A nurse is providing care for a client who is in labor.
The nurse notes variable decelerations on the fetal heart rate monitor.
What could be the cause?

Choice A rationale:

Checking the client’s blood pressure is important, but it is not the first action the nurse should take. Hypotension could

indicate hemorrhage, but the nurse needs to address the immediate risk of excessive bleeding.

Choice B rationale:

The nurse should first massage the client’s fundus. A saturated perineal pad could indicate a postpartum hemorrhage.

Massaging the fundus helps the uterus contract and may stop the bleeding.

Choice C rationale:

Observing for pooling of blood under the buttocks is a way to assess for bleeding. However, this is not the first action because

it does not address the cause of the bleeding.

Choice D rationale:

Administering oxytocin can help the uterus contract and reduce bleeding. However, this is not the first action because it

requires a physician’s order.

Choice A rationale:

There is no evidence to suggest that epidural anesthesia delays the rupture of fetal membranes. The timing of rupture of fetal

membranes is influenced by various factors, including the strength of uterine contractions, the position of the baby, and the

elasticity of the amniotic sac. Epidural anesthesia does not directly affect these factors.

Choice B rationale:

Epidural anesthesia can prolong labor by interfering with the natural process of labor. It can weaken uterine contractions,

slow down cervical dilation, and potentially lead to a prolonged second stage of labor. This is because the anesthesia blocks the

nerve signals that control the muscles of the uterus. When these signals are blocked, the contractions may become less

frequent and less intense. This can delay the progress of labor and increase the risk of interventions such as forceps delivery

or cesarean section.

Choice C rationale:

While epidural anesthesia can have some effects on the baby, it is not a primary cause of fetal depression. Fetal depression is

typically caused by other factors, such as decreased oxygen supply to the baby, maternal infection, or placental problems.

Epidural anesthesia can sometimes lead to a temporary decrease in the baby's heart rate, but this is usually well-managed by

the healthcare team and does not typically lead to significant fetal depression.

Choice D rationale:

Epidural anesthesia does not typically cause maternal hypertension. In fact, it can sometimes have the opposite effect and

cause a slight decrease in blood pressure. This is because the anesthesia can relax the blood vessels, which can lead to a drop

in blood pressure. However, this is usually not a significant concern and is easily managed by the healthcare team.