A nurse is caring for a client who is nulliparous and in the first stage of labor. The last
internal assessment revealed 100% cervical effacement with 5 cm of dilatation. At the end of the last contraction, the nurse observes a large gush of fluid coming out of the client's perineal area. Which of the following is a priority action by the nurse?

A.

A. Hospice care improves quality of life through palliative care - This is a central aspect of hospice care, focusing on pain and symptom management to enhance the patient's comfort and quality of life.

B. Hospice care provides 24-hr, in-home care - While hospice care may provide support, it typically does not offer around-the-clock care in the home.

C. Hospice care is intended to postpone death - Hospice care aims to provide comfort and support in the final stages of life, not to postpone death.

D. Hospice care encourages the family to coordinate health care services - While family

involvement is important, hospice care typically involves a coordinated interdisciplinary team rather than relying solely on family for coordination.

A. Taking the client to the bathroom after a preoperative injection may be unsafe because many preoperative medications can cause sedation or dizziness, increasing the risk of falls.
B. Verification of the surgical site should occur before administration of preoperative medications, as the client may be sedated and unable to participate accurately afterward.
C. Teaching deep breathing and coughing exercises is most effective before sedation, when the client is alert and able to learn and follow instructions.
D. Raising the side rails on the bed is a priority safety measure after administering preoperative sedatives, as it helps prevent falls and injury while the client is drowsy or unsteady.