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: Obtaining an ABG assesses oxygenation in COPD but is not needed before postural drainage, which mobilizes secretions. ABGs are invasive, used for exacerbations. Explaining positions prepares the client, enhancing cooperation for effective mucus clearance, addressing airway obstruction without unnecessary invasive testing.

Choice B reason: Postural drainage uses gravity in five positions (e.g., Trendelenburg, lateral) to drain lung segments in COPD, where mucus obstructs airways. Explaining this reduces anxiety, ensuring cooperation, optimizing secretion clearance to improve ventilation and gas exchange, addressing the pathophysiological need for airway clearance.

Choice C reason: Drainage after meals risks aspiration, as a full stomach increases reflux in positions like Trendelenburg. COPD’s mucus retention obstructs airways, and timing drainage appropriately enhances efficacy. Explaining positions ensures effective procedure execution, avoiding complications like aspiration, making this approach unsafe.

Choice D reason: Shallow, fast breathing is contraindicated in COPD, where deep, slow breaths reduce air trapping and improve alveolar ventilation. Postural drainage clears mucus, and proper breathing enhances efficacy. Explaining positions prepares the client, optimizing outcomes, making this instruction incorrect for effective breathing.

Choice A reason: Comparing vital signs to baseline may show tachycardia from pain-induced sympathetic activation, but this is non-specific, as fever or anxiety can mimic these. Pain is subjective, involving nociceptor signaling, and the client’s direct intensity description provides the most accurate severity measure, guiding targeted treatment.

Choice B reason: Reviewing medical history provides pain context but not current severity. Pain perception involves spinal and cortical nociceptive pathways, and only the client’s description quantifies intensity. Historical data informs diagnosis, but direct assessment is more precise for evaluating present pain, ensuring appropriate analgesic intervention.

Choice C reason: Noting analgesic frequency suggests pain control needs but not current severity. Frequent dosing may indicate tolerance or inadequate relief, not intensity. Pain’s subjective nature, mediated by neural pathways, requires the client’s report to assess severity accurately, guiding dosing over indirect medication usage patterns.

Choice D reason: Asking the client to describe pain intensity directly captures their subjective experience, mediated by nociceptors and cortical perception. Using a 0–10 scale quantifies severity, guiding precise analgesia. This is most effective, as pain is personal, ensuring accurate assessment and tailored treatment to alleviate discomfort effectively.