A nurse is caring for a client who is in labor and is reporting intense pain during contractions. The client has no previous knowledge of nonpharmacological comfort measures. Which of the following nursing interventions should the nurse implement?

Choice A Reason:

Placing the client in a supine position for 30 minutes following the first dose of anesthetic solution is not a standard recommendation. The positioning during epidural placement is typically a seated or side-lying position.

Choice B Reason:

Administering 1,000 mL of dextrose 5% in water prior to the first dose of anesthetic solution is not a standard practice for epidural anesthesi

A. Fluids may be administered, but the type and volume depend on the patient's individual needs and the healthcare provider's orders.

Choice C Reason:

Monitoring the client's blood pressure every minute following the first dose of anesthetic solution is appropriate. Epidural anesthesia can potentially cause hypotension (low blood pressure), which is a common side effect. Therefore, close monitoring of the client's blood pressure is crucial, especially following the administration of the initial dose of the anesthetic solution. The goal is to promptly detect and manage any decrease in blood pressure to ensure the well-being of both the mother and the baby.

Choice D Reason:

Ensuring the client has been NPO (nothing by mouth) for 4 hours prior to the placement of the epidural and the first dose of anesthetic solution is not a specific requirement for epidural anesthesi

A. NPO status is more relevant to surgical procedures involving general anesthesia and is not typically a strict requirement for epidural placement.

The correct answer is B. An excessive amount of amniotic fluid is present.

A. Polyhydramnios is primarily characterized by an increased volume of amniotic fluid, and it is not directly linked to congenital anomalies, growth restriction, or fetal distress. However, it can be associated with certain conditions that affect fetal swallowing or the production of amniotic fluid.

B. Correct. Polyhydramnios refers to an abnormal increase in the amount of amniotic fluid surrounding the fetus. This condition can result from various factors, such as fetal anomalies, maternal diabetes, or gastrointestinal malformations in the fetus that affect the swallowing of amniotic fluid.

C. An elevated level of alpha-fetoprotein (AFP) in the amniotic fluid is associated with neural

tube defects, not polyhydramnios.

D. Carrying more than one fetus (multifetal gestation) can be associated with an increased risk of polyhydramnios due to factors such as increased fetal urine production, but the presence of polyhydramnios does not necessarily indicate a multifetal pregnancy.