When caring for a client with cardiovascular disease during labor, the nurse should limit the client's efforts to:

In the context of caring for a client with cardiovascular disease during labor, it is important to limit intense physical exertion that can exacerbate the client's condition. The act of bearing down, which is a strong and forceful action often associated with the second stage of labor, significantly increases intrathoracic pressure. This increased pressure can compromise venous return to the heart and lead to reduced cardiac output, potentially causing distress to a client with cardiovascular issues.

By limiting this effort, the nurse helps to minimize the risk of complications that could arise from excessive strain on the heart.

While pushing during contractions and moving in bed are also physical efforts that might need to be managed, bearing down is specifically a more vigorous and sustained action that poses a greater risk to the cardiovascular system. Speaking, on the other hand, usually does not impose a significant strain and can often be permitted as it does not create the same physiological stress as the physical exertion of bearing down.