A primigravida client at 36-weeks gestation is admitted to the labor and delivery unit because her membranes ruptured 30 minutes ago. Initial assessment indicates a 2 cm cervical dilatation, 50% effaced, -2 station, vertex presentation, greenish-colored amniotic fluid, and contractions occurring every 3 to 5 minutes, with a decrease in fetal heart rate after the last four contraction peaks. Which action should the nurse implement first?

- Decreased hemoglobin and hematocrit levels: Consistent with iron deficiency anemia, vitamin B12 deficient anemia, and folic acid deficient anemia. Iron deficiency anemia results from
inadequate iron stores, while vitamin B12 deficient anemia and folic acid deficient anemia are characterized by inadequate levels of these respective vitamins, all of which contribute to decreased hemoglobin and hematocrit levels.
- Uptake often impeded by medications: Consistent with iron deficiency anemia and vitamin B12 deficient anemia. Iron absorption can be affected by certain medications, such as proton pump
inhibitors or antacids, which can hinder iron uptake. Vitamin B12 deficiency can result from medications that interfere with its absorption, such as proton pump inhibitors or metformin.

- Often associated with chronic alcoholism: Consistent with vitamin B12 deficient anemia. Chronic alcoholism can lead to vitamin B12 deficiency due to poor dietary intake,
malabsorption, or liver dysfunction associated with excessive alcohol consumption.

- Can be caused by malabsorption syndrome: Consistent with vitamin B12 deficient anemia and folic acid deficient anemia. Malabsorption syndromes, such as celiac disease or Crohn's disease, can impair the absorption of both vitamin B12 and folic acid from the gastrointestinal tract,
leading to deficiencies.

- Result of dietary deficiency: Consistent with iron deficiency anemia, vitamin B12 deficient anemia, and folic acid deficient anemia. Iron deficiency anemia results from inadequate dietary intake of iron-rich foods, while vitamin B12 deficient anemia and folic acid deficient anemia stem from insufficient dietary intake of foods rich in these respective vitamins.

A. Gained 10 lb (4.5 kg) within one month. Weight gain is not typically associated with the onset of type 1 diabetes. In fact, weight loss is more common due to the body's inability to use glucose properly.
B. Drinks more fluids than previously. Increased thirst (polydipsia) is a classic symptom of type 1 diabetes due to high blood sugar levels causing dehydration.
C. Voids only one or two times per day. Increased urination (polyuria) is a common symptom of type 1 diabetes as the body attempts to excrete excess glucose, so decreased urination is unlikely.
D. Refuses to eat favorite meals at home. While changes in appetite can occur, it is not a primary symptom of type 1 diabetes. Increased hunger (polyphagia) is more typical.