A nurse is assessing a client who is receiving morphine IV for pain. Which of the following findings should the nurse report to the provider first?

A. Diplopia. Double vision (diplopia) is more commonly associated with neurological or ophthalmic disorders such as multiple sclerosis or cranial nerve dysfunction. It is not a typical manifestation of lupus exacerbations.
B. Fever. Fever is a common and expected finding during an acute exacerbation of systemic lupus erythematosus (SLE). It results from systemic inflammation and immune system activation, often indicating disease flare-up or potential infection.
C. Esophagitis. Esophagitis is more often linked to gastroesophageal reflux disease or infections, not systemic lupus. Although lupus can affect many organs, the esophagus is not a typical site of acute involvement in SLE exacerbations.
D. Bradykinesia. Bradykinesia, or slowness of movement, is a hallmark feature of Parkinson’s disease. It is not associated with SLE and would not be expected during a lupus flare.

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.