Immediately after birth, the father of the newborn holds the baby close, stares into his eyes, and seems captivated by him. The nurse recognizes this as the normal process of:

A) Decrease the client's IV fluids:
Sinusoidal fetal heart rate patterns are concerning and typically indicate severe fetal distress, which is often associated with conditions such as fetal anemia, hypoxia, or central nervous system (CNS) damage. Decreasing IV fluids is not an appropriate response to a sinusoidal pattern. The primary focus should be on fetal well-being, not fluid management, in this situation.

B) Prepare the client for an emergent birth:
This pattern is typically associated with severe fetal compromise and is an ominous sign. Immediate intervention is required, and emergent delivery may be necessary to prevent further fetal distress and potential harm. The nurse should promptly notify the healthcare provider and prepare the client for an emergency cesarean delivery or other urgent interventions.

C) Turn the client to a supine position:
The supine position is not recommended for managing fetal distress, as it may decrease uterine blood flow and worsen the situation, especially if the fetus is experiencing hypoxia. The appropriate intervention for addressing a sinusoidal heart rate pattern is not repositioning the client in a supine position, but rather preparing for emergency delivery and providing immediate support to stabilize both mother and fetus.

D) Document the findings:
While it is important to document any fetal heart rate pattern, sinusoidal patterns require immediate action. Documentation alone is not sufficient in this case, as it does not address the potential life-threatening situation for the fetus. The nurse should not delay action, and the focus should be on preparing for emergency birth and notifying the healthcare provider immediately.

Uterine rupture: A client in active labor with a history of prior vaginal birth is at risk for uterine rupture, particularly when experiencing intense contractions and increasing pelvic pressure. While previous vaginal delivery lowers the risk compared to a history of cesarean section, prolonged or strong contractions can still contribute to uterine rupture, especially if there is an undiagnosed uterine scar or excessive uterine stress.

Increasing pelvic pressure: The client reports increasing pelvic pressure despite receiving an epidural, which can be a sign of impending uterine rupture. While pelvic pressure is expected during labor, a sudden or intense sensation, particularly in the setting of strong contractions and rapid cervical dilation, warrants close monitoring.