An antenatal client at 32 weeks' gestation has been admitted to the hospital with premature rupture of membranes.
She is not exhibiting any signs of labor.
What is the priority nursing intervention for this client?

Choice A rationale

Decreased urine output is not typically associated with patent ductus arteriosus (PDA). PDA causes an abnormal connection between the aorta and pulmonary artery, leading to left-to-right shunting of blood, which predominantly affects the cardiovascular and pulmonary systems rather than renal output directly.

Choice B rationale

Bradycardia is not a hallmark sign of PDA. Instead, PDA commonly leads to increased cardiac workload and tachycardia. The persistent opening between the aorta and pulmonary artery creates volume overload in the heart, which does not slow heart rate but rather increases it to compensate for the extra demand.

Choice C rationale

Cyanosis of the extremities is more typical in conditions involving right-to-left shunting, which is not characteristic of PDA. In PDA, the blood flow is typically left-to-right, meaning oxygenated blood flows back into the pulmonary circulation, which may lead to pulmonary congestion but not peripheral cyanosis.

Choice D rationale

A continuous "machinery-like" heart murmur is a classic sign of PDA due to the turbulent flow of blood between the high-pressure aorta and low-pressure pulmonary artery during both systole and diastole. This characteristic sound is often used diagnostically to identify PDA in newborns.

Choice A rationale

While pelvic inflammatory disease can lead to infertility, it does not specifically cause endometriosis. PID involves infection of the reproductive organs, while endometriosis is the presence of endometrial tissue outside the uterus, characterized by pain and inflammation during menstruation.

Choice B rationale

An atypical Papanicolaou smear indicates abnormal cervical cells, often related to infection or precancerous changes, but is not indicative of endometriosis. Endometriosis involves ectopic endometrial tissue and does not affect cervical cell morphology directly.

Choice C rationale

Dysmenorrhea unresponsive to NSAIDs is a hallmark of endometriosis. This condition causes severe pain due to the inflammation and cyclic bleeding of ectopic endometrial tissue, often resulting in scarring and adhesions that exacerbate discomfort during menstruation.

Choice D rationale

Abdominal bloating starting before menses may be associated with premenstrual syndrome or other hormonal changes rather than endometriosis. Although some women with endometriosis report bloating, it is not a definitive diagnostic criterion compared to chronic pain and infertility.