A laboring client has just received an epidural.

Ten minutes after the epidural placement, the client begins to feel dizzy and lightheaded and the BP is 92/54. What should be the nurse’s first response?

Perform a vaginal examination.

Turn the client onto her side.

Catheterize the client.

Decrease the IV fluid rate.

Answer and Explanation

The Correct Answer is B

Choice A rationale:

Performing a vaginal exam is not the priority intervention for a client experiencing hypotension after an epidural. While a vaginal exam may be necessary to assess cervical dilation and fetal station, it does not address the underlying cause of the client's hypotension.

Additionally, a vaginal exam could potentially worsen the client's hypotension by stimulating the vagus nerve, which can lead to decreased heart rate and blood pressure.

Therefore, it is not the most appropriate initial response in this situation.

Choice B rationale:

Turning the client onto her side is the most appropriate initial response to hypotension after an epidural. This position helps to increase venous return to the heart, which can improve cardiac output and blood pressure.

It also helps to prevent aortocaval compression, which can occur when the pregnant uterus compresses the inferior vena cava, reducing blood flow back to the heart.

By turning the client onto her side, the nurse can quickly and easily address the underlying cause of the hypotension and help to improve the client's hemodynamic status.

Choice C rationale:

Catheterizing the client may be necessary if the client is unable to void spontaneously, but it is not the priority intervention for hypotension after an epidural.

Urinary retention can occur after an epidural, but it is not typically the cause of hypotension in this setting.

Therefore, catheterization would not be the most appropriate initial response.

Choice D rationale:

Decreasing the IV fluid rate may be necessary if the client is experiencing fluid overload, but it is not the priority intervention for hypotension after an epidural.

In fact, decreasing the IV fluid rate could potentially worsen the hypotension by reducing the circulating blood volume.

Therefore, it is not the most appropriate initial response.

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Correct Answer is C

Explanation

Choice A rationale:

Incorrect. This statement describes autosomal dominant inheritance, not autosomal recessive inheritance. In autosomal dominant inheritance, only one copy of the abnormal gene is needed to cause the disorder. However, in autosomal recessive inheritance, both copies of the gene must be abnormal for the disorder to be expressed.

Choice B rationale:

Incorrect. This statement describes X-linked recessive inheritance, not autosomal recessive inheritance. In X-linked recessive inheritance, the abnormal gene is located on the X chromosome. Males have only one X chromosome, so if they inherit the abnormal gene, they will have the disorder. Females have two X chromosomes, so they must inherit two copies of the abnormal gene (one from each parent) to have the disorder.

Choice C rationale:

Correct. This statement accurately describes autosomal recessive inheritance. In autosomal recessive inheritance, both copies of the gene must be abnormal for the disorder to be expressed. This means that both parents must be carriers of the abnormal gene in order for their child to have the disorder.

Choice D rationale:

Incorrect. This statement is partially correct, but it does not fully describe autosomal recessive inheritance. The disorder can occur in both males and females, but it is not limited to heterozygous females. Homozygous females (those who have two copies of the abnormal gene) will also have the disorder.

A. Prostaglandins B. Episiotomy C. None of the answers are correct D. Amnioinfusion

Correct Answer is ["A","D"]

Explanation

Choice A rationale:

Prostaglandins:

Mechanism of action: Prostaglandins are hormone-like substances that play a crucial role in labor initiation. They act by softening and ripening the cervix, stimulating uterine contractions, and rupturing the amniotic sac.

Types: Prostaglandins used for labor induction include:

Dinoprostone (Cervidil, Prepidil): Inserted into the vagina as a gel or pessary.

Misoprostol (Cytotec): Administered orally or vaginally.

Effectiveness: Generally effective in initiating labor within 24 hours, with success rates ranging from 60-85%.

Advantages:

Can be used when the cervix is unfavorable (not ripe).

Can be administered in a variety of ways to suit the patient's preferences.

May have a lower risk of uterine hyperstimulation compared to oxytocin.

Disadvantages:

Can cause side effects such as nausea, vomiting, diarrhea, and fever.

May increase the risk of uterine rupture, especially in women with a history of cesarean delivery.

Choice D rationale:

Amnioinfusion:

Procedure: Involves the infusion of sterile saline solution into the amniotic sac through a small catheter.

Mechanism of action: Not fully understood, but it's thought to work by:

Increasing amniotic fluid volume, which can help to stimulate contractions.

Stretching the uterine walls, which may trigger the release of prostaglandins.

Reducing pressure on the umbilical cord, which can improve fetal oxygenation.

Effectiveness: Usually used in conjunction with other induction methods, such as oxytocin or prostaglandins. Has a success rate of about 50-60% in initiating labor within 24 hours.

Advantages:

May be helpful in cases of low amniotic fluid (oligohydramnios).

Can decrease the risk of umbilical cord compression.

Disadvantages:

Requires the insertion of a catheter into the uterus, which carries a small risk of infection.

May cause discomfort for the mother.

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A laboring client has just received an epidural. Ten minutes after the epidural placement, the client begins to feel dizzy and lightheaded and the BP is 92/54. What should be the nurse’s first response?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When assessing the knowledge of new parents of a child born with Maple Syrup Urine Disease (MSUD), an autosomal recessive inherited disorder, which statement is true?

Correct Answer is C

Explanation

In addition to oxytocin (Pitocin) administration, what other methods can induce labor?

Correct Answer is ["A","D"]

Explanation

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A laboring client has just received an epidural.

Ten minutes after the epidural placement, the client begins to feel dizzy and lightheaded and the BP is 92/54. What should be the nurse’s first response?