A nurse is assessing a client who is in the first stage of labor.

Which finding should the nurse report to the provider immediately?

The client's serum albumin level is 4.0 g/dL.

Rationale: A serum albumin level of 4.0 g/dL indicates that the client's nutritional status is improving, as albumin is a protein that reflects the client's protein intake and nutritional status. The normal range for serum albumin levels is 3.5 to 5.0 g/dL.

Incorrect options:

B) The client's blood urea nitrogen (BUN) level is 60 mg/dL. - This finding indicates that the client's nutritional status is worsening, as BUN is a waste product of protein metabolism that accumulates in the blood due to impaired renal function. A high BUN level can indicate excessive protein intake or inadequate dialysis. The normal range for BUN levels is 10 to 20 mg/dL.

C) The client's body weight is 2 kg higher than the dry weight. - This finding indicates that the client has fluid retention, not improved nutritional status. Dry weight is the weight of the client after dialysis, when all excess fluid has been removed. A weight gain of more than 1 kg above the dry weight can indicate inadequate fluid restriction or dialysis.

D) The client's serum creatinine level is 3.0 mg/dL. - This finding indicates that the client has impaired renal function, not improved nutritional status. Creatinine is a waste product of muscle metabolism that accumulates in the blood due to reduced glomerular filtration rate (GFR). A high creatinine level can indicate decreased muscle mass or inadequate dialysis. The normal range for serum creatinine levels is 0.6 to 1.2 mg/dL.

The client's fetal heart rate is 180 beats per minute.

Rationale: A fetal heart rate of 180 beats per minute is above the normal range of 110 to 160 beats per minute and indicates fetal distress. The nurse should report this finding to the provider immediately and prepare for interventions to improve fetal oxygenation, such as changing the client's position, administering oxygen, or initiating a fluid bolus.

Incorrect options:

A) The client's cervix is dilated to 4 cm. - This is a normal finding for the first stage of labor, which lasts until the cervix is fully dilated to 10 cm.

C) The client's contractions are 5 minutes apart. - This is a normal finding for the active phase of the first stage of labor, which occurs when the contractions are 3 to 5 minutes apart and last for 40 to 60 seconds.

D) The client's amniotic fluid is clear and odorless. - This is a normal finding that indicates the absence of infection or meconium staining in the amniotic fluid.