A nurse is caring for a client who is at 40 weeks gestation and is in active labor. The client has 6 cm of cervical dilation and 100% cervical effacement. The nurse obtains the client's blood pressure reading as 82/52 mm Hg. Which of the following nursing interventions should the nurse perform?

Choice A reason:

Basal metabolic rate reduction. This is incorrect because a newborn under a radiant heat warmer will have an increased basal metabolic rate, not a reduced one. The basal metabolic rate is the amount of energy the body uses at rest, and it is influenced by temperature. A warmer environment will stimulate the newborn's metabolism and increase the energy expenditure. • Choice B reason:

Brown fat production. This is incorrect because a newborn under a radiant heat warmer will have less need for brown fat production, not more. Brown fat is a type of fat tissue that generates heat by burning calories. It is found in newborns and helps them maintain their body temperature in cold environments. A warmer environment will reduce the need for brown fat activation. • Choice C reason:

Shivering. This is incorrect because a newborn under a radiant heat warmer will not shiver, but shivering is not the main mechanism of heat production in newborns. Shivering is an involuntary contraction of muscles that generates heat by increasing metabolism. Newborns have limited ability to shiver because of their immature nervous system and low muscle mass. They rely more on brown fat and increased metabolic rate to produce heat. • Choice D reason:

Cold stress. This is correct because a newborn under a radiant heat warmer will prevent cold stress, which is a condition where the newborn's body temperature drops below normal and causes adverse effects. Cold stress can impair oxygen delivery, increase acidosis, decrease blood glucose, and increase the risk of infection and bleeding. A radiant heat warmer provides a neutral thermal environment for the newborn and prevents heat loss by radiation.

: 1 : 2 : 3 : 4.

Assist the client to turn onto her side. This is the correct answer because turning the client onto her side can improve blood flow to the placenta and increase fetal oxygenation. Hypotension is a common cause of decreased uteroplacental perfusion, which can lead to fetal distress and late decelerations on the fetal monitor. The nurse should also administer oxygen, increase IV fluids, and notify the provider. • Choice B reason:

Prepare for an immediate vaginal delivery. This is not the correct answer because there is no indication that the client is ready for delivery. The client has 6 cm of cervical dilation, which means she is still in the active phase of labor. The second stage of labor begins when the cervix is fully dilated (10 cm) and ends with delivery of the baby. Preparing for an immediate vaginal delivery would not address the cause of hypotension or improve fetal oxygenation. • Choice C reason:

Prepare for a cesarean birth. This is not the correct answer because there is no indication that the client needs a cesarean birth. A cesarean birth may be indicated if there are signs of fetal compromise, such as severe variable or late decelerations, or maternal complications, such as placenta previa or cord prolapse. However, these conditions are not present in this scenario. Preparing for a cesarean birth would not address the cause of hypotension or improve fetal oxygenation. • Choice D reason:

Assist the client to an upright position. This is not the correct answer because placing the client in an upright position can worsen hypotension and decrease uteroplacental perfusion. An upright position can increase pressure on the inferior vena cava and reduce venous return to the heart. This can lower cardiac output.