A nurse is caring for a client who is 2 hours postpartum. The nurse notes that the client soaked a perineal pad in 10 minutes, the client's skin color is ashen, and she states she feels weak and lightheaded. After applying oxygen via nonrebreather face mask at 10 L/min, which of the following actions should the nurse take next?

Choice a reason:
Slightly below the umbilicus is not the expected location for the fundus at 22 weeks of gestation. Typically, the fundus is located at the level of the umbilicus at 20 weeks and rises about 1 cm above the umbilicus each week thereafter.

Choice b reason:
3 cm above the umbilicus would be more consistent with a gestational age of approximately 23 weeks, as the fundus rises approximately 1 cm per week after reaching the level of the umbilicus at 20 weeks.

Choice C rationale: At 22 weeks of gestation, the fundus is typically located slightly above the umbilicus. The uterus has grown sufficiently by this stage to reach this position, aligning with the expected fundal height measurements. This corresponds with normal pregnancy progression, as fundal height in centimeters is expected to approximate the gestational age in weeks.

Choice D rationale: By 22 weeks of gestation, the fundus has already risen above the umbilicus, so palpating the fundus 3 cm below the umbilicus is inconsistent with normal pregnancy progression. Earlier in pregnancy, such as around 16 to 18 weeks, the fundus might be found below the umbilicus, but this does not apply at 22 weeks.

Choice A reason:
Initiating pushing in a client with suspected placenta previa is contraindicated. Placenta previa is a condition where the placenta covers the cervix, and pushing could lead to severe bleeding and compromise both the mother and the fetus. The normal labor process involves pushing only after full cervical dilation, and in the case of placenta previa, this could exacerbate the condition.

Choice B reason:
Preparation for cesarean birth is the correct action when placenta previa is suspected. With placenta previa, vaginal delivery could cause significant hemorrhage due to the placenta's position over the cervical opening. A cesarean birth bypasses the cervix, thereby avoiding disruption of the placenta and preventing excessive bleeding.

Choice C reason:
Magnesium sulfate is used in obstetrics to prevent seizures in preeclampsia and to delay preterm labor, not for placenta previa. While it is important to manage the client's overall condition, magnesium sulfate would not address the immediate concern of potential hemorrhage due to placenta previa.

Choice D reason:
An examination to determine cervical status in the presence of placenta previa should be avoided unless absolutely necessary and performed under controlled conditions, such as in an operating room where a cesarean delivery can be performed if needed. Digital cervical examinations can dislodge the placenta and cause bleeding.