A primigravida at 40 weeks gestation is contracting every 2 minutes, and her cervix is 9 cm dilated and 100% effaced. The fetal heart rate is 120 beats/minute. The client is screaming and her husband is alarmed. Which intervention should the nurse implement?

Choice A reason: Excessive levothyroxine causes hyperthyroidism, increasing T3/T4, stimulating beta-adrenergic receptors, leading to palpitations (tachycardia) and shortness of breath from heightened cardiac workload and oxygen demand. These indicate overdose, risking atrial fibrillation, requiring immediate dose adjustment to prevent cardiovascular complications in this thyroid-treated client.

Choice B reason: Lethargy and lack of appetite suggest hypothyroidism, indicating low thyroid hormone levels from insufficient levothyroxine. These are opposite to overdose symptoms like palpitations, driven by excessive metabolism. High doses cause hyperthyroid effects, making this incorrect for identifying excessive dosing in goiter treatment.

Choice C reason: Muscle cramps and dry, flushed skin are not typical of levothyroxine overdose. Hyperthyroidism causes warm, moist skin from increased metabolism, not dryness. Cramps relate to electrolytes. Palpitations and shortness of breath are hallmark overdose signs, reflecting thyroid-driven cardiovascular overstimulation, making this less accurate.

Choice D reason: Bradycardia and constipation indicate hypothyroidism from low thyroid hormones, reducing heart rate and metabolism. This suggests inadequate levothyroxine, not overdose. Excessive doses cause hyperthyroidism, with palpitations and dyspnea from metabolic hyperactivity, making these symptoms incorrect for high-dose levothyroxine effects.

Choice A reason: Administering a PRN narcotic at 9 cm dilation is inappropriate, as labor is in transition, nearing delivery. Narcotics risk fetal respiratory depression, crossing the placenta, especially with a stable fetal heart rate (120 beats/minute). Preparing for imminent delivery is critical, prioritizing a safe birth environment over pain relief.

Choice B reason: Asking the husband to leave does not address the client’s advanced labor (9 cm, 100% effaced, frequent contractions). His presence may provide support, and removal could increase distress. Setting up the delivery table is urgent, as birth is imminent, ensuring a sterile, safe environment for delivery.

Choice C reason: At 9 cm dilation, 100% effacement, and contractions every 2 minutes, the client is in transition, with delivery imminent. Setting up the delivery table ensures readiness for vaginal birth, providing a sterile field and equipment, addressing the physiological progression of labor for safe delivery of the newborn.

Choice D reason: Notifying the rapid response team is unnecessary, as the fetal heart rate (120 beats/minute) is normal (110–160), and screaming reflects labor pain. Delivery is imminent, making table setup the priority to facilitate safe birth, avoiding escalation to emergency response for a normal labor progression.