Adllent, 1 day postpartum, is being monitored after a postpartum hemorrhage. Which of the following should the nurse report to the obstetrician?

Choice A) Increased urinary output: This is not a sign of sepsis in newborns. In fact, sepsis can cause reduced urinary output due to poor blood flow to the kidneys and dehydration.

Choice B) Hypothermia: This is a sign of sepsis in newborns. Sepsis can cause changes in temperature, often fever, but sometimes low temperature. Hypothermia can indicate a severe infection that affects the body's ability to regulate its temperature.

Choice C) Wakefulness: This is not a sign of sepsis in newborns. Sepsis can cause reduced activity and lethargy due to inflammation and organ dysfunction.

Choice D) Interest in feeding: This is not a sign of sepsis in newborns. Sepsis can cause reduced sucking and difficulty feeding due to poor appetite, nausea, vomiting, and abdominal distension.

Choice a) Consult the physician, because the dose is too high is incorrect because this is not a necessary or appropriate action for a nurse who is following a valid order for betamethasone. Betamethasone is a corticosteroid that can be used to accelerate fetal lung maturation and reduce the risk of respiratory distress syndrome and other complications in preterm infants. The recommended dose for betamethasone is 12 mg IM every 24 hours for two doses, which is exactly what the physician ordered. Therefore, there is no reason to question or consult the physician about the dose, as it is within the normal range and based on evidence-based practice.

Choice b) Schedule the second dose for 11 am on the next day is incorrect because this is not a correct or accurate way to implement the order for betamethasone. Betamethasone should be given at least 24 hours apart, but not more than 48 hours apart, to achieve optimal fetal lung development and neonatal outcomes. Scheduling the second dose for 11 am on the next day would result in a 24-hour interval between the doses, which is acceptable, but not ideal. The best time to schedule the second dose would be between 24 and 48 hours after the first dose, such as at 11 pm on the same day or at 7 am on the next day.

Choice c) Prepare to administer the medication intramuscularly between contractions is correct because this is the best and most appropriate way to implement the order for betamethasone. Betamethasone should be given by intramuscular injection in a large muscle mass, such as the deltoid or gluteus, using a 21-gauge needle and a syringe with an air lock. The injection site should be cleaned with alcohol and aspirated before injecting. The medication should be administered between contractions, when the uterine blood flow is maximal and the fetal absorption is optimal. The nurse should also monitor the woman and the fetus for any adverse effects of betamethasone, such as maternal hyperglycemia, hypertension, infection, or edema, or fetal tachycardia, hypoglycemia, or infection.

Choice d) Explain to the woman that this medication will reduce her heart rate and help her to breathe easier is incorrect because this is not a true or relevant statement about betamethasone. Betamethasone does not have any direct effect on the maternal heart rate or respiratory function, as it is mainly intended to improve the fetal lung maturation and reduce the risk of respiratory distress syndrome and other complications in preterm infants.

Betamethasone may cause some side effects such as increased blood pressure, blood sugar, or fluid retention in the mother, which may affect her cardiovascular or respiratory status indirectly. However, these effects are usually transient and mild, and do not outweigh the benefits of betamethasone for the fetus. Therefore, this statement is misleading and inaccurate.