Nokea
The nurse is caring for a patient in transition. Which sign is most indicative that this phase of labor is occurring?
- A. Regular contractions every 3 minutes lasting 60 seconds.
- B. Increased bloody show and complaints of pressure.
- C. The urge to push with each contraction.
- D. Cervical dilation of 4 to 5 cm.
Correct Answer: B
Rationale: The correct answer is B because increased bloody show and complaints of pressure are indicative of the transition phase of labor. This phase occurs when the cervix dilates from 8 to 10 cm and contractions are strong and close together. This is a sign that the baby is moving down the birth canal. The other choices are incorrect because A describes the active phase of labor, C indicates the second stage of labor, and D reflects early labor. B is the most appropriate choice as it specifically aligns with the characteristics of the transition phase.
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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.
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.
You are preparing a patient for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.)
- A. Administer a bolus of 500 to 1000 mL of D normal saline prior to catheter placement.
- B. Have ephedrine availableN aUt bR eSdsI idNeG duTrB in. g C caOthM eter placement.
- C. Monitor blood pressure of patient frequently during catheter insertion and for the first 15 minutes of epidural administration.
- D. Insert a Foley catheter prior to epidural catheter placement.
Correct Answer: A
Rationale: The correct answer is A because administering a bolus of 500 to 1000 mL of D5 normal saline prior to catheter placement helps prevent hypotension, a common side effect of epidural anesthesia. This bolus helps maintain adequate fluid volume, which is crucial for hemodynamic stability during the procedure.
Choice B is incorrect because having ephedrine available is not a necessary intervention for preparing a patient for epidural placement.
Choice C is incorrect because while monitoring blood pressure is important during epidural administration, it should be done continuously rather than just for the first 15 minutes.
Choice D is incorrect because inserting a Foley catheter is not a routine intervention for epidural catheter placement and is not directly related to the procedure's success or safety.
A nurse is assisting a laboring patient with breathing techniques to reduce labor pain. Which technique involves exhaling slowly while concentrating on relaxing each muscle group?
- A. Cleansing breaths
- B. Slow-paced breathing
- C. Modified-paced breathing
- D. Effleurage
Correct Answer: B
Rationale: The correct answer is B: Slow-paced breathing. This technique involves exhaling slowly while focusing on relaxing each muscle group, which helps reduce labor pain. Slow-paced breathing promotes relaxation and reduces stress, making it an effective pain management technique during labor. Cleansing breaths (A) focus on deep breathing to clear the mind, not necessarily on muscle relaxation. Modified-paced breathing (C) involves breathing in a controlled pattern but may not specifically target muscle relaxation. Effleurage (D) is a massage technique involving light stroking movements, not breathing techniques for pain management.
Excessive anxiety during labor heightens the patient's sensitivity to pain by increasing
- A. muscle tension.
- B. the pain threshold.
- C. blood flow to the uterus.
- D. rest time between contractions.
Correct Answer: A
Rationale: The correct answer is A: muscle tension. Excessive anxiety can lead to increased muscle tension, which can amplify the perception of pain during labor. Tense muscles can make contractions feel more intense and uncomfortable. Increased anxiety does not directly affect the pain threshold (B), blood flow to the uterus (C), or rest time between contractions (D) in a way that would heighten sensitivity to pain. Thus, choice A is the most appropriate explanation for how anxiety impacts pain perception during labor.