11. A nurse is caring for a client who has a tracheostomy and requires suctioning. Identify the sequence of steps the nurse should follow after applying sterile gloves. (Move the steps into the box, placing them in the selected order of performance. Use all the steps.)

A. Contraction intensity increased by ambulation. This finding is typical of true labor, as walking or changing positions usually causes contractions to increase in strength, duration, and frequency. In contrast, false labor contractions often subside with rest or activity changes and do not intensify with movement.
B. Slow change in dilation and effacement. Any change in cervical dilation or effacement, even if slow, is more consistent with true labor. False labor does not produce any significant cervical change, and the cervix remains closed or minimally altered with time or contractions.
C. Presence of bloody show. Bloody show is the expulsion of the mucus plug mixed with blood, a common sign of cervical softening and dilation. This is a key indicator of true labor, as it reflects actual physical changes in preparation for delivery.
D. Intermittent painless contractions. These contractions, also called Braxton Hicks contractions, are a hallmark of false labor. They are usually irregular, mild, and do not lead to cervical changes. They often resolve with hydration, rest, or position changes and are considered a normal part of the body's preparation for labor, not the onset of true labor.

A. Refer the family to a chronic pain support group. While helpful, this is a later step in the care plan. The nurse must first assess the child's specific condition and patterns of pain.
B. Set up an appointment with the school nurse. This is a supportive measure but not the priority. The nurse must gather more information before involving school personnel.
C. Review the child's electronic pain diary. This is the first action because it allows the nurse to assess the frequency, triggers, severity, and duration of the migraines. Understanding the child's pain pattern is essential for effective treatment planning.
D. Request a change in medication from the provider. This may be necessary, but the nurse should first gather complete data on the child's symptoms and current response to treatment before suggesting changes to the medication regimen.