A nurse is teaching a client who has a new prescription for a metered-dose inhaler. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)

A. Hypotension (low blood pressure) is a common side effect of epidural anesthesia due to the vasodilatory effects of the local anesthetic. It can lead to decreased perfusion to vital organs and compromise fetal oxygenation. Hypotension is a critical finding because it can affect both the mother and the fetus. In severe cases, hypotension can lead to maternal dizziness, nausea, vomiting, decreased

uteroplacental perfusion, and fetal distress. Prompt intervention such as administering IV fluids and positioning the client to improve venous return is necessary to stabilize blood pressure and prevent adverse outcomes.

B. Leg weakness can occur as a result of epidural anesthesia affecting the lower extremities. It is typically a transient and expected side effect. While leg weakness can impact the client's comfort and mobility, it is not as immediately concerning as hypotension in terms of potential complications for both the mother and the fetus.

C. Urinary retention is a common side effect of epidural anesthesia but is generally managed by monitoring and, if necessary, catheterization. While it requires attention, it is not typically considered a higher priority compared to hypotension.

D. An elevated temperature can indicate infection or a systemic inflammatory response, which may require investigation and treatment. While an elevated temperature is concerning and warrants further assessment to determine its cause, it is not typically the highest priority compared to managing hypotension, which can have more immediate and significant effects on both the mother and the fetus.

C. Crackles in the lungs can indicate fluid accumulation, such as pulmonary edema or pneumonia. Morphine can exacerbate respiratory conditions by depressing the respiratory drive and increasing the risk of respiratory complications. Crackles in the lungs suggest potential pulmonary issues that may compromise respiratory function. The nurse should withhold morphine and contact the provider to assess the client's respiratory status and determine if further evaluation or treatment is needed before administering morphine.

A. Urinary retention is a potential side effect of morphine. However, it is not typically a reason to withhold morphine unless it is severe or accompanied by other concerning symptoms. The nurse should monitor urinary output and consider interventions to alleviate retention if necessary, but it may not require withholding morphine alone.

B. A respiratory rate of 16 breaths per minute is within the normal range for adults. However, the nurse should assess for any signs of respiratory distress, such as shallow breathing or decreased respiratory effort, which could indicate impending respiratory depression. If there are concerns about potential respiratory depression, the nurse should withhold morphine and notify the provider for further assessment.

D. Morphine can cause bradycardia as a side effect by depressing the cardiovascular system. A heart rate of 68 beats per minute is within the normal range for adults. However, the nurse should consider the client's baseline heart rate and any signs of hemodynamic instability. If the client shows signs of significant bradycardia or other concerning cardiovascular symptoms, withholding morphine and contacting the provider for further evaluation would be appropriate.