A nurse is providing teaching to a postpartum client who has type 1 diabetes mellitus and is breastfeeding her newborn. Which of the following instructions should the nurse give the client?

Choice A rationale:

Requesting that the provider insert an intrauterine pressure catheter is not the immediate action the nurse should take when the umbilical cord is palpated during a vaginal examination. The priority is to relieve pressure on the cord and improve fetal oxygenation.

Choice B rationale:

Exerting continuous upward pressure on the presenting part is the correct action when the nurse palpates the umbilical cord during a vaginal examination. This manoeuvre is called "vaginal elevation,”. helps lift the presenting part off the umbilical cord, reducing the risk of cord compression and fetal distress until the provider can take further action.

Choice C rationale:

Initiating oxytocin via continuous IV infusion is not appropriate when the umbilical cord is palpated during a vaginal examination. Oxytocin can cause uterine contractions, potentially further compromising the cord and fetus.

Choice D rationale:

Placing the client in the left-lateral position is not the best immediate action for cord palpation. While the left-lateral position is useful for relieving pressure on the vena cava in cases of supine hypotensive syndrome, the priority here is to relieve cord compression, and upward pressure on the presenting part is more effective.

The correct answer is choiceB. Decreased ability to bear down.

Choice A rationale:

Fetal bradycardia is not a common adverse effect of a pudendal nerve block.This block primarily affects the mother’s pelvic region and does not typically impact fetal heart rate.

Choice B rationale:

Decreased ability to bear down is correct because the pudendal nerve block can numb the perineal area, reducing the mother’s ability to feel contractions and effectively bear down during labor.

Choice C rationale:

Maternal hypertension is not associated with pudendal nerve blocks.This block is localized and does not generally affect systemic blood pressure.

Choice D rationale:

Uterine hyperstimulation is not a known adverse effect of pudendal nerve blocks.This condition is more commonly associated with the use of labor-inducing drugs like oxytocin.