A nurse manager is planning to assist with resolving conflict within a group of nurses. Which of the following actions should the nurse manager take?

Choice A reason: Cheyne-Stokes respirations, alternating hyperventilation and apnea, indicate neurological dysfunction or end-of-life changes in brain tumor patients, not pain. This reflects brainstem involvement, requiring respiratory management rather than analgesics, as it is a physiological response to disease progression in palliative care.
Choice B reason: Mottled skin signals poor perfusion or impending death, common in palliative care as circulation declines. It is not a pain indicator but a sign of systemic shutdown, requiring comfort measures like warmth, not analgesics, which are irrelevant to this physiological change in terminal illness.
Choice C reason: Constricted pupils may reflect opioid effects or neurological changes in brain tumor patients but do not directly indicate pain. They suggest autonomic or brainstem dysfunction, necessitating neurological assessment, not immediate pain medication, in palliative care where comfort is prioritized based on clear pain cues.
Choice D reason: Grimacing indicates pain in palliative care patients with brain tumors, reflecting physical discomfort. As a facial expression of distress, it signals the need for analgesics to improve comfort and quality of life, aligning with palliative goals to manage pain effectively in end-stage disease.

Choice A reason: Occasional mild nausea is common in early pregnancy due to hormonal changes and does not typically require reporting unless severe or persistent. It is not a concerning finding at 14 weeks, so this is incorrect for urgent reporting.
Choice B reason: Mild ankle swelling in the evening can be normal due to fluid retention but is not urgent unless accompanied by other preeclampsia signs. It is less critical than bleeding, so this is incorrect for priority reporting.
Choice C reason: Vaginal bleeding at 14 weeks is abnormal and may indicate miscarriage, placental issues, or other complications, requiring immediate reporting to the provider for evaluation. This finding is critical at 14 weeks gestation, aligning with obstetric emergency protocols, making it the correct choice for teaching.
Choice D reason: Increased appetite is normal in pregnancy as nutritional needs rise and does not warrant urgent reporting. It reflects healthy adaptation rather than a complication, so this is incorrect for inclusion in teaching about concerning findings.