Promoting Client Comfort During Labor and Delivery

Promoting Client Comfort During Labor and Delivery Related

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A labor patient, gravida 2, para 1, at term has received meperidine (Demerol) for pain control during labor. Her most recent dose was 15 minutes ago and birth is now imminent. Maternal vital signs have been stable and the EFM tracing has not shown any baseline changes. Which medication does the nurse anticipate would be required in the birth room for administration?

  • A. Oxytocin (Pitocin)
  • B. Naloxone (Narcan)
  • C. Bromocriptine (Parlodel)
  • D. Oxygen
Correct Answer: B

Rationale: The correct answer is B: Naloxone (Narcan). Meperidine is an opioid analgesic that can cross the placenta and potentially cause respiratory depression in the newborn if given close to delivery. Naloxone is a specific opioid antagonist that can reverse the effects of opioids like meperidine quickly and effectively. Administering naloxone in this scenario can help prevent or reverse neonatal respiratory depression.

Choice A: Oxytocin (Pitocin) is not required in this scenario as it is used to induce or augment labor, not to counter the effects of meperidine.

Choice C: Bromocriptine (Parlodel) is a medication used to suppress lactation and is not indicated in this situation.

Choice D: Oxygen may be needed during delivery for maternal or fetal distress, but it is not the specific medication needed to counter the effects of meperidine in the newborn.

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A patient in active labor is experiencing hypotension after receiving an epidural block. What is the nurse's first action?

  • A. Administer a fluid bolus as prescribed.
  • B. Elevate the patient's legs.
  • C. Place the patient in a side-lying position.
  • D. Notify the anesthesiologist immediately.
Correct Answer: C

Rationale: The correct answer is C. Placing the patient in a side-lying position is the first action because it helps to improve venous return, cardiac output, and blood pressure by increasing blood flow to the heart and brain. This can help alleviate hypotension associated with epidural block. Elevating the legs (choice B) may not be as effective in improving blood flow in this situation. Administering a fluid bolus (choice A) may be necessary but should not be the initial action. Notifying the anesthesiologist (choice D) is important, but addressing the patient's immediate physiological needs should come first.

The labor nurse is developing a plan of care for a patient admitted in active labor with

  • A. On admission, vital signs were as follows: maternal heart rate (HR) 92 bpm; fetal rate (FHR) baseline, 150 to 160 bpm; blood pressure, 124/76 mm Hg; temperature 37.2° C (99° F). What is the priority nursing action for this patient?
  • B. Fetal acoustic stimulation
  • C. Assess temperature everyN 2 hRourIs G
  • D. Change absorption pads under her hips every 2 hours
Correct Answer: A

Rationale: The correct answer is A: On admission, vital signs were as follows: maternal heart rate (HR) 92 bpm; fetal rate (FHR) baseline, 150 to 160 bpm; blood pressure, 124/76 mm Hg; temperature 37.2° C (99° F). The priority nursing action for this patient is to assess the vital signs. The maternal heart rate, fetal heart rate, blood pressure, and temperature are crucial indicators of the patient's and the fetus's well-being during labor. Monitoring these vital signs helps the nurse detect any abnormalities or signs of distress promptly, allowing for timely intervention.

Choice B, fetal acoustic stimulation, is not the priority at this stage as there are no indications in the question stem that suggest the need for this intervention. Choice C, assessing temperature every 2 hours, is not the priority as the patient's temperature is within normal range on admission. Choice D, changing absorption pads under her hips every 2 hours,

What nursing intervention can be performed prior to epidural placement to potentially reduce a blood pressure drop?

  • A. routine use of ephedrine
  • B. IV fluid bolus
  • C. insertion of indwelling urinary catheter
  • D. upright positioning of the laboring person
Correct Answer: B

Rationale: The correct answer is B: IV fluid bolus. Prior to epidural placement, administering an IV fluid bolus can help prevent a drop in blood pressure by increasing preload and maintaining cardiac output. This helps offset the vasodilation effects of the epidural anesthesia. Options A, C, and D are incorrect. Ephedrine (A) is not routinely used before epidural placement due to its potential adverse effects. Insertion of a urinary catheter (C) is not directly related to preventing a blood pressure drop. Upright positioning (D) may actually worsen hypotension by pooling blood in the lower extremities.

Nausea and vomiting are common discomforts in labor. When treating with promethazine, what must the nurse do when administering this medication?

  • A. Administer subcutaneously.
  • B. Never administer with an opioid.
  • C. Dilute before IV administration.
  • D. Never administer in first stage labor.
Correct Answer: C

Rationale: The correct answer is C: Dilute before IV administration. Promethazine is a vesicant and can cause tissue damage if not properly diluted before IV administration. Diluting the medication helps reduce the risk of phlebitis and tissue irritation. Administering it subcutaneously (A) can cause pain and irritation at the injection site. Administering with an opioid (B) can increase the risk of respiratory depression. Administering promethazine in first stage labor (D) is generally safe, but diluting before IV administration is still necessary to prevent adverse effects.

Which clinical finding would be an indication to the nurse that the fetus may be compromised?

  • A. Active fetal movements
  • B. Fetal heart rate in the 140s
  • C. Contractions lasting 90 seconds
  • D. Meconium-stained amniotic fluid
Correct Answer: D

Rationale: The correct answer is D. Meconium-stained amniotic fluid indicates fetal distress due to possible hypoxia. Meconium in the fluid can lead to meconium aspiration syndrome, a serious condition. The other choices are incorrect because active fetal movements (A) and a fetal heart rate in the 140s (B) are normal signs of fetal well-being. Contractions lasting 90 seconds (C) could indicate labor progress but do not necessarily indicate fetal compromise.

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