An infant with tetralogy of Fallot becomes acutely cyanotic and hyperpneic. Which action should the nurse implement first?

A. Place the infant in the knee-chest position: In a hypercyanotic (“Tet”) spell, placing the infant in a knee-chest position increases systemic vascular resistance, reduces right-to-left shunting, and improves pulmonary blood flow and oxygenation. Immediate positioning is a first-line emergency intervention. B. Start an IV for fluids: Establishing IV access is important for administering medications and fluids, but it is secondary to immediate measures to relieve cyanosis and improve oxygenation during a Tet spell. C. Prepare the infant for surgery: Surgical repair is definitive treatment for tetralogy of Fallot, but emergent stabilization takes priority before operative intervention can occur. D. Raise the head of the bed: Elevating the head may aid comfort and respiratory mechanics in some conditions, but it does not address the acute pathophysiology of right-to-left shunting causing cyanosis during a Tet spell.