A nurse is caring for a client who is at 26 weeks of gestation. Which of the following statements indicates the client is having difficulty accepting the body image changes associated with pregnancy?

A. Current level of consciousness. Changes in mental status, such as confusion or decreased alertness, can indicate hypoxia, infection, or worsening respiratory distress. Given the client’s history and symptoms, altered consciousness requires immediate follow-up to assess for possible hypoxemia or sepsis.
B. Heart rate. While the heart rate of 104/min is slightly elevated, it is not critically abnormal. Tachycardia can occur due to fever, anxiety, or respiratory distress, but it is not the most urgent concern compared to other findings.
C. Respiratory rate. The client’s respiratory rate of 30/min is significantly elevated, indicating possible respiratory distress. Increased work of breathing suggests inadequate oxygenation or potential pneumonia, requiring immediate evaluation and intervention.
D. Chronic health condition. The client has Parkinson’s disease and a history of smoking, both of which are important considerations in their overall care but do not require immediate intervention in the current scenario.
E. Tremors. Tremors are a common symptom of Parkinson’s disease and do not indicate an acute emergency. They do not require urgent follow-up in this case.
F. Oxygen saturation level. An oxygen saturation of 89% on room air is concerning, as it indicates hypoxemia. Immediate intervention, such as supplemental oxygen and further respiratory assessment, is necessary to prevent further deterioration.

A. "Establish a daily exercise routine." Regular physical activity helps regulate the sleep-wake cycle and promotes deeper sleep. Exercising earlier in the day enhances sleep quality, but vigorous exercise close to bedtime should be avoided as it can be stimulating.
B. "Keep the television volume low while you are trying to fall asleep." Watching television before bed can interfere with melatonin production due to blue light exposure, making it harder to fall asleep. A dark, quiet environment is recommended for better sleep.
C. "Remain in bed until you fall asleep." Staying in bed while struggling to sleep can reinforce insomnia. It is recommended to get out of bed and engage in a relaxing activity if unable to sleep within 20 minutes, then return when drowsy.
D. "Sleep longer hours on the weekend." Sleeping in on weekends disrupts the body's internal clock and can worsen sleep difficulties. Maintaining a consistent sleep schedule, even on weekends, helps regulate circadian rhythms and improve sleep quality.