A first-time pregnant woman at 36 weeks of gestation is admitted to the labor and delivery unit because her membranes ruptured 30 minutes ago.

The initial assessment indicates a 2 cm cervical dilation, 50% effacement, -2 station, vertex presentation, greenish- colored amniotic fluid, and contractions occurring every 3 to 5 minutes.

There is a decrease in fetal heart rate after the last four contraction peaks.

What should the nurse do first?

Choice A rationale
Monitoring leukocytes, neutrophils, and thyroxine is not the most crucial for a patient with end-stage renal disease (ESRD). While these lab values can provide information about the patient’s immune function and thyroid function, they do not directly relate to the patient’s renal function.
Choice B rationale
Monitoring serum potassium, calcium, and phosphorus levels is crucial for a patient with ESRD. These electrolytes are typically excreted by the kidneys, and their levels can become imbalanced in patients with ESRD. Imbalances can lead to serious complications, such as cardiac arrhythmias and bone disease.
Choice C rationale
Monitoring erythrocytes, hemoglobin, and hematocrit is important for a patient with ESRD, as these patients often develop anemia due to decreased erythropoietin production by the kidneys. However, these are not the only lab values that should be monitored in these patients.
Choice D rationale

Monitoring blood pressure, heart rate, and temperature is important for all patients, but these are not specific to patients with ESRD. Patients with ESRD are at risk for electrolyte imbalances, which can affect cardiac function, making monitoring of serum potassium, calcium, and phosphorus levels more crucial.

Management of respiratory distress in a long-term smoker requires knowledge of oxygen delivery systems and airway humidification. The nurse must apply principles of respiratory therapy to select equipment that ensures precise flow regulation and moisture addition to prevent mucosal drying during supplemental oxygen administration.

Choice A rationale: Lamb’s wool is occasionally used to protect skin from pressure sores caused by medical tubing. However, it is not a standard or essential component for initiating oxygen therapy, as modern medical-grade foam dressings or specialized tubing protectors are more commonly utilized in clinical practice.

Choice B rationale: Sterile water is essential for the humidification process when oxygen flow rates exceed 4 liters per minute. It serves as the reservoir liquid in the humidifier bottle to ensure the inhaled gas is moist, preventing the drying of sensitive respiratory mucosa and secretions.

Choice C rationale: Tape is generally avoided when securing nasal cannulas because it can cause skin irritation or breakdown on the face. The cannula is designed to be secured using the integrated sliding bolo or by looping the flexible tubing comfortably behind the patient's ears.

Choice D rationale: A suction canister is used for removing secretions from the oropharynx or trachea. While it may be present at the bedside for safety, it is not a functional component of the oxygen delivery system itself, which focuses on gas inhalation rather than extraction.

Choice E rationale: A humidifier bottle is necessary to add water vapor to the dry oxygen gas provided by the wall source. Humidification is vital for patient comfort and to maintain the integrity of the mucociliary escalator, especially for patients with chronic lung irritation from smoking.

Choice F rationale: The nasal cannula is the primary interface for delivering low-to-medium concentrations of oxygen. It consists of two prongs that fit into the nares, allowing the patient to breathe supplemental oxygen while still being able to speak and consume fluids or meals.

Choice G rationale: A flowmeter is a critical device that attaches to the oxygen wall outlet to regulate the liters per minute delivered. It allows the nurse to accurately titrate the oxygen dose according to the healthcare provider's specific orders and the patient's oxygenation needs.