A nurse is preparing to administer an opioid analgesic to a client who is in active labor.
Which of the following assessments should the nurse perform?

Choice A rationale

Group B Streptococcus (GBS) colonization in a pregnant client does not typically necessitate a cesarean birth. The primary concern with GBS is the risk of vertical transmission to the neonate during vaginal birth, which can lead to severe neonatal infections like sepsis, meningitis, or pneumonia. Cesarean section is generally reserved for obstetric indications and does not eliminate the risk of GBS transmission if membranes rupture.

Choice B rationale

Intravenous antibiotic prophylaxis is the cornerstone of preventing neonatal GBS disease in colonized mothers. The recommended antibiotics, typically penicillin or ampicillin, are administered during labor once ruptured membranes or active labor commence. This intrapartum treatment significantly reduces bacterial colonization in the birth canal, thereby minimizing the neonate's exposure to the bacteria during passage.

Choice C rationale

A vaginal culture for GBS is typically performed between 36 and 37 weeks of gestation as part of routine prenatal screening. If the client has already been screened and identified as GBS positive at 36 weeks, repeating the culture during active labor is not indicated as the colonization status is already known, and the focus shifts to prophylaxis.

Choice D rationale

Metronidazole is an antibiotic primarily effective against anaerobic bacteria and certain parasites. It is not the drug of choice for Group B Streptococcus prophylaxis. Penicillin or ampicillin are the preferred antibiotics for GBS intrapartum prophylaxis due to their effectiveness against GBS and their favorable safety profile for both the mother and the fetus.

Choice A rationale

The human body possesses compensatory mechanisms, such as sympathetic nervous system activation leading to vasoconstriction and increased heart rate, that can maintain vital organ perfusion despite significant blood loss. These mechanisms can mask overt signs of shock, such as hypotension, until approximately 20-25% of the total blood volume (around 1000-1250 mL in an average adult) has been acutely lost. This delay in visible manifestations can be critical in situations like postpartum hemorrhage, where rapid blood loss can occur.

Choice B rationale

Hemorrhagic shock typically leads to a state of metabolic acidosis, not an increase in serum pH. This occurs due to inadequate tissue perfusion, resulting in anaerobic metabolism and the accumulation of lactic acid. The reduced oxygen delivery forces cells to switch from efficient aerobic respiration to less efficient anaerobic glycolysis, producing lactate as a byproduct, which lowers the blood pH. A normal serum pH range is 7.35 to 7.45.

Choice C rationale

While urine output is a valuable indicator of renal perfusion and overall circulatory status, it is not the most accurate or immediate indicator of *overall* organ perfusion. Other parameters like mental status, skin perfusion (capillary refill), and arterial blood pressure (MAP) provide more global and rapid assessments of tissue oxygenation. Urine output primarily reflects renal blood flow, which can be maintained by compensatory mechanisms even when other organs are hypoperfused. Normal urine output is generally considered to be 0.5 to 1 mL/kg/hr.

Choice D rationale

The standard resuscitation guideline for hemorrhagic shock is to administer 3 mL of isotonic crystalloid solution, such as lactated Ringer's, for every 1 mL of estimated blood loss. This 3: ratio accounts for the rapid redistribution of crystalloids from the intravascular space to the interstitial space, meaning that only about one-third remains within the vascular compartment to expand circulating blood volume effectively.