A nurse is admitting a client who is at 38 weeks of gestation and is 5/70/-1. Which of the following assessment findings is of concern and should be reported to the provider first?

Choice A reason: An increase in blood pressure is not a direct indicator of oxytocin’s effectiveness. Blood pressure changes may occur due to fluid shifts or vasoconstriction, but they do not confirm control of hemorrhage.

Choice B reason: An increase in lochia rubra would actually suggest worsening bleeding rather than improvement. Oxytocin should reduce blood loss by contracting the uterus, not increase it.

Choice C reason: Relief of afterpains is subjective and not a reliable measure of oxytocin’s effectiveness. Oxytocin often increases afterpains due to uterine contractions, so this is not a valid indicator.

Choice D reason: A firm uterus on palpation is the best indicator of oxytocin effectiveness. Oxytocin stimulates uterine smooth muscle contraction, which compresses blood vessels at the placental site, reducing hemorrhage. A firm uterus means bleeding is controlled.

Choice A reason: Administering an IV fluid bolus may be helpful in preventing hypotension or maintaining hydration, but it is not the most critical action before oxytocin induction. Oxytocin can cause uterine tachysystole and fetal distress, so fluid bolus alone does not address the primary risk.

Choice B reason: Inserting a urinary catheter can help monitor urine output and bladder distension, but it is not essential before starting oxytocin. Catheterization is more relevant in surgical or anesthesia contexts rather than induction safety.

Choice C reason: Performing glucose monitoring is important in diabetic clients, but it is not universally required before oxytocin induction. Oxytocin does not directly alter glucose metabolism, so this is not the priority action.

Choice D reason: Continuous electronic fetal monitoring is the most important action because oxytocin increases uterine contractions, which can reduce placental perfusion and oxygen delivery to the fetus. A client with a prior cesarean is at higher risk for uterine rupture, so monitoring ensures early detection of fetal distress or abnormal contraction patterns.