A nurse is assisting in the care of a client in labor who states, "I am really afraid of giving birth," and begins crying.
The client is currently in active labor and vaginal exam reveals 7 cm dilation, 80% effacement, and 0 station. Which of the following factors of labor should the nurse identify as needing addressed at this time?

Choice A rationale

Repositioning the client to a left lateral position aims to improve uteroplacental perfusion by alleviating compression of the inferior vena cava by the gravid uterus. This enhances venous return to the mother's heart, increasing cardiac output and ultimately improving blood flow and oxygen delivery to the placenta and fetus, which can resolve late decelerations caused by uteroplacental insufficiency.

Choice B rationale

Documenting findings is a crucial nursing responsibility, but it is not the immediate intervention for addressing late decelerations. Scientific principles dictate that physiological stabilization takes precedence over documentation when fetal well-being is compromised. Documentation would follow after initial interventions are implemented to improve the fetal status.

Choice C rationale

Adjusting fetal monitor sensors might be necessary if the tracing is poor quality, but it does not directly address the physiological cause of late decelerations. Late decelerations reflect uteroplacental insufficiency, not merely a monitoring artifact. Addressing the underlying physiological compromise is the priority before troubleshooting equipment.

Choice D rationale

Inserting a fetal scalp electrode provides a more accurate assessment of fetal heart rate by directly monitoring the fetus. However, this is an invasive procedure and is typically considered after initial conservative measures, such as maternal repositioning and oxygen administration, have been attempted without resolution of the late decelerations.

Choice A rationale

Staphylococcus aureus is the most prevalent bacterial pathogen responsible for osteomyelitis, a bone infection. This bacterium possesses virulence factors such as adhesins, which enable it to adhere to bone tissue, and various toxins that contribute to tissue damage and inflammation. It can enter the bone through direct inoculation, contiguous spread, or hematogenous dissemination.

Choice B rationale

Haemophilus influenzae can cause invasive infections, including meningitis and epiglottitis, particularly in unvaccinated children. While it can cause localized infections, it is not a common cause of osteomyelitis. Its primary colonization sites and mechanisms of infection are generally distinct from those leading to bone infections.

Choice C rationale

Escherichia coli is a common inhabitant of the gastrointestinal tract and a frequent cause of urinary tract infections and sepsis, particularly in neonates. While it can cause osteomyelitis, especially in specific populations such as neonates or individuals with compromised immune systems, it is significantly less common than Staphylococcus aureus as an overall cause.

Choice D rationale

Streptococcus pneumoniae is a leading cause of bacterial pneumonia, otitis media, and meningitis. While it can cause invasive infections and has been implicated in rare cases of osteomyelitis, it does not possess the same propensity for bone tissue colonization as Staphylococcus aureus, making it a much less common etiologic agent for bone infections.