A nurse is caring for a client who is in active labor and is scheduled to receive epidural anesthesia. Which of the following actions should the nurse take?

Choice A rationale Monitoring blood pressure every 30 minutes following epidural placement is insufficient. Epidural anesthesia often causes sympathetic blockade, leading to vasodilation and a rapid drop in blood pressure. Frequent monitoring, typically every 2-5 minutes initially, is critical to detect and manage hypotension promptly, ensuring adequate placental perfusion. Choice B rationale Administering a lactated Ringer's 500 mL bolus intravenously prior to epidural placement is a crucial prophylactic measure. This fluid bolus expands intravascular volume, counteracting the vasodilation and subsequent hypotension that can occur with sympathetic blockade from epidural anesthesia, thereby maintaining maternal blood pressure and placental perfusion. Choice C rationale Administering oxygen via nasal cannula at 2 L/min prior to epidural placement is generally not indicated as a routine prophylactic measure. Oxygen supplementation is typically reserved for instances where maternal oxygen saturation is low or there is fetal distress, not as a standard pre-epidural intervention for normoxic clients. Choice D rationale Repositioning the client every 2 hours following epidural placement is not frequent enough. To promote even distribution of the anesthetic and prevent prolonged pressure on specific areas, the client should be repositioned more frequently, typically every 30-60 minutes, from side to side, especially during active labor.