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Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?
- A. Narcotics
- B. Spinal block
- C. Epidural anesthesia
- D. Breathing and relaxation techniques
Correct Answer: C
Rationale: The correct answer is C: Epidural anesthesia. At 8 cm cervical dilation, the patient is in active labor and close to delivery. Epidural anesthesia is the safest method as it provides effective pain relief without affecting the baby's central nervous system. Narcotics can pass through the placenta and affect the baby's breathing. Spinal block may cause a sudden drop in blood pressure. Breathing and relaxation techniques may not be sufficient at 8 cm dilation. Epidural anesthesia is the most appropriate for pain management in this scenario.
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The laboring person is anxious and hurting. What can the nurse do to help the laboring person?
- A. Offer her an epidural.
- B. Encourage frequent position changes.
- C. Explain that she has to care for two other persons.
- D. Tell them to call someone to come sit with them.
Correct Answer: B
Rationale: The correct answer is B because encouraging frequent position changes can help alleviate discomfort during labor by reducing pressure on certain areas and promoting better circulation. This also helps with the progression of labor. Choice A (Offer her an epidural) may be a valid option, but it should not be the first line of intervention for all laboring individuals. Choice C (Explain that she has to care for two other persons) is irrelevant and may increase anxiety. Choice D (Tell them to call someone to come sit with them) does not address the physical discomfort and is not a direct intervention to support the laboring person.
The method of anesthesia in labor that is considered the safest for the fetus is
- A. epidural block.
- B. pudendal block.
- C. local infiltration.
- D. spinal (subarachnoi
Correct Answer: A
Rationale: The correct answer is A: epidural block. Epidural anesthesia in labor is considered the safest for the fetus because it does not directly affect the baby's central nervous system. It provides effective pain relief for the mother while minimizing the risk of medication passing to the fetus. It also allows for adjustment of the dose as needed during labor.
Summary of why other choices are incorrect:
B: Pudendal block is a regional anesthesia technique that primarily provides pain relief to the perineum and does not affect the fetus directly.
C: Local infiltration anesthesia is limited in its coverage and may not provide adequate pain relief during labor.
D: Spinal (subarachnoid) anesthesia may lead to a rapid and significant drop in blood pressure, affecting fetal oxygenation and require careful monitoring.
The nurse is caring for a patient in the fourth stage of labor. Which assessment findings should the nurse identify as a potential complication? (Select all that apply.)
- A. Soft boggy uterus
- B. Maternal temperature of 37.2°C (99F)
- C. High uterine fundus displaced to the right
- D. Intense vaginal pain unrelieved by analgesics
Correct Answer: A
Rationale: The correct answer is A: Soft boggy uterus. In the fourth stage of labor, the uterus should be firm and well-contracted to prevent postpartum hemorrhage. A soft, boggy uterus indicates uterine atony, a potential complication that can lead to excessive bleeding.
B: Maternal temperature of 37.2°C (99F) is within normal range and not indicative of a complication.
C: High uterine fundus displaced to the right could indicate a full bladder or uterine displacement, but it is not a direct sign of a complication in the fourth stage of labor.
D: Intense vaginal pain unrelieved by analgesics may be due to various reasons but is not a typical complication in the fourth stage of labor.
The nurse is monitoring the person's vital signs after the epidural is placed and notices a blood pressure of 80/50 mm Hg. What nursing intervention can be performed prior to the epidural placement to potentially reduce this side effect?
- 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: Correct Answer: B - IV fluid bolus
Rationale:
1. IV fluid bolus can help increase blood volume and improve blood pressure.
2. Adequate hydration is crucial before epidural placement to prevent hypotension.
3. Other choices are not directly related to improving blood pressure in this scenario.
Summary:
- A: Routine use of ephedrine is not recommended as a routine prophylactic measure.
- C: Insertion of indwelling urinary catheter is important for monitoring urine output but not for improving blood pressure.
- D: Upright positioning may help prevent hypotension after epidural, but it's not a pre-epidural intervention to address low blood pressure.
The nurse is preparing to administer a vaginal prostaglandin preparation to ripen the cervix of her patient. With which patient should the nurse question the use of vaginal prostaglandin as a cervical ripening agent?
- A. The patient who has a Bishop's score of 5
- B. The patient who is at 42 weeks of gestation
- C. The patient who had a previous low transverse cesarean birth
- D. The patient who had previous surgery in the upper uterus
Correct Answer: D
Rationale: The correct answer is D because a patient with previous surgery in the upper uterus is at risk for uterine rupture with prostaglandin use. Previous surgery in the upper uterus may weaken the uterine wall, increasing the risk of complications such as uterine rupture during cervical ripening.
A: Bishop's score of 5 indicates a moderate readiness for induction, making vaginal prostaglandin appropriate.
B: 42 weeks of gestation is considered post-term, where cervical ripening is often needed.
C: Previous low transverse cesarean birth is not a contraindication for prostaglandin use for cervical ripening.