A nurse is providing care for a patient who is 28 weeks pregnant and has received betamethasone.
The nurse recognizes that the use of betamethasone affects which of the following?

Choice A rationale

Increasing the rate of maintenance IV infusion is not the first action the nurse should take when observing that the fetal heart rate begins to slow after the start of a contraction and the lowest rate occurs after the peak of the contraction. This pattern is known as late decelerations and is often associated with fetal hypoxemia due to insufficient placental perfusion.

Choice B rationale

The nurse should first place the client in the lateral position. This position can improve placental blood flow and may help to resolve the late decelerations.

Choice C rationale

Administering oxygen using a nasal cannula may be beneficial, but it is not the first action the nurse should take. The priority is to improve placental blood flow, which can be achieved by changing the client’s position.

Choice D rationale

Elevating the client’s legs is not the first action the nurse should take. This action would not directly address the issue of late decelerations.

Choice A rationale

Returning the platelet bag and tubing to the blood bank is not the immediate action to take when a client reports having lower back pain and feeling chilled and itchy during a PRBC transfusion. These symptoms could indicate a transfusion reaction, which is a serious complication that requires immediate intervention.

Choice B rationale

Stopping the infusion is the first action the nurse should take when a client reports symptoms of a transfusion reaction. This is because continuing the transfusion could worsen the reaction and potentially lead to more serious complications.

Choice C rationale

While notifying the provider is an important step in managing a transfusion reaction, it is not the first action the nurse should take. The nurse should first stop the infusion to prevent further exposure to the blood product.

Choice D rationale

Collecting a urine sample from the client is not the immediate action to take when a client reports having lower back pain and feeling chilled and itchy during a PRBC transfusion. These symptoms could indicate a transfusion reaction, which requires immediate intervention.