A peripheral IV (PIV) is started in the left hand with a 20-gauge catheter. Lab specimens are drawn. IV fluids of lactated Ringer's started infusing at 75 mL/hour. Contractions are now every 4 minutes, lasting 45 seconds. Mother says they are getting more painful. She and her husband are instructed on slow breathing and relaxation techniques. Husband will assist with her breathing. Client is instructed she can have pain medication if she needs it until time for epidural. A client is in the active phase of the first stage of labor. She is 5 cm dilated, 90% effaced, and at 0 station. Her contractions are every 4 minutes, and she reports increasing pain. Which of the following actions or clinical developments should the nurse anticipate next?

Choice A rationale The scenario indicates that the client's contractions are increasing in frequency and intensity, and she reports significant pain, prompting a request for an epidural. The cervical exam shows she is 5 cm dilated and 90% effaced, with the baby at 0 station, which is typical for the active phase of labor. This is the appropriate time for an epidural, as pain management is often needed when contractions become more intense and dilation progresses. Clear amniotic fluid after artificial rupture of membranes also suggests no immediate complications. Choice B rationale Immediate cesarean section is generally reserved for situations of fetal distress or other obstetric emergencies. There is no mention of fetal heart rate abnormalities or other signs of distress in the scenario. While MS can complicate pregnancy, it does not automatically necessitate a cesarean section without specific indications. The decision for cesarean should be based on maternal or fetal indications not present in this case. Choice C rationale The instruction to start pushing is only appropriate during the second stage of labor when the cervix is fully dilated (10 cm). The client is 5 cm dilated, indicating she is still in the active phase of the first stage of labor. Encouraging pushing at this stage would be premature and could cause unnecessary exhaustion and potential harm to the cervix and fetus. Pushing is typically reserved for the final stage when the baby's head is crowning. Choice D rationale Administering an epidural and experiencing immediate pain relief aligns with the standard protocol for labor analgesia when requested by the client. Epidural anesthesia is a common and effective method for pain management during labor. This option respects the client's expressed need for pain relief and involves the healthcare provider in safely administering the epidural. Immediate relief from pain can help the client focus on labor progression and reduce stress.