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A nurse is preparing to administer an opioid analgesic to a client who is in active labor.
Which of the following assessments should the nurse perform? (Select all that apply.)

A nurse on an antepartum unit is caring for a 28-year-old gravida 1 para 0 female client at 32 weeks of gestation.

Exhibit 1: History and Physical The client is 32 weeks pregnant and has been experiencing cramping and low back pain for the past 3 hours. She rates her pain as 2 on a scale of 0 to 10. She describes the pain as stronger than usual Braxton Hicks contractions and mentions having a little urinary leakage earlier in the day. She denies vaginal bleeding. The client decided to come in for evaluation at her doctor's advice.
 

Exhibit 2: Nurse's Notes 0900: The client reports cramping and low back pain started 3 hours ago. She rates the pain as 2 on a scale of 0 to 10. She feels the contractions are stronger than usual Braxton Hicks contractions. She mentions urinary leakage earlier today but denies any vaginal bleeding. The external fetal monitor shows contractions occurring every 5 minutes, lasting 30 seconds, and of moderate intensity. Fetal heart rate is 140/min. A vaginal exam reveals the cervix is closed and 80% effaced. No bleeding is noted, but there is clear mucus discharge on the exam glove.

Exhibit 3:

Vital Signs Heart rate: 80/min

Blood pressure: 120/80 mmHg

Respiratory rate: 18/min

Temperature: 36.8°C (98.2°F)

Oxygen saturation: 98%Exhibit 4:

Physical Examination Results

The client's abdomen is soft, non-tender, and the fundal height corresponds to the gestational age. No signs of vaginal bleeding are observed. Clear mucus discharge is noted on the exam glove. The cervix is closed and 80% effaced. The fetal heart rate is regular at 140/min. The client appears anxious but is in no acute distress. The fetal movements are felt and reported to be normal.

Complete the following sentence by using the list of options. The nurse should identify that _______ are findings that require follow-up.

A nurse is providing teaching about nifedipine for a client who is at 34 weeks of gestation and has gestational hypertension.
For which of the following adverse effects should the nurse instruct the client to notify the provider?

A client who is in active labor is admitted to a labor and delivery unit reporting "My water just broke and my baby is breech.”. Which of the following actions should the nurse take first?

A nurse is reviewing the results of a nonstress test for a client who is at 37 weeks of gestation.
Which of the following findings indicates a reactive nonstress test?

A charge nurse is teaching a newly licensed nurse about substance use disorders during pregnancy.
Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?

A nurse is preparing to administer methotrexate to a client who is experiencing an ectopic pregnancy.
Which of the following actions should the nurse take?

A nurse is caring for a client who is at 28 weeks of gestation and has received two doses of terbutaline subcutaneously.
Which of the following adverse effects is the priority for the nurse to report to the provider?

A nurse is providing discharge teaching to a postpartum client who had no immunity to rubella and received the rubella immunization.
Which of the following statements by the client indicates an understanding of the teaching?

A nurse is assessing a client who has placenta previa and is receiving fetal monitoring.
Which of the following clinical findings should the nurse expect?

A nurse is planning to obtain a blood specimen from a newborn via a heel stick.
Which of the following actions should the nurse take?