A pregnant patient at 28 weeks has become anemic.
The nurse would anticipate giving the following guidelines regarding iron supplementation, except:

Choice A rationale

Applying oxygen is a supportive measure for fetal or maternal hypoxemia, but it does not address the underlying cause of the supine hypotension syndrome, which is compression of the vena cava. Oxygen (10 L/min by simple face mask) may be administered after or concurrently with positional change if symptoms persist, but restoring blood flow by repositioning is the essential first step. Simply administering oxygen will not relieve the mechanical obstruction.

Choice B rationale

While the medical provider should be notified of the patient's deteriorating condition, the immediate priority is to correct the cause of the supine hypotension syndrome and stabilize the patient. The patient's pale, clammy, and dizzy symptoms indicate immediate circulatory compromise due to aortocaval compression. Turning the patient is a rapid, non-invasive intervention that should precede making a phone call to the provider.

Choice C rationale

Administering an IV fluid bolus of 250 mL of Lactated Ringer's is appropriate for true hypovolemia or shock. However, in this case, the hypotension is caused by a mechanical obstruction (aortocaval compression) from the heavy gravid uterus pressing on the vena cava, reducing venous return and cardiac output. The first action must be to alleviate the compression by changing the maternal position, which is faster and addresses the root problem.

Choice D rationale

The patient's symptoms (pallor, clamminess, dizziness) while lying flat on her back are classic signs of supine hypotension syndrome, also known as aortocaval compression. The heavy uterus compresses the inferior vena cava, decreasing venous return to the heart, which drastically reduces cardiac output and maternal blood pressure. The immediate and most effective intervention is to turn the patient to her left side (or right side) to displace the uterus and relieve the compression, rapidly restoring blood flow.

Choice A rationale

Shortness of breath, or dyspnea, when climbing stairs is a common and often normal physiological complaint in the third trimester of pregnancy, including at 35 weeks. This symptom is typically caused by the enlarging uterus pushing the diaphragm upward, which reduces the total lung capacity and increases the effort required for inspiration, but it is not usually indicative of a major pathology.

Choice B rationale

Dependent edema, such as ankle edema that is worse in the afternoon and relieved with elevation, is a very common and normal occurrence in the third trimester. It results from increased pressure from the gravid uterus on the vena cava, which impedes venous return, combined with increased total body water and capillary permeability. It does not typically require extensive additional assessment unless it is sudden or associated with hypertension.

Choice C rationale

Backache, particularly with prolonged standing, is another extremely common complaint in late pregnancy. This is due to the increased weight of the uterus and the resulting exaggerated lumbar lordosis, which shifts the woman's center of gravity and strains the lower back muscles and ligaments. This is a normal musculoskeletal adaptation and generally managed with conservative measures.

Choice D rationale

Abdominal pain at 35 weeks of gestation is a symptom that always requires immediate and additional assessment to rule out serious conditions. While it could be benign, such as Braxton Hicks contractions or round ligament pain, it could also signal placental abruption, preterm labor, or a non-obstetric emergency like appendicitis. The differential diagnosis requires urgent evaluation of the fetal heart rate pattern and maternal status.