A nurse is assisting with the care of a client who is in labor.
Immediately after delivery of a newborn, which of the following actions should the nurse take first?

Choice A rationale

Maternal marijuana use is not typically associated with the classic constellation of physical features described (small for gestational age, small eyes, thin upper lip, microcephaly). While it can potentially affect fetal growth and neurodevelopment, the specific pattern of dysmorphic facial features and microcephaly strongly points to a distinct syndrome.

Choice B rationale

Heroin (an opioid) use during pregnancy is associated with neonatal abstinence syndrome (NAS), characterized by central nervous system hyperirritability and autonomic dysfunction post-birth. While growth restriction can occur, the characteristic craniofacial anomalies (small eyes, thin upper lip, microcephaly) are not the primary features of in utero opioid exposure.

Choice C rationale

Cocaine use during pregnancy can lead to vasoconstriction and placental insufficiency, resulting in fetal growth restriction (SGA) and potential central nervous system damage (microcephaly). However, the specific pattern of distinctive facial anomalies described is not the hallmark of cocaine embryopathy.

Choice D rationale

Maternal alcohol consumption, particularly heavy intake, can cause Fetal Alcohol Syndrome (FAS). The physical findings described—small for gestational age, microcephaly, short palpebral fissures (small eyes), and an indistinct or thin upper lip—are the classic diagnostic triad for FAS, resulting from alcohol's teratogenic effects on cell migration and development.

Choice A rationale

Palpating the fundus is crucial because a full bladder displaces the uterus superiorly and laterally, impeding its ability to contract effectively (uterine atony). Uterine atony is the primary cause of early postpartum hemorrhage (PPH). Assessing the fundal location and tone provides direct evidence of uterine involution progress and identifies potential PPH risk; a soft, boggy fundus requires immediate intervention to prevent excessive blood loss.

Choice B rationale

Assessing the client's blood pressure (BP) and pulse is an essential rapid assessment for signs of hypovolemic shock, which can result from excessive blood loss indicated by saturating four perineal pads in one hour (suggestive of PPH). A decrease in BP (hypotension) and an increase in pulse rate (tachycardia) are classic compensatory mechanisms and late indicators of significant volume depletion, demanding prompt resuscitation and definitive hemorrhage control. Normal adult BP is typically less than 120/80 mmHg; normal pulse is 60-100 beats/minute.

Choice C rationale

Inspecting under the client's buttocks is vital because blood can pool there without being immediately visible on the perineal pad, leading to an underestimation of total blood loss. Postpartum hemorrhage is defined as blood loss greater than 500 mL following a vaginal birth or greater than 1000 mL after a Cesarean birth. Hidden blood accumulation contributes to delayed recognition of the severity of PPH, which can rapidly progress to instability.

Choice D rationale

Administering a non-additive intravenous infusion (like 0.9.

Choice E rationale

Placing the client in the reverse Trendelenburg position involves lowering the head and raising the foot of the bed, which increases venous pooling in the lower extremities and may slightly lower cerebral perfusion. This position is generally contraindicated in a client with suspected or active postpartum hemorrhage (PPH) or hypovolemic shock, as it can worsen hypotension and compromise circulation to vital organs. The Trendelenburg position (head lower than feet) is sometimes used for shock, but the reverse position is inappropriate.