A nurse in an obstetric clinic is caring for four clients. The nurse should identify that an intrauterine device is contraindicated for which of the following clients?

(A) Diuresis:
Diuresis, or increased urine production, is not a typical adverse effect of nalbuphine hydrochloride. Opioids generally do not affect urine output in the same way as diuretic medications.

(B) Fever:
Fever is not a common adverse effect of nalbuphine hydrochloride. If a client develops a fever during labor, it could indicate other underlying causes such as infection or inflammation, but it is not directly related to the administration of this medication.

(C) Diarrhea:
Diarrhea is not a typical adverse effect of nalbuphine hydrochloride. Opioid medications are more commonly associated with constipation due to their effects on gastrointestinal motility and function.

(D) Sedation:
Nalbuphine hydrochloride is an opioid analgesic used for pain relief during labor. Sedation is a common adverse effect of opioid medications, including nalbuphine. Opioids can depress the central nervous system, leading to drowsiness, sedation, and decreased level of consciousness. It's essential for the nurse to monitor the client closely for signs of sedation, especially during labor, to ensure the safety of both the mother and the baby.

(A) Assist the client to empty her bladder:
Emptying the bladder is an essential intervention, especially in laboring women with epidural anesthesia, as a full bladder can contribute to hypotension. However, in this scenario, the priority is to address the hypotension directly with fluid administration. After stabilizing the client's blood pressure, assisting with bladder emptying would be appropriate.

(B) Place the client in knee-chest position:
The knee-chest position is not typically indicated for managing hypotension. While this position can increase venous return to the heart and potentially increase blood pressure, it is not the initial intervention for hypotension associated with epidural anesthesia. Intravenous fluid administration is the primary intervention to increase blood pressure in this situation.

(C) Administer methylergonovine IM:
Methylergonovine is a medication used to prevent or treat postpartum hemorrhage by causing uterine contractions. It is not indicated for the management of hypotension associated with epidural anesthesia during labor. Administering methylergonovine in this situation could potentially exacerbate hypotension and should be avoided.

(D) Give a bolus of lactated Ringer's:
The client's blood pressure is low (80/40 mm Hg), indicating hypotension. Hypotension can be a common side effect of epidural anesthesia during labor. Administering a bolus of intravenous fluids, such as lactated Ringer's solution, is the initial intervention to address hypotension. Fluid administration helps increase intravascular volume, improving blood pressure and perfusion to vital organs.