The Nurse Is Caring for a Woman in Labor Who

The nurse is caring for a woman in labor who is given Talwin (pentazocine) . Which of the following actions should the nurse take next?

A) Elevate the side rails and instruct the patient to call before attempting to ambulate.
B) Prepare for the placement of an internal monitoring device.
C) Encourage the client to lie on her right side.
D) Monitor the patient's blood pressure every 15 min.