A nurse is caring for a client on postpartum day 2 who is preparing to go home with their newborn.
The nurse notes that the client's blood type is O- and the newborn's blood type is A+. Which of the following actions by the nurse is appropriate?

Choice A rationale

While positioning the client is a crucial step for the procedure, it is not the first priority. The client is positioned after the preliminary steps, such as administering the fluid bolus, are completed. The fetal position is used to open the intervertebral spaces, allowing for easier needle insertion. However, the first priority is to prevent a known and common complication.

Choice B rationale

Preparing a sterile field is a necessary step for any invasive procedure to prevent infection. The supplies are prepared while the client is getting ready for the procedure. However, the priority intervention is focused on the client's physiological safety and preventing a known and common complication, which takes precedence over setting up the sterile field.

Choice C rationale

Reviewing the client's medical history and lab results is part of the initial admission process and is necessary to ensure the client is a suitable candidate for the procedure. This is done before the decision is made to proceed with the epidural. However, the priority intervention immediately before the procedure is a physiological intervention to prevent a potential complication.

Choice D rationale

Epidural anesthesia can cause vasodilation and a rapid drop in blood pressure due to the blockade of sympathetic nerves. A fluid bolus, typically 500-1000 mL of an isotonic solution, is administered to increase intravascular volume and preload, which helps to counteract this potential hypotensive effect. Preventing maternal hypotension is a priority because it can lead to decreased placental perfusion and fetal distress.

Choice A rationale

This response is dismissive and does not address the patient's concerns. Providing accurate information empowers the patient to make informed decisions about their health. The nurse should always address patient concerns and provide education, especially when it relates to their birth experience and future reproductive health. Failing to do so can erode trust and negatively impact the patient-provider relationship.

Choice B rationale

This statement is an oversimplification and potentially inaccurate. The feasibility of a vaginal birth after a cesarean section (VBAC) depends on several factors, including the type of uterine incision. A classical vertical incision, for instance, is a strong contraindication due to a significantly increased risk of uterine rupture in subsequent pregnancies. The nurse must provide a more nuanced and accurate explanation.

Choice C rationale

This is an incorrect and potentially harmful statement. A previous cesarean section does not automatically preclude a future vaginal delivery. A vaginal birth after cesarean (VBAC) is a viable option for many individuals, particularly those who had a low transverse uterine incision. The decision is based on a careful assessment of risks and benefits with the patient's provider.

Choice D rationale

This statement is the most accurate and scientifically grounded response. The type of uterine incision is the most significant factor determining the safety of a future vaginal delivery. A low transverse incision has a lower risk of rupture during a trial of labor, making VBAC a safe option for many. A classical (vertical) incision, conversely, carries a high risk of uterine rupture, necessitating a repeat cesarean.