The nurse is caring for a client that is Gravida 2 Para 1 admitted at 4-5 cm cervical dilation and is requesting pain medication.
Which of the following is the most appropriate method of pain management at this time:

The correct answer is Choice D, Choice F

Choice A rationale: Gestational age of 39 weeks and 2 days falls within the normal term range, which spans from 37 weeks to 41 weeks and 6 days. At this stage, fetal lung maturity is typically achieved, and labor is considered appropriate. There is no pathological implication associated with this gestational age, and it does not warrant provider notification unless accompanied by abnormal findings. Therefore, this parameter is physiologically expected and not concerning in isolation.

Choice B rationale: Cervical dilation of 8 cm with 100% effacement and fetal station +1 indicates the transition phase of labor, which is a normal progression during active labor. Station +1 means the fetal presenting part is descending into the birth canal, and full effacement reflects readiness for delivery. These findings are expected and do not represent a deviation from normal labor physiology. No pathological signs are present, so provider notification is not immediately required.

Choice C rationale: Contractions every 2 minutes lasting 90 seconds with strong intensity are common during the late active or transition phase of labor. This pattern reflects adequate uterine activity for cervical change and fetal descent. While frequent, this contraction pattern is not abnormal unless accompanied by signs of fetal distress or uterine hyperstimulation. In isolation, it does not necessitate provider contact unless additional concerning signs are present.

Choice D rationale: A blood pressure of 162/108 mmHg exceeds the diagnostic threshold for severe hypertension in pregnancy, which is ≥160 systolic or ≥110 diastolic. This level raises concern for preeclampsia or eclampsia, especially if accompanied by proteinuria, headache, or visual disturbances. Normal pregnancy blood pressure should remain below 140/90 mmHg. Immediate provider notification is warranted due to risk of maternal and fetal complications including placental abruption and stroke.

Choice E rationale: A pain rating of 7 out of 10 during active labor is expected and reflects the intensity of uterine contractions and cervical dilation. Pain perception varies, but this level is not considered abnormal or indicative of pathology. Pain management should be addressed per patient preference, but it does not require urgent provider notification unless pain is unrelieved or associated with other concerning symptoms.

Choice F rationale: A fetal heart rate of 170 beats per minute exceeds the normal range of 110 to 160 bpm and is classified as fetal tachycardia. Minimal variability further suggests compromised autonomic regulation, possibly due to hypoxia, infection, or maternal fever. Variability is a key indicator of fetal well-being, and minimal variability (<5 bpm) is concerning. These findings warrant immediate provider notification to assess fetal status and intervene if necessary.

Choice A rationale

Reducing carbohydrate intake is part of dietary management in gestational diabetes.

Choice B rationale

Women with gestational diabetes have an increased risk of developing type 2 diabetes later in life.

Choice C rationale

Increasing exercise is beneficial for managing blood sugar levels in gestational diabetes.

Choice D rationale

Glyburide is not typically the first-line treatment for gestational diabetes; insulin is often recommended for better control.