A nurse is caring for a patient in labor who is receiving oxytocin (Pitocin) by IV infusion to stimulate uterine contractions.
Which assessment finding would indicate to the nurse that the infusion needs to be discontinued?

Choice A rationale:

Performing a vaginal exam is not the priority intervention for a client experiencing hypotension after an epidural. While a vaginal exam may be necessary to assess cervical dilation and fetal station, it does not address the underlying cause of the client's hypotension.

Additionally, a vaginal exam could potentially worsen the client's hypotension by stimulating the vagus nerve, which can lead to decreased heart rate and blood pressure.

Therefore, it is not the most appropriate initial response in this situation.

Choice B rationale:

Turning the client onto her side is the most appropriate initial response to hypotension after an epidural. This position helps to increase venous return to the heart, which can improve cardiac output and blood pressure.

It also helps to prevent aortocaval compression, which can occur when the pregnant uterus compresses the inferior vena cava, reducing blood flow back to the heart.

By turning the client onto her side, the nurse can quickly and easily address the underlying cause of the hypotension and help to improve the client's hemodynamic status.

Choice C rationale:

Catheterizing the client may be necessary if the client is unable to void spontaneously, but it is not the priority intervention for hypotension after an epidural.

Urinary retention can occur after an epidural, but it is not typically the cause of hypotension in this setting.

Therefore, catheterization would not be the most appropriate initial response.

Choice D rationale:

Decreasing the IV fluid rate may be necessary if the client is experiencing fluid overload, but it is not the priority intervention for hypotension after an epidural.

In fact, decreasing the IV fluid rate could potentially worsen the hypotension by reducing the circulating blood volume.

Therefore, it is not the most appropriate initial response.

Choice A rationale:

Incorrect. The quad screen test does not examine fetal DNA to determine gender. That is the role of other tests, such as amniocentesis or chorionic villus sampling (CVS).

Gender determination is not a primary objective of the quad screen test.

Focusing on gender unnecessarily narrows the scope of the test's potential findings.

Choice B rationale:

Incorrect. The quad screen test does not use fetal tissue. It is a non-invasive blood test that measures levels of four substances in the mother's blood: alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin A.

Fetal tissue sampling is more invasive and carries risks, while the quad screen is a safer alternative.

Clarifying the non-invasive nature of the test is crucial for informed consent and patient understanding.

Choice C rationale:

Incorrect. While AFP levels can be affected by maternal liver function, that is not the primary focus of the quad screen test.

Liver function tests are specifically designed to assess liver health, and they are not part of the quad screen panel.

Distinguishing between liver function assessment and AFP's role in screening for fetal anomalies is essential for accurate interpretation.

Choice D rationale:

Correct. The quad screen test measures levels of AFP, hCG, uE3, and inhibin A in the mother's blood. These substances can provide information about the risk of certain fetal chromosomal abnormalities and neural tube defects.

Elevated AFP levels can indicate an increased risk for neural tube defects such as spina bifida or anencephaly.

Low AFP levels can be associated with Down syndrome or other chromosomal abnormalities.

Understanding the specific disorders that can be indicated by AFP levels is crucial for patient counseling and further testing decisions.