A nurse is assisting with the care of a client who is in active labor. For each nursing intervention, click to specify if the intervention is essential or contraindicated for the client.

• Monitor fetal heart rate: After epidural placement, continuous or frequent fetal heart rate monitoring is critical because maternal hypotension and uteroplacental perfusion changes can reduce fetal oxygenation. The presence of minimal variability requires close surveillance to detect deterioration. • Place the client in left lateral position: Left lateral positioning improves uteroplacental blood flow by reducing compression of the inferior vena cava. This intervention supports fetal oxygenation and is appropriate when variability decreases following epidural anesthesia. • Decrease the IV flow rate: Following an epidural, IV fluids are typically maintained or increased to prevent maternal hypotension. Reducing IV fluids can worsen hypotension and compromise placental perfusion, negatively affecting fetal status. • Request a prescription for ephedrine: Ephedrine is indicated only if maternal hypotension develops. The client’s blood pressure remains stable, so requesting a vasopressor at this time is unnecessary and could cause hypertension and uterine vasoconstriction. • Assist with administration of ampicillin IV: The client is group B streptococcus positive, and intrapartum antibiotic prophylaxis is required to reduce the risk of neonatal infection. Ampicillin administration during labor is a priority nursing intervention.