A nurse is providing discharge teaching to a new guardian about car seat safety.
Which of the following statements by the guardian indicates an understanding of the teaching?

Choice A rationale

Delaying the epidural until the client reaches a specific dilation, such as 7 cm, is not based on current standards of pain management; an epidural can be administered at any time during active labor, as long as the client desires it and there are no contraindications. Labor progress is often enhanced, not hindered, by effective pain relief, which reduces catecholamine release and subsequent uterine vasoconstriction, promoting efficient uterine contractions. The decision to administer an epidural is primarily based on maternal request and clinical assessment.

Choice B rationale

Placing the client in a supine position (lying flat on the back) before epidural placement or during labor is contraindicated because the gravid uterus can compress the vena cava and aorta, reducing venous return and subsequently decreasing cardiac output and uteroplacental perfusion. This supine hypotension syndrome can lead to fetal distress. The client should be positioned on their side or sitting upright with feet supported, or with a wedge under the hip to maintain lateral tilt.

Choice C rationale

Administering an intravenous fluid bolus, typically 500 to 1000 mL of an isotonic solution like Lactated Ringer's or 0.9% Sodium Chloride, is a standard prophylactic measure before epidural anesthesia. This fluid load expands the intravascular volume, which helps to mitigate the common side effect of hypotension caused by the sympathetic blockade resulting from the anesthetic agents diffusing into the epidural space and causing peripheral vasodilation.

Choice D rationale

Ondansetron is an antiemetic used to prevent nausea and vomiting, which can sometimes occur with labor or as a side effect of opioid use or hypotension associated with epidural placement. However, it is not the primary or most immediate action before an epidural, nor is it a universal prophylactic requirement. The priority before an epidural is the IV fluid bolus to prevent hypotension, which poses a greater immediate risk to the mother and fetus.

Choice A rationale

Newborns require substantial sleep for optimal growth and neurological development, often sleeping for 16 to 20 hours in a 24-hour period, though this varies. This is a normal physiologic finding, reflecting the rapid growth and high metabolic demands of infancy, and does not require immediate medical attention. The sleep is typically fragmented into short bouts.

Choice B rationale

Decreased urine output, specifically fewer than 6 to 8 wet diapers in 24 hours after the first few days of life, is a critical sign of dehydration and inadequate fluid intake, especially if the newborn is breastfed. This insufficient hydration can lead to hyperbilirubinemia, weight loss, and electrolyte imbalance, requiring prompt medical evaluation.

Choice C rationale

Newborn stools can normally be loose and frequent, especially in breastfed infants, who often pass stools several times a day. Stools in the first week progress from meconium to transitional to yellow, seedy, and loose, which is a normal finding and generally does not warrant contacting the provider unless signs of illness or diarrhea are present.

Choice D rationale

The umbilical cord stump usually dries and falls off within 1 to 3 weeks after birth due to a process of dry gangrene and separation. While most detach earlier, remaining attached after 1 week is still within the realm of normal variation and is not typically a cause for immediate concern unless signs of infection are present.