Which of the following actions should a nurse take for a client receiving epidural anesthesia who is hypotensive with decreased placental perfusion?

Choice A reason: Transmission of HSV-2 to the newborn is higher with active lesions at birth, as direct contact during vaginal delivery increases neonatal herpes risk. The virus can cause severe neonatal infections, affecting the central nervous system. Cesarean delivery is often recommended to reduce transmission, per obstetric virology guidelines.

Choice B reason: Antiviral medications like acyclovir suppress HSV-2 symptoms and reduce transmission but do not cure the condition, as the virus remains latent in nerve ganglia. Chronic management is required, and this statement misrepresents the virological nature of herpes, which persists lifelong despite treatment, per infectious disease principles.

Choice C reason: Wearing tight-fitting undergarments during HSV-2 lesions is not recommended, as it may cause irritation, delaying healing. Loose clothing minimizes friction, supporting lesion recovery. This advice does not address viral transmission or fetal risk, focusing on comfort rather than the virological or obstetric management of HSV-2.

Choice D reason: HSV-2 can harm the fetus, especially with primary infection, causing congenital herpes, preterm birth, or neurological damage. While rare, transplacental transmission or exposure during delivery poses risks. This statement is incorrect, as HSV-2’s potential for fetal harm necessitates careful management, per perinatal infection guidelines.

Choice A reason: Applying petroleum gauze to an omphalocele is inappropriate, as it does not provide a sterile barrier and risks infection or adhesion to exposed viscera. Omphaloceles require protection from contamination and dehydration, which sterile plastic wrap achieves, preserving bowel integrity until surgical repair, per neonatal surgical protocols.

Choice B reason: Positioning a newborn with an omphalocele in a supine position risks pressure on exposed viscera, potentially causing trauma or ischemia. A side-lying position supports the defect, preventing bowel damage. Proper positioning minimizes complications before surgical correction, as supine posture does not protect the omphalocele’s delicate membrane.

Choice C reason: Placing the newborn under a radiant heat source without covering the omphalocele risks dehydration and injury to exposed viscera. While thermoregulation is important, uncovered viscera lose moisture and are prone to infection. Sterile wrapping takes priority to protect the defect, followed by controlled warming, per neonatal care standards.

Choice D reason: Using sterile plastic wrap to cover the omphalocele prevents infection and dehydration of exposed viscera, maintaining bowel integrity until surgical repair. The wrap creates a sterile barrier, reducing bacterial contamination and fluid loss, critical for stabilizing the newborn’s condition and supporting preoperative management, per congenital defect care protocols.