typically report any symptoms of GBS during her pregnancy. This does not explain why the test was not conducted earlier.
Choice D rationale
GBS testing is typically done between 35-37 weeks of gestation. This is because GBS can come and go in the body, so testing during this time frame gives the best prediction of whether or not the woman will have GBS at the time of delivery.