A nurse is caring for a client who is receiving epidural anesthesia. The client is hypotensive with decreased placental perfusion.
Which of the following actions should the nurse take?

Choice A rationale

Herpes simplex virus 2 (HSV-2) can be harmful to a developing fetus and newborn. While primary infection during the first trimester can rarely lead to congenital anomalies, the most significant risk is neonatal herpes, which occurs when the newborn is exposed to the virus during passage through the birth canal if active lesions are present. Neonatal herpes can cause severe, life-threatening complications.

Choice B rationale

Transmission of HSV-2 to the newborn is significantly higher if active genital lesions are present at the time of vaginal birth. The virus can be shed from these lesions and infect the infant as they pass through the birth canal. Therefore, a Cesarean section is typically recommended if active lesions are present at the onset of labor.

Choice C rationale

Wearing tight-fitting undergarments can increase moisture and friction, potentially irritating existing lesions and hindering healing. Loose-fitting cotton undergarments are generally recommended to allow air circulation and reduce irritation, promoting a more favorable environment for lesion resolution and comfort.

Choice D rationale

Antiviral medications, such as acyclovir, valacyclovir, or famciclovir, can help manage genital herpes by reducing the frequency, duration, and severity of outbreaks. They work by inhibiting viral replication. However, these medications do not cure the condition; HSV-2 remains a lifelong viral infection.

1. Administer magnesium sulfate bolus: Anticipated. Magnesium sulfate is the drug of choice to prevent seizures in severe preeclampsia or eclampsia. The client shows signs of severe preeclampsia (hypertension, headache, visual disturbances, hyperreflexia, clonus, epigastric pain), so a magnesium sulfate bolus is appropriate to reduce CNS irritability and prevent eclamptic seizures.
2. Insert an indwelling urinary catheter: Anticipated. Monitoring urine output is essential in hypertensive disorders of pregnancy to assess kidney function and fluid balance. The client’s urine output (25–55 mL/hr) is borderline low (normal >30 mL/hr), so catheter insertion allows accurate measurement.
3. Initiate intravenous (IV) fluids: Contraindicated. In preeclampsia, patients often have intravascular volume depletion with risk of pulmonary edema due to increased capillary permeability. IV fluids should be carefully restricted to avoid fluid overload, so routine IV fluid initiation is contraindicated unless hypovolemia or dehydration is confirmed.
4. Administer nifedipine 30 mg intermittent IV bolus: Contraindicated. Nifedipine, a calcium channel blocker, is given orally for hypertension in pregnancy, but intermittent IV bolus administration is not recommended because it can cause abrupt hypotension and fetal distress.
5. Begin intermittent electronic fetal monitoring: Anticipated. Continuous or intermittent fetal monitoring is critical for detecting fetal distress, especially in high-risk pregnancies with maternal hypertension and irregular contractions, ensuring timely intervention if needed.