A nurse is discussing the components of the working phase of the nurse-client relationship with a client. Which of the following tasks are specific for this stage to create a therapeutic environment?

• Administer betamethasone: Betamethasone is administered to pregnant clients at risk of preterm delivery to promote fetal lung maturity. Given the client's gestational age of 31 weeks and signs of severe preeclampsia, administering corticosteroids is critical to prepare for potential early delivery.
• Monitor intake and output every hour: Severe preeclampsia can impair renal function, leading to decreased urine output and worsening fluid retention. Hourly monitoring of intake and output helps detect early signs of renal compromise and fluid overload, both of which require immediate intervention.
• Assist RN with performing a vaginal examination every 12 hr: Vaginal examinations are avoided in cases of severe preeclampsia unless absolutely necessary because they can stimulate uterine contractions or introduce infection. Therefore, routinely assisting every 12 hours with vaginal exams is not appropriate in this client's plan of care.
• Obtain a 24-hr urine specimen: A 24-hour urine collection assesses the degree of proteinuria and provides a clearer diagnostic picture of the severity of preeclampsia. Quantifying protein excretion helps guide clinical management and decisions about timing of delivery.
• Provide a low-stimulation environment: A calm, quiet environment minimizes the risk of seizure activity in clients with severe preeclampsia. Reducing auditory, visual, and environmental stimulation is a standard preventative measure to decrease neurological irritability.
• Give antihypertensive medication: Severe hypertension must be promptly treated to prevent complications like stroke, placental abruption, and progression to eclampsia. Administering antihypertensive therapy helps stabilize maternal blood pressure and protects both maternal and fetal health.
• Maintain bedrest: Bedrest helps reduce blood pressure and physical stress, promoting better perfusion to the placenta. Although strict bedrest is controversial long-term, short-term bedrest is often used in severe preeclampsia management while stabilization measures are implemented.

A. "I will take my inhaler treatment before each meal and at bedtime.": Budesonide is a corticosteroid used for long-term control of asthma, not for timing around meals. It is usually taken at set times daily to maintain airway inflammation control, not specifically related to mealtimes or bedtime alone.

B. "I should use my inhaler before exercising.": Using an inhaler before exercise is a strategy typically applied to short-acting bronchodilators like albuterol to prevent exercise-induced bronchospasm. Budesonide is a maintenance medication and is not intended for pre-exercise use.

C. "I should use my inhaler when I have an asthma attack.": Budesonide is not a rescue inhaler and should not be used during an acute asthma attack. Quick-relief inhalers like albuterol are used for immediate symptom management during asthma exacerbations.

D. "I will rinse my mouth and gargle with water after each inhaler treatment.": Rinsing the mouth after using an inhaled corticosteroid like budesonide is important to prevent oral thrush (candidiasis). This action demonstrates correct understanding of medication use and necessary precautions.