A nurse is caring for a client who is receiving an epidural for continuous labor analgesia.
Which of the following findings should indicate to the nurse that the treatment is effective?
The client reports slight pressure with contractions.
The client has bladder distention.
The client's systolic blood pressure decreases by 20 mm Hg.
The client is unable to move their legs or feet.
The Correct Answer is A
Choice A rationale
The primary goal of epidural analgesia is to provide effective pain relief while allowing the client to maintain some sensation, particularly pressure, which indicates the epidural is blocking nociceptive pain signals effectively without completely eliminating proprioceptive awareness. This selective blockade allows the client to feel contractions, facilitating pushing efforts, while minimizing pain perception by blocking transmission of pain impulses via spinal nerves.
Choice B rationale
Bladder distention is a common side effect of epidural analgesia, resulting from the blockade of parasympathetic nerve fibers innervating the bladder, which can impair the micturition reflex. While it indicates the epidural's systemic effect, it is an adverse effect requiring intervention, such as catheterization, rather than a direct indicator of effective pain management.
Choice C rationale
A decrease in systolic blood pressure by 20 mm Hg, or more, is a common adverse effect of epidural analgesia, caused by sympathetic blockade, leading to vasodilation and subsequent peripheral pooling of blood. While it demonstrates the systemic absorption and action of the anesthetic, it signifies a complication requiring management, not an indicator of effective pain relief for labor.
Choice D rationale
Inability to move legs or feet suggests a dense motor blockade, which can occur with epidural analgesia but is not the desired outcome for labor. While a degree of motor weakness may be present, complete motor paralysis can hinder effective pushing during the second stage of labor and is usually avoided to allow for maternal participation in the birth process.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Step 1 is to determine the number of days from April 1 to December 26. Days in April = 30 - 1 + 1 = 30 days. Days in May = 31 days. Days in June = 30 days. Days in July = 31 days. Days in August = 31 days. Days in September = 30 days. Days in October = 31 days. Days in November = 30 days. Days in December = 26 days. Total number of days = 30 + 31 + 30 + 31 + 31 + 30 + 31 + 30 + 26 = 270 days.
Step 2 is to convert the total number of days into weeks. 270 days ÷ 7 days/week = 38.57 weeks.
Step 3 is to round to the nearest whole week. The anticipated gestational age is 39 weeks.
Correct Answer is []
Explanation
Rationale for correct condition
Placenta previa occurs when the placenta partially or completely covers the cervical opening, causing painless bright red vaginal bleeding during the second or third trimester. The client’s presentation of painless vaginal bleeding without contractions or abdominal tenderness supports this diagnosis. Fundal height measuring 27 cm at 28 weeks aligns with normal gestation, and the absence of uterine irritability or pain differentiates it from abruptio placentae. Fetal heart rate of 170/min with minimal variability reflects fetal stress but no immediate decelerations. These features are consistent with placenta previa rather than other causes of bleeding.
Rationale for correct actions
Strict bed rest reduces mechanical disruption of the placenta previa site, minimizing further bleeding risk and improving maternal-fetal oxygenation. Large-bore IV access is essential to rapidly administer fluids or blood products if hemorrhage occurs, maintaining maternal hemodynamic stability. Both actions are critical for managing acute vaginal bleeding while ensuring safety until delivery or further intervention.
Rationale for correct parameters
Monitoring fetal well-being via continuous electronic fetal monitoring detects signs of hypoxia or distress, guiding timely interventions. Tracking vaginal bleeding quantifies blood loss and progression, essential to assess severity and need for transfusion. Both parameters directly evaluate maternal and fetal status during placenta previa management.
Rationale for incorrect conditions
Abruptio placentae involves premature placental separation causing painful bleeding and uterine tenderness, absent here. Chorioamnionitis presents with maternal fever, uterine tenderness, and fetal tachycardia due to infection, none reported. Vasa previa entails fetal vessel rupture causing rapid fetal distress and bleeding; no signs of fetal demise or sudden distress are evident.
Rationale for incorrect actions
Administering pitocin is contraindicated as it may cause contractions worsening bleeding in placenta previa. Methotrexate treats ectopic pregnancy or trophoblastic disease, unrelated here. Vaginal examination risks provoking hemorrhage and is avoided in placenta previa.
Rationale for incorrect parameters
White blood cell count monitors infection, not relevant in this case without fever or leukocytosis. Cervical dilation monitoring is contraindicated due to risk of hemorrhage in placenta previa. Beta-human chorionic gonadotropin levels evaluate pregnancy viability or trophoblastic disease, irrelevant here.
Take home points
- Placenta previa presents as painless bright red bleeding in the third trimester.
- Avoid vaginal examinations to prevent hemorrhage in placenta previa.
- Strict bed rest and IV access are critical management steps.
- Differentiate placenta previa from abruptio placentae by pain and uterine tenderness.
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