A nurse is assisting with the care of a client who is using paced breathing during the first stage of labor.
The client says she feels lightheaded and her fingers are tingling.
Which of the following actions should the nurse take?

Choice A rationale:

Administering the measles, mumps, rubella (MMR) vaccine two weeks before attempting pregnancy again is not the correct timing. It is important to provide the MMR vaccine postpartum before the client is discharged from the hospital after giving birth. This timing is appropriate to protect the woman from rubella and to avoid vaccinating during pregnancy.

Choice B rationale:

The correct timing for the MMR vaccine is prior to discharge from the hospital after giving birth. This approach ensures that the woman is protected against rubella before leaving the hospital and potentially becoming pregnant again. It is crucial to avoid vaccinating during pregnancy because the MMR vaccine contains live attenuated viruses.

Choice C rationale:

Administering the MMR vaccine prior to giving birth is not the recommended timing. Vaccination should be done postpartum to avoid any potential risks to the developing fetus.

Choice D rationale:

Administering the MMR vaccine when the client does not desire future pregnancies is not the most appropriate option. The vaccine should be given postpartum to protect the woman and any future pregnancies from rubella. It is important to provide vaccination recommendations based on evidence-based guidelines and the client's specific situation.

Choice A rationale:

Increasing carbohydrates to 65% of daily nutritional intake is not the appropriate action for a client with blood glucose levels ranging from 180 mg/dL to 250 mg/dL following meals. In this scenario, the client's blood glucose levels are already elevated, and increasing carbohydrates may further exacerbate hyperglycemia. It's important to focus on blood glucose control rather than increasing carbohydrate intake.

Choice B rationale:

Scheduling a 2-hour oral glucose tolerance test is not the immediate action required in this case. While this test can help diagnose gestational diabetes, the client's elevated post-meal blood glucose levels are already a concern. The primary concern is addressing and managing these high levels before proceeding with additional testing.

Choice C rationale:

Anticipating an order for insulin administration is the correct action. When a client with gestational diabetes has blood glucose levels consistently above the target range, despite dietary modifications, insulin administration may be necessary to achieve glycemic control. This is a key intervention to prevent complications for both the mother and the baby.

Choice D rationale:

Obtaining an HbA1c is not typically done during pregnancy to assess glucose control, as it reflects the average blood glucose levels over the past 2-3 months. In this case, more immediate monitoring and intervention are required to address the high post-meal blood glucose levels. Now, let's move on to the final question.