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A nurse is caring for a client who is hypotensive following the administration of epidural anesthesia. Which of the following actions should the nurse take?

Massage the client's fundus

Turn the client to a side-lying position

Apply oxygen at 2 L/min via nasal cannula

Assist the client to empty their bladder.

Answer and Explanation

The Correct Answer is B

Rationale:

A. Massaging the client's fundus is not indicated for hypotension following epidural anesthesia.

Fundal massage is typically performed to prevent or manage uterine atony and postpartum hemorrhage.

B. Turning the client to a side-lying position is a recommended intervention for hypotension following epidural anesthesia. This position helps improve venous return to the heart and can help alleviate hypotension by reducing aortocaval compression.

C. Applying oxygen via nasal cannula may be indicated if the client is experiencing respiratory distress, but it is not the primary intervention for hypotension.

D. Assisting the client to empty their bladder may be appropriate to relieve urinary retention but is not the priority intervention for hypotension.

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Correct Answer is A

Explanation

- A: Subconjunctival hemorrhage is generally a benign condition in newborns, often caused by the pressure changes during birth and does not typically require intervention.
- B: Rust-stained urine could indicate urate crystals, which are common in newborns and not usually a concern unless accompanied by other symptoms.
- C: Transient circumoral cyanosis can occur normally in newborns due to immature circulation but should resolve quickly; persistent or severe cases may require further evaluation.
- D: Single palmar creases may be associated with certain genetic conditions and warrant further investigation and reporting to a healthcare provider.

A. Instruct the client that an autopsy should be performed within 24 hr. B. Inform the client that the law requires them to name the fetus. C. Provide the client with photos of the fetus. D. Limit the amount of time the fetus is in the client's room.

Correct Answer is C

Explanation

A. While an autopsy can be an option for determining the cause of stillbirth, it is not a requirement, and the decision should be made by the parents. This statement may add undue pressure on the client.

B. There is no legal requirement for parents to name a stillborn fetus. This can be a sensitive topic, and it is essential to respect the parents' wishes and feelings in this regard.

C. Providing the client with photos of the fetus can help the parents in their grieving process, allowing them to create memories and acknowledge their loss. This action can offer emotional support and validation of their experience.

D. Limiting the time the fetus is in the client's room may not consider the parents' need for closure and the opportunity to say goodbye. Encouraging the family to spend time with their stillborn child can be an important aspect of the grieving process.

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A nurse is caring for a client who is hypotensive following the administration of epidural anesthesia. Which of the following actions should the nurse take?

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