A practical nurse is assigned to assist in the care of a laboring client at 42-weeks gestation with maternal intrapartum fever, chorioamnionitis. Four hours after admission, the practical nurse observes fetal heart rate decelerations occurring after the peak of contractions.
Which action should the practical nurse take?

Choice A rationale

Elevating the head of the examination table would not effectively alleviate supine hypotensive syndrome. This condition occurs due to compression of the vena cava by the gravid uterus, reducing venous return to the heart. While elevating the head might provide some comfort, it does not directly address the underlying circulatory compromise.

Choice B rationale

Assisting the client to a lateral position, particularly the left lateral position, is the most effective intervention. This maneuver displaces the gravid uterus off the inferior vena cava, increasing venous return to the heart, thereby improving cardiac output and uteroplacental perfusion, which alleviates symptoms of faintness and dizziness.

Choice C rationale

Placing the examination table in Trendelenburg position involves lowering the head and raising the foot of the bed. This position would further exacerbate vena caval compression in a pregnant client, potentially worsening supine hypotensive syndrome and increasing the risk of aspiration, making it an contraindicated intervention.

Choice D rationale

Stepping out of the room to notify the healthcare provider (HCP) before addressing the immediate physiological distress is inappropriate. The PN should first implement immediate interventions to stabilize the client's condition, such as repositioning, and then promptly inform the HCP about the event and the interventions performed.

Choice A rationale

Deep tendon reflexes are neurological assessments primarily used to evaluate neuromuscular excitability, particularly in conditions like preeclampsia where magnesium sulfate is administered. They are not indicated for managing fetal heart rate decelerations or chorioamnionitis, as these conditions do not directly impact spinal reflex arcs or necessitate this specific neurological monitoring. Normal reflexes range from 1+ to 2+.

Choice B rationale

Late decelerations, occurring after the peak of a contraction, indicate uteroplacental insufficiency, meaning reduced blood flow and oxygen to the fetus. A left side-lying position alleviates compression of the vena cava and aorta by the gravid uterus, thereby increasing venous return to the heart and improving uterine perfusion and oxygenation to the fetus, which is a crucial intervention.

Choice C rationale

Insertion of an indwelling urinary catheter to monitor hourly output is primarily indicated for assessing renal perfusion and fluid balance, particularly in critically ill clients or those at risk for fluid volume alterations, such as severe preeclampsia. It does not directly address or correct the underlying physiological cause of late fetal heart rate decelerations. Normal urine output is typically greater than 30 mL/hour.

Choice D rationale

Collecting a urine specimen for electrolytes and protein is a diagnostic measure for evaluating renal function, hydration status, and potential complications like preeclampsia, which presents with proteinuria. While important for overall assessment, it does not provide an immediate physiological intervention to improve uteroplacental perfusion and resolve acute fetal distress manifested by late decelerations.