A nurse is caring for a client who is dilated to 10 cm and pushing. Which of the following pain-management measures should the nurse identify as a safe option for the client?

Rationale: A. Pudendal block: A pudendal block is a safe and effective pain management option for a client who is fully dilated and pushing during the second stage of labor. It provides local anesthesia to the perineal area, reducing pain associated with delivery and episiotomy without affecting uterine contractions or the fetus. B. Naloxone hydrochloride: Naloxone is not a pain medication; it is an opioid antagonist used to reverse the effects of opioid-induced respiratory depression. Administering naloxone at this stage would not relieve labor pain and is inappropriate unless needed for opioid reversal. C. Spinal anesthesia: Spinal anesthesia is typically administered before the second stage of labor, such as for a cesarean birth. Administering it when the client is fully dilated and pushing could delay delivery and increase the risk of complications from sudden hemodynamic changes. D. Butorphanol tartrate: Butorphanol is an opioid agonist-antagonist analgesic that can cause respiratory depression in the newborn if given too close to delivery. Since the client is already in the pushing stage, administering this medication poses a risk to the fetus and is therefore unsafe.