After assisting the provider with an amniotomy on a laboring client, what is the nurse's priority action?

Choice A rationale

This response is dismissive and does not address the patient's concerns. Providing accurate information empowers the patient to make informed decisions about their health. The nurse should always address patient concerns and provide education, especially when it relates to their birth experience and future reproductive health. Failing to do so can erode trust and negatively impact the patient-provider relationship.

Choice B rationale

This statement is an oversimplification and potentially inaccurate. The feasibility of a vaginal birth after a cesarean section (VBAC) depends on several factors, including the type of uterine incision. A classical vertical incision, for instance, is a strong contraindication due to a significantly increased risk of uterine rupture in subsequent pregnancies. The nurse must provide a more nuanced and accurate explanation.

Choice C rationale

This is an incorrect and potentially harmful statement. A previous cesarean section does not automatically preclude a future vaginal delivery. A vaginal birth after cesarean (VBAC) is a viable option for many individuals, particularly those who had a low transverse uterine incision. The decision is based on a careful assessment of risks and benefits with the patient's provider.

Choice D rationale

This statement is the most accurate and scientifically grounded response. The type of uterine incision is the most significant factor determining the safety of a future vaginal delivery. A low transverse incision has a lower risk of rupture during a trial of labor, making VBAC a safe option for many. A classical (vertical) incision, conversely, carries a high risk of uterine rupture, necessitating a repeat cesarean.

Choice A rationale

Measuring blood pressure hourly is an important part of monitoring a postpartum client, but it is not the priority. While vital signs are crucial, the immediate physiological threat is ongoing hemorrhage from uterine atony, which must be addressed directly to prevent shock.

Choice B rationale

Preparing to administer blood products may become necessary if the client experiences significant blood loss, but it is not the initial priority. The first intervention is to stop or reduce the bleeding by promoting uterine contraction, which will minimize the need for subsequent blood transfusions.

Choice C rationale

Administering intravenous fluids is a supportive measure to maintain circulatory volume, but it does not address the underlying cause of the hemorrhage. The priority is to stimulate uterine contractions to compress the myometrial arteries and prevent further blood loss.

Choice D rationale

Initiating an oxytocin infusion is the priority nursing intervention. Oxytocin is a potent uterotonic agent that stimulates uterine contractions, causing the myometrium to clamp down on blood vessels at the placental site, thereby reducing postpartum hemorrhage.