A nurse is caring for a client who is at 38 weeks of gestation, is in active labor, and has ruptured membranes. Which of the following actions should the nurse take?

Rationale for correct choices:

• Apply oxygen via nasal cannula: The client’s oxygen saturation levels of 87–88% on room air indicate moderate to severe hypoxemia, requiring immediate correction. Since the client has a history of COPD and is post-MI, improving oxygenation is essential to reduce myocardial workload and prevent further ischemia or respiratory distress.
• Initiating a consult for cardiac rehabilitation: Once the client's immediate needs are stabilized, early initiation of cardiac rehabilitation is appropriate. This supports physical recovery, promotes lifestyle changes like smoking cessation and exercise, and reduces future cardiac risk.

Rationale for incorrect choices:

• Administer a second dose of nitroglycerin: The client’s chest pain has resolved following the initial dose, so there is no current indication to give a second dose. Re-administering nitroglycerin unnecessarily can lead to hypotension or reflex tachycardia, especially risky in a post-MI patient.
• Request a prescription for a PRN anxiolytic: The client has already been prescribed alprazolam 0.5 mg three times daily, and their anxiety has improved. Requesting an additional anxiolytic is unnecessary at this point and does not address the more urgent issue of low oxygen saturation.
• Requesting a prescription for a WBC count: There are no signs or symptoms of infection such as fever, chills, or elevated WBC to justify this request. The focus should remain on the client’s cardiopulmonary status and rehabilitation rather than diagnostics that are not clinically indicated.
• Administering a bolus of fluids: There is no clinical indication of fluid volume deficit, hypotension, or dehydration. Administering fluids to a post-MI patient with COPD may lead to fluid overload, pulmonary edema, or increased myocardial strain.

Rationale:

A. Nitroglycerin transdermal patch: This prescription is incomplete because it lacks a dosage strength, application site, frequency, and duration. Without these details, safe administration cannot be ensured.

B. Aspirin 1 tablet daily: The prescription is incomplete as it does not specify the tablet’s strength (e.g., 81 mg or 325 mg). "1 tablet" is ambiguous and can vary based on available formulations.

C. Metoprolol 5 mg IV now: This is a complete prescription it includes the medication name, dose (5 mg), route (IV), and timing ("now"). It gives the nurse all essential information to safely administer the drug.

D. Furosemide 20 mg BID: While the medication, dosage, and frequency are provided, the route is missing. Furosemide can be given orally or intravenously, so this omission makes the prescription incomplete.