A nurse is caring for a postpartum client who has preeclampsia and is being treated with magnesium sulfate IV. The nurses' assessment reveals that deep-tendon reflexes are absent. Which of the following actions should the nurse take first?

A. Fetal lung maturity is the primary indication for performing an amniocentesis in a client at or near term who is at risk for preterm delivery. The procedure allows analysis of amniotic fluid for lecithin-sphingomyelin (L/S) ratio and presence of phosphatidylglycerol (PG), which are markers of pulmonary maturity. This information helps the provider determine whether it is safe to deliver the fetus or if interventions are needed to reduce the risk of neonatal respiratory distress.

B. Amniocentesis is not used to determine fetal size or weight. These assessments are typically done through ultrasound measurements, not amniotic fluid analysis.

C. Fetal glucose levels are not routinely measured via amniocentesis. Maternal blood glucose control and fetal well-being are monitored through maternal labs and noninvasive fetal assessments rather than direct glucose measurement in amniotic fluid.

D. Genetic abnormalities are typically assessed via amniocentesis earlier in pregnancy (15–20 weeks). At 36 weeks, the focus shifts from genetic testing to evaluating lung maturity and readiness for safe delivery, not chromosomal analysis.

A. Vaginal exams are appropriate in this scenario. Assessing cervical dilation, effacement, fetal station, and position is critical at this stage of labor to determine whether the client is ready to begin pushing. Performing the exam helps guide safe labor management and supports maternal and fetal outcomes.

B. Vaginal exams are contraindicated in the presence of unexplained vaginal bleeding during pregnancy, particularly in the third trimester, because the bleeding could indicate placenta previa, vasa previa, or other serious placental issues. Performing a vaginal exam in such cases risks provoking severe hemorrhage, leading to maternal hypovolemic shock and fetal compromise. Before performing any vaginal examination, the cause of bleeding must be evaluated using non-invasive methods such as ultrasound, fetal monitoring, and laboratory studies. Even if the client is asymptomatic for pain, the risk of disrupting placental attachment makes vaginal exams unsafe.

C. Vaginal exams are safe and routine in latent labor. They help monitor cervical progression, effacement, and fetal position. Frequent exams may be limited to reduce infection risk, but there is no absolute contraindication in a low-risk latent labor client.

D. Vaginal exams are generally indicated after rupture of membranes to monitor labor progress. However, precautions must be taken to maintain aseptic technique and reduce the risk of infection (chorioamnionitis). Unless other contraindications exist (such as vaginal bleeding from placenta previa or signs of infection), the exam is considered safe and clinically necessary.