A client at 42-weeks gestation arrives at the labor and delivery unit for a scheduled induction but refuses the prescribed oxytocin infusion because she wants to have a "natural" delivery.

Which action is most important for the nurse to implement?

Choice A rationale:

“Reflection is thinking about what I did and how I can improve.” Rationale: Reflection involves self-assessment and critical thinking about past actions to identify areas for improvement. This statement correctly defines reflection and does not indicate a need for further teaching.

Choice B rationale:

“Analysis is breaking down a complex situation into smaller parts.” Rationale: Analysis is the process of examining complex situations by breaking them down into smaller, manageable components for a more in-depth understanding. This statement accurately describes analysis and does not indicate a need for further teaching.

Choice C rationale:

“Inference is making assumptions based on my experience.” Rationale: Inference involves drawing conclusions or making predictions based on available evidence rather than personal experience. This statement incorrectly defines inference, indicating a need for further teaching.

Choice D rationale:

“Evaluation is checking the reliability and validity of information.” Rationale: Evaluation refers to the process of assessing the credibility, accuracy, and relevance of information or data. This statement accurately defines evaluation and does not indicate a need for further teaching.

The correct answer is D. Notify your healthcare provider if you start having abdominal pain.

Choice A rationale:

Exenatide does not act in the same way as insulin. Insulin directly lowers blood glucose levels by facilitating the uptake of glucose into cells, while exenatide is an incretin mimetic that enhances glucose-dependent insulin secretion and slows gastric emptying.

Choice B rationale:

Exenatide should be injected within 30 minutes before or after a meal, but this is not the most critical information for discharge instructions.

Choice C rationale:

There are precautions about taking exenatide with other medications, especially those that affect kidney function or interact with exenatide.

Choice D rationale:

Notifying the healthcare provider if abdominal pain starts is crucial because exenatide can cause side effects such as pancreatitis, which presents with severe abdominal pain. Early detection and intervention are essential for patient safety.