A nurse midwife is examining a client who is primigravida at 42 weeks of gestation and states that she believes she is in labor. Which of the following findings confirm to the nurse that the client is in labor?

Choice A rationale
This is incorrect because monitoring vital signs every 5 min is not the priority action. The client's blood pressure is low, indicating hypotension, which is a common complication of epidural anesthesia. Hypotension can compromise the placental blood flow and fetal oxygenation, so the nurse should act quickly to correct it.

Choice B rationale
This is incorrect because elevating the client's legs is not the priority action. Elevating the legs can increase venous return and cardiac output, but it can also worsen the hypotension by pooling blood in the lower extremities. The nurse should lower the head of the bed and place the client in a lateral position to improve blood pressure and fetal perfusion.

Choice C rationale
This is incorrect because notifying the provider is not the priority action. The nurse should first implement interventions to correct the hypotension, such as placing the client in a lateral position, administering oxygen, and increasing IV fluids. The nurse should notify the provider after stabilizing the client's condition or if the interventions are ineffective.

Choice D rationale
This is correct because placing the client in a lateral position is the priority action. This helps to relieve the pressure of the gravid uterus on the inferior vena cava and improve venous return, cardiac output, and blood pressure. It also enhances placental blood flow and fetal oxygenation, which are vital for a successful labor and delivery.

Choice A rationale
Monitoring the fetal heart rate and movement is an important nursing intervention for this client. The client is at risk of fetal distress due to the high blood pressure, the preeclampsia, and the gestational diabetes. The fetal heart rate and movement can indicate the fetal well-being and oxygenation. The nurse should monitor the fetal heart rate continuously and perform a nonstress test or a biophysical profile as indicated.

Choice B rationale
Administering magnesium sulfate as prescribed is an important nursing intervention for this client. The client is at risk of seizures due to the severe preeclampsia. Magnesium sulfate is a medication that prevents and treats seizures in preeclamptic clients. The nurse should administer magnesium sulfate as prescribed and monitor the client's vital signs, reflexes, urine output, and magnesium level.

Choice C rationale
Encouraging the client to drink plenty of fluids is not an important nursing intervention for this client. The client is at risk of fluid overload due to the high blood pressure and the preeclampsia. Fluid overload can cause pulmonary edema, heart failure, and cerebral edema in the client. The nurse should restrict the client's fluid intake and monitor the client's weight, edema, and lung sounds.

Choice D rationale
Educating the client about the signs of preterm labor is not an important nursing intervention for this client. The client is at 34 weeks of gestation, which is close to the term pregnancy. The client is more likely to have a planned delivery or an induction of labor due to the high-risk conditions. The nurse should educate the client about the signs of preeclampsia, such as headache, blurred vision, epigastric pain, and decreased urine output.