A nurse assists with epidural placement. What position should a client be in for epidural placement
Supine
Prone
Sitting or lateral
Standing
The Correct Answer is C
Epidural anesthesia requires access to the epidural space between the ligamentum flavum and the dura mater. Proper positioning maximizes the intervertebral space by flexing the lumbar spine, allowing for easier needle insertion. This prevents accidental dural puncture or vascular cannulation during the procedure.
A. Supine: Placing a pregnant client flat on her back causes aortocaval compression by the heavy uterus, leading to maternal hypotension and fetal distress. Furthermore, the supine position makes it anatomically impossible for the anesthetist to access the vertebral column for needle placement.
B. Prone: Lying on the abdomen is physically impossible and dangerous for a client in late gestation. The prone position would exert lethal pressure on the gravid uterus and the fetus. It provides no clinical benefit for accessing the spinal canal in an obstetric setting.
C. Sitting or lateral: These positions allow the client to arch their back like a "mad cat," which widens the spinous processes. The sitting position is often preferred for better midline identification, while the lateral decubitus position is used for clients who cannot sit upright. Both facilitate catheter insertion.
D. Standing: A standing position is unstable and unsafe for a client receiving regional anesthesia, as they may experience a vasovagal response or sudden leg weakness. Maintaining the strict stillness required for spinal needle placement is impossible while standing. It is never used for this procedure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
The postictal phase following an eclamptic seizure requires immediate stabilization to prevent aspiration pneumonia and monitor for fetal hypoxia. Nursing care focuses on restoring maternal oxygenation and preventing seizure recurrence via pharmacological intervention. Continuous assessment of uterine activity is vital to rule out placental abruption triggered by the convulsion.
A. Administer oxygen: Seizure activity causes maternal apnea and increased metabolic demand, leading to significant hemoglobin desaturation. Providing supplemental oxygen via a non-rebreather mask ensures maximal oxygen delivery to both the mother and the placental unit. This mitigates the risk of fetal acidemia following the event.
B. Prepare magnesium sulfate: This is the primary medication used to prevent further seizures by depressing the central nervous system and blocking neuromuscular transmission. It is superior to traditional anticonvulsants in the management of eclampsia. Careful monitoring for magnesium toxicity, including loss of patellar reflexes, is required.
C. Leave client alone: This action is dangerous and negligent, as the client remains at high risk for airway obstruction, vomiting, or recurrent seizures during the postictal state. Constant bedside presence is required to ensure safety. The nurse must maintain a protective environment and monitor vital signs closely.
D. Maintain airway: Placing the client in a lateral recumbent position prevents the tongue from obstructing the glottis and facilitates the drainage of secretions. Suctioning the oropharynx may be necessary to prevent aspiration of saliva or gastric contents. Maintaining a patent airway is the absolute priority intervention post-seizure.
E. Monitor fetal status: Eclamptic seizures can trigger fetal bradycardia or late decelerations due to uterine artery vasospasm and maternal hypoxia. Continuous electronic fetal monitoring is essential to assess for recovery or signs of distress. It also helps detect concealed abruption evidenced by increased uterine resting tone.
Correct Answer is D
Explanation
Crowning occurs during the second stage of labor when the widest diameter of the fetal head stretches the vulvar ring. It signifies that delivery is imminent and the head no longer recedes between contractions. This stage requires the nurse to support the perineal body to minimize maternal tissue trauma.
A. Shoulder delivery: This occurs after the head has been born and the fetus undergoes external rotation to align the shoulders with the pelvic outlet. Crowning specifically refers to the cephalic portion of the fetus. Shoulder delivery is a subsequent step in the mechanism of labor.
B. Full dilation: While crowning only happens after the cervix is 10 centimeters dilated, the term "crowning" refers to a visible physical landmark rather than a cervical measurement. Full dilation is the start of the second stage, whereas crowning occurs at its conclusion.
C. Placenta delivery: The expulsion of the placenta is the defining event of the third stage of labor. Crowing is a second-stage phenomenon involving the fetus. Placental delivery follows the birth of the neonate and involves uterine contraction to shear the placenta from the wall.
D. Fetal head visible: Crowning is precisely defined as the point when the fetal scalp remains visible at the vaginal opening even after a contraction has subsided. It indicates that the pelvic floor is fully distended. This is the final stage before the expulsion of the fetal head.
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