A laboring woman is lying in the supine position.
The most appropriate nursing action at this time is to:.

Choice A rationale:
Pulmonary stenosis is characterized by a systolic ejection murmur best heard at the upper left sternal border. It does not typically produce a continuous machinery-like murmur. Pulmonary stenosis results from narrowing at the pulmonary valve, obstructing blood flow from the right ventricle to the pulmonary artery.
Choice B rationale:
A continuous machinery-like murmur is characteristic of patent ductus arteriosus (PDA). PDA is a congenital heart defect where the ductus arteriosus, a fetal blood vessel that should close after birth, remains open, allowing continuous blood flow between the aorta and pulmonary artery. This murmur is often best heard in the left infraclavicular region.
Choice C rationale:
Ventricular septal defect (VSD) typically produces a harsh holosystolic murmur heard best at the lower left sternal border. VSD is a hole in the septum separating the ventricles, allowing blood to flow from the higher-pressure left ventricle to the lower-pressure right ventricle.
Choice D rationale:
Coarctation of the aorta causes a murmur due to increased blood flow across the aortic valve. However, this murmur is not continuous and is usually systolic and best heard in the back over the left scapula.

Choice A rationale:

Cigarette smoke contains harmful chemicals that can cause birth defects and other complications during pregnancy. Pregnant women should avoid exposure to cigarette smoke to protect the developing fetus.

Choice B rationale:

Isotretinoin (Retin A) is a medication used to treat severe acne. It is known to cause severe birth defects and should be avoided during pregnancy. Women of childbearing age who are prescribed isotretinoin must use effective contraception to prevent pregnancy while taking the medication.

Choice C rationale:

Vitamin C, also known as ascorbic acid, is a water-soluble vitamin that is essential for various bodily functions. It is not a teratogen and is safe for consumption during pregnancy in recommended amounts. In fact, pregnant women are encouraged to consume an adequate amount of vitamin C to support their overall health and the development of the baby.

Choice D rationale:

Salicylic acid is commonly found in skincare products and is used to treat acne. While oral use of high doses of salicylic acid during pregnancy can be harmful, the small amounts used in topical skincare products are generally considered safe. However, it's advisable for pregnant women to use salicylic acid-containing products in moderation.

Choice E rationale:

Rubella, also known as German measles, is a contagious viral infection that can cause birth defects if a pregnant woman becomes infected, especially during the early stages of pregnancy. Rubella vaccination before pregnancy is recommended to prevent congenital rubella syndrome.