During augmentation of labor with intravenous oxytocin (Pitocin), a multiparous client becomes pale and diaphoretic and complains of severe lower abdominal pain with a tearing sensation. An abnormal FHR tracing is noted on the monitor. The nurse should suspect:

A. Internal fetal monitoring. Internal fetal monitoring is contraindicated when placenta previa is suspected because it involves inserting a catheter or electrode into the uterus, which can increase the risk of hemorrhage if the placenta is covering the cervix.

B. Amniocentesis for fetal lung maturity. While fetal lung maturity assessment may be relevant if early delivery is being considered, it is not an immediate diagnostic procedure for evaluating the cause of vaginal bleeding. The priority is to determine placenta location and rule out placenta previa.

C. Contraction stress test. A contraction stress test evaluates fetal response to contractions but is not the appropriate initial diagnostic test in a patient with vaginal bleeding. Stimulating contractions could worsen bleeding if placenta previa or another placental abnormality is present.

D. Ultrasound for placenta location. The first-line diagnostic test for painless, bright red vaginal bleeding in the third trimester is an ultrasound. It helps determine whether the bleeding is due to placenta previa, a condition where the placenta partially or completely covers the cervix, which requires careful management to prevent complications.

A. To prevent uterine atony. Suprapubic pressure is not used to prevent uterine atony. Uterine atony, which leads to postpartum hemorrhage, is managed through uterine massage and medications such as oxytocin.

B. To facilitate the delivery of the baby's head. The baby's head has already been delivered in shoulder dystocia. The emergency arises because the shoulders are stuck behind the pubic bone, requiring specific maneuvers to release them.

C. To facilitate the delivery of the baby's shoulders. Shoulder dystocia occurs when the anterior shoulder becomes impacted behind the maternal pubic bone, preventing delivery. Suprapubic pressure is applied to help dislodge the shoulder by compressing it downward, allowing it to pass under the pubic bone. This maneuver, along with the McRoberts position, is commonly used to resolve the dystocia.

D. To prepare for the third stage of labor. The third stage of labor refers to the delivery of the placenta, which occurs after the baby is born. Suprapubic pressure is specifically used to assist in the second stage of labor when shoulder dystocia occurs.