A nurse is caring for a client who is at 28 weeks of gestation and has received two doses of terbutaline subcutaneously. Which of the following adverse effects is the priority for the nurse to report to the provider?

Choice A rationale Terbutaline is a beta-adrenergic agonist that can cause significant cardiovascular side effects, including tachycardia. A heart rate of 132/min is significantly elevated above the normal range (60-100/min) and indicates a potentially dangerous adverse effect, increasing myocardial oxygen demand and risk of cardiac complications. Choice B rationale Headache is a common side effect of terbutaline due to its vasodilatory effects. While uncomfortable, it is generally not life-threatening and is considered less urgent than significant cardiac or respiratory compromise. Management often involves supportive care and pain relief. Choice C rationale Nasal congestion is a less common and generally benign side effect of terbutaline. It is typically related to generalized vasodilation and does not pose a significant threat to maternal or fetal well-being, thus not being the priority for immediate reporting. Choice D rationale Tremors are a common and expected side effect of terbutaline due to its beta-agonist activity on skeletal muscle. While bothersome, they are typically self-limiting and do not indicate a severe adverse reaction requiring immediate reporting unless they are excessively severe or debilitating.