Which of the following interventions should a nurse implement first for a client who is at 38 weeks of gestation and has a nonstress test showing a series of late decelerations?

Choice A reason: Elevating the client’s legs does not address late decelerations, which indicate uteroplacental insufficiency. This position may reduce venous return, worsening maternal cardiac output and placental perfusion. Late decelerations require interventions to improve fetal oxygenation, such as repositioning or oxygen, not leg elevation, which is irrelevant to fetal distress. Choice B reason: Administering lactated Ringer’s via IV bolus addresses maternal hypotension but is not the first intervention for late decelerations. Positioning improves placental perfusion immediately, while fluids take longer to act. Late decelerations reflect fetal hypoxia from reduced uteroplacental blood flow, requiring urgent repositioning to optimize circulation before secondary measures like fluids. Choice C reason: Preparing for cesarean birth is not the first intervention for late decelerations, as intrauterine resuscitation (e.g., lateral positioning) may resolve fetal hypoxia. Cesarean is considered if decelerations persist despite interventions. Immediate surgical preparation delays reversible measures, risking unnecessary maternal morbidity while bypassing simpler methods to restore fetal oxygenation. Choice D reason: Placing the client in a lateral position is the first intervention for late decelerations, as it relieves uterine pressure on the inferior vena cava, improving maternal cardiac output and placental perfusion. This corrects fetal hypoxia by enhancing uteroplacental blood flow, addressing the physiological cause of decelerations, per obstetric emergency protocols.