A nurse is caring for a client who is in labor and tested positive for group B streptococcus B- hemolytic. Which of the following actions should the nurse take?

Choice A reason:

The nurse should not remind the client to void every 4 hours because epidural anesthesia can cause temporary loss of bladder sensation, making it difficult for the client to know when to void. Instead, the nurse should use a bladder scanner to assess for urinary retention and encourage the client to void regularly.

Choice B reason:

Encouraging the client to alternate from side to side every 2 hours is not directly related to the administration of epidural anesthesia. This action is commonly advised for clients who are on bed rest to prevent pressure ulcers and promote circulation. However, it is not specifically necessary for the client receiving epidural anesthesia for pain management during labor.

Choice C reason:

Raising the four side rails on the client's bed is not necessary in this situation. The use of side rails should be based on the client's mobility and risk assessment for falls. If the client is receiving epidural anesthesia, they may experience reduced mobility, but the decision to use side rails should be made on an individual basis, not solely based on the anesthesia.

Choice D reason:

Monitoring the client's blood pressure is a crucial action when a client is receiving epidural anesthesia. Epidural anesthesia can cause a drop in blood pressure, leading to hypotension. By regularly monitoring the client's blood pressure, the nurse can detect any significant changes and take appropriate actions to maintain hemodynamic stability.

The fracture does not cross through the bone. Choice A reason:

The statement in Choice A is incorrect because it describes a greenstick fracture as the bone bending and causing a microscopic fracture line. This is not true for a greenstick fracture. A greenstick fracture is an incomplete fracture where the bone bends and partially breaks on one side while remaining intact on the other side. The rationale for this is that pediatric bones are more flexible than adult bones, and when a force is applied, they tend to bend rather than completely break.

Choice B reason:

Choice B is the correct answer. A greenstick fracture does not cross through the bone; it involves only one side of the bone being broken while the other side remains intact. This type of fracture is common in children because their bones are still developing and contain more collagen, making them more flexible and prone to bending rather than breaking completely.

Choice C reason:

The statement in Choice C is incorrect because it describes a different type of fracture. A compressed fracture involves the bone being crushed or shortened, leading to a raised area at the fracture site. This is not characteristic of a greenstick fracture, which involves bending and partial breakage rather than compression.

Choice D reason:

The statement in Choice D is incorrect because it describes a complete fracture that completely divides the bone into two separate pieces. A greenstick fracture, as explained earlier, is an incomplete fracture and does not completely divide the bone.