A Client in Labor Is Approaching the Transition Stage and Already

Multiple Choice

A client in labor is approaching the transition stage and already has an epidural in place. An additional dose of medication has been prescribed and administered to the client. Which priority intervention should be done by the nurse to help evaluate clinical response to treatment?

A) Obtain a pain scale response from the client based on a 0 to 10 scale.
B) Document maternal blood pressure and fetal heart rates following medication administration and observe for any variations.
C) Document intake and output on the electronic health record (EHR) .
D) Increase the flow rate of prescribed parenteral fluid to maintain hydration.