The nurse is preparing to administer magnesium sulfate to a laboring client whose blood pressure has increased from 110/60 mm Hg to 140/90 mm Hg. Which nursing protocol has the highest priority?

Assess deep tendon reflexes (DTRS) every 4 hours.

Provide a quiet environment with subdued lighting.

Have calcium gluconate immediately available.

Insert an indwelling urinary catheter with a urimeter to monitor hourly output.