A client asks when she can receive an epidural. Which of the following is the best response?
Only at 6cm dilation
Upon request
Only during transition
After delivery
The Correct Answer is B
Epidural analgesia is a versatile regional anesthetic technique used to provide continuous pain relief throughout labor. Modern clinical guidelines emphasize that the timing of administration should be individualized based on maternal perception of pain intensity. There is no evidence that early administration increases the risk of cesarean delivery.
A. Only at 6cm dilation: Waiting for a specific cervical measurement is an outdated practice that can lead to unnecessary suffering. Pain is subjective, and significant distress can occur well before the active phase of labor. Analgesia can be safely initiated regardless of the centimeter count.
B. Upon request: The current standard of care is to provide pain management whenever the laboring patient finds the intensity intolerable. As long as there are no contraindications and the patient is in established labor, the epidural can be placed. This prioritizes maternal autonomy and comfort.
C. Only during transition: Transition is the most intense phase of labor, but placing an epidural at this late stage may not provide relief in time for the expulsive phase. It is often technically difficult to place the catheter while the patient is experiencing frequent contractions. Earlier placement is generally preferred.
D. After delivery: An epidural is used primarily to manage the nociceptive signals of uterine contractions and cervical stretching during labor. While it can be used for postpartum repair, its primary purpose is intrapartum analgesia. Suggesting it only after delivery ignores the patient's need for pain control.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","E"]
Explanation
Chorionic Villus Sampling (CVS) is a diagnostic procedure performed between 10 and 13 weeks to detect chromosomal abnormalities. It involves aspirating a small sample of placental tissue either transcervically or transabdominally. While providing early results, it carries a slightly higher risk profile than mid-trimester amniocentesis.
A. Bleeding: The insertion of a catheter or needle into the developing placenta can cause subchorionic or vaginal bleeding. Most post-procedure bleeding is minor, but it must be monitored to ensure it does not lead to pregnancy loss. This risk is inherent to invasive sampling techniques.
B. Infection: Any procedure that bypasses the natural protective barriers of the cervix or skin can introduce bacteria into the uterine cavity. Chorioamnionitis is a rare but serious complication that can jeopardize both the pregnancy and maternal health. Strict aseptic technique is required during the procedure.
C. Fetal anemia: This is not a typical risk associated with CVS, as the sample is taken from the placenta rather than the fetal circulation. Fetal anemia is a more common risk of percutaneous umbilical blood sampling (PUBS). CVS focuses on genetic material within the trophoblastic cells.
D. Hypertension: The CVS procedure does not cause systemic maternal hypertension or preeclampsia. While a client may experience transient stress-induced tachycardia, there is no physiological link between placental tissue sampling and the development of gestational hypertension. It does not alter blood pressure.
E. Miscarriage: CVS carries an estimated procedure-related pregnancy loss risk of approximately 0.2% to 1.0%. The mechanical disruption of the gestational environment or subsequent infection can trigger spontaneous abortion. Counseling must include this risk to ensure informed consent by the client.
Correct Answer is D
Explanation
The Papanicolaou (Pap) test involves a cytological evaluation of cells collected from the transformation zone of the cervix. This procedure identifies cervical dysplasia or cellular atypia caused by persistent high-risk Human Papillomavirus (HPV) infection. Early detection of precancerous lesions, such as cervical intraepithelial neoplasia, allows for curative intervention before malignancy develops.
A. "It measures hormones.": Hormonal assays for estrogen or progesterone are typically performed via serum blood tests or specific endometrial biopsies rather than a Pap smear. A cytological smear focuses on cellular morphology rather than endocrine concentrations. It cannot diagnose menopause or other hormonal imbalances.
B. "It detects pregnancy.": Pregnancy is diagnosed by measuring human chorionic gonadotropin levels in urine or blood, or through ultrasonography. While hormonal changes of pregnancy can affect the appearance of cervical cells, a Pap smear is not a diagnostic tool for gestation. It has no role in obstetric confirmation.
C. "It checks ovulation.": Ovulation is monitored using basal body temperature charts, urinary luteinizing hormone kits, or follicular ultrasound. Cervical mucus changes can provide clues to fertility, but the laboratory analysis of a Pap smear is designed to identify malignant transformations. It does not track the ovulatory cycle.
D. "It screens for cervical cancer.": The primary clinical utility is the identification of squamous cell carcinoma or its precursors. By scraping the ectocervix and endocervix, clinicians can detect abnormal cells early. Regular screening significantly reduces maternal mortality associated with invasive cervical malignancies.
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