A nurse is planning care for a client who is scheduled for an amniocentesis and is Rh negative. Which of the following actions should the nurse plan to take?

Choice A rationale Instructing the client to be NPO (nil per os), or nothing by mouth, is not typically required before an amniocentesis procedure. The client can usually eat and drink normally. Fasting is more commonly associated with procedures involving general anesthesia or those where there is a risk of aspiration, neither of which is routine for an amniocentesis. Clients may be asked to empty their bladder before the procedure to avoid puncturing it. Choice B rationale For an Rh-negative client undergoing an amniocentesis, there is a risk of fetomaternal hemorrhage during the procedure, which can lead to the mother's immune system producing Rh antibodies that attack the fetus's red blood cells in the current or future pregnancies. Therefore, administering Rh(D) immune globulin (RhoGAM) after the procedure is essential to prevent Rh sensitization. The standard dose is administered within 72 hours of the procedure. Choice C rationale Positioning the client in a left lateral position is typically used to promote optimal uteroplacental perfusion or during the second stage of labor. For an amniocentesis, the client is usually positioned in a supine position with a wedge placed under the right hip to slightly tilt the uterus and prevent vena cava compression, providing the provider with a clear anatomical view for ultrasound guidance. Choice D rationale The insertion site on the client's abdomen is cleaned with an antiseptic solution, such as povidone-iodine or chlorhexidine, to reduce the risk of introducing bacteria into the sterile field or uterus. Irrigating the site with sterile water is an inappropriate action for skin preparation as it is not a primary antiseptic and may interfere with the effectiveness of the chosen antiseptic solution.