A nurse is teaching a client who is at 14 weeks of gestation about expected body changes during pregnancy.
Which of the following manifestations should the nurse include in the teaching?

Choice A rationale

Methylergonovine is an uterotonic agent that acts on the smooth muscle of the uterus to stimulate strong, sustained contractions, which are essential for compressing the intramyometrial blood vessels and achieving hemostasis to stop postpartum hemorrhage, especially from uterine atony.

Choice B rationale

While oxygen is important for hypoxia secondary to blood loss, administering it at 2 L/min via nasal cannula is typically insufficient for a client experiencing significant hemorrhage. High-flow oxygen, such as 10 to 15 L/min via nonrebreather mask, is usually required to maximize oxygen saturation.

Choice C rationale

Starting an IV bolus of Dextrose 5.

Choice D rationale

The knee-chest position is generally used to relieve cord compression or help with the manual rotation of the fetus, but it is not an established intervention for managing postpartum hemorrhage. The client should be positioned flat with legs elevated to promote venous return and manage shock.

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.