A patient experienced a large hemorrhage postpartum because of a relaxed uterus.
Which of the following anesthesia methods is most likely to have contributed to this problem?
General anesthesia.
Pudendal block.
Epidural anesthesia.
Local anesthesia.
The Correct Answer is A
Choice A rationale
General anesthesia, particularly with halogenated inhalational agents, can cause uterine atony. These agents act as uterine smooth muscle relaxants, which can prevent the uterus from contracting effectively after birth. A relaxed, or atonic, uterus is the most common cause of postpartum hemorrhage because it cannot compress the blood vessels at the placental site, leading to uncontrolled bleeding.
Choice B rationale
A pudendal block provides anesthesia to the perineum, vulva, and lower vagina by injecting an anesthetic into the pudendal nerves near the ischial spines. It does not affect the uterine muscle or its contractility. Therefore, a pudendal block would not contribute to uterine atony or increase the risk of postpartum hemorrhage from a relaxed uterus.
Choice C rationale
An epidural provides regional anesthesia by blocking nerve impulses in the lower spinal segments. While high concentrations of anesthetic agents can have a mild effect on uterine contractility, modern low-dose epidurals typically do not significantly impair uterine muscle tone. The risk of postpartum hemorrhage from uterine atony is not as high with epidural anesthesia as it is with general anesthesia.
Choice D rationale
Local anesthesia, such as a perineal infiltration for an episiotomy or repair, involves injecting an anesthetic directly into the tissues of the perineum. This localized effect does not circulate systemically in a way that would relax the uterine smooth muscle. Therefore, local anesthesia would not contribute to a relaxed uterus or postpartum hemorrhage.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While many inductions of labor are performed for medical reasons, such as preeclampsia or post-term pregnancy, not all are. Elective inductions, performed for non-medical reasons, are also common, although they are associated with certain risks. The decision to induce labor is a medical one, but the indication is not always strictly medical, making this statement inaccurate.
Choice B rationale
A trial of labor (TOL) is a term used specifically for patients who have had a prior cesarean section and are attempting a vaginal delivery. It is also known as a TOLAC (Trial of Labor After Cesarean). Induction of labor is a broader term and refers to stimulating contractions before the spontaneous onset of labor. The two terms are not synonymous.
Choice C rationale
Induction of labor is a process initiated by methods like oxytocin infusion or prostaglandin gels. Internal and external version are procedures used to change the fetal presentation (e.g., from breech to cephalic) and are not methods for initiating labor. These procedures may be followed by induction, but they are not the induction methods themselves.
Choice D rationale
The Bishop score is a scoring system used to predict the likelihood of a successful induction of labor. It assesses five components: cervical dilation, effacement, consistency, position, and fetal station. A higher Bishop score (typically 8 or greater) indicates a more favorable cervix and a greater chance of successful induction, making this a crucial assessment tool.
Correct Answer is ["C","D","E"]
Explanation
Choice A rationale
Checking urinary output is an important part of overall patient care to assess hydration status and kidney function. However, it is not a direct or immediate intrauterine resuscitation measure for addressing late decelerations, which are a sign of uteroplacental insufficiency and require interventions to improve oxygenation and blood flow to the fetus.
Choice B rationale
Cardiopulmonary resuscitation (CPR) is a life-saving procedure performed when a person's heart stops beating or they stop breathing. It is not an appropriate intervention for a laboring mother with late decelerations unless she experiences a cardiopulmonary arrest herself, which is not indicated by this fetal heart rate pattern.
Choice C rationale
Repositioning the mother onto her side, especially the left side, shifts the weight of the gravid uterus off the inferior vena cava and aorta. This action scientifically improves venous return to the heart and increases cardiac output, thereby enhancing blood flow and oxygen delivery to the placenta and fetus, which can resolve late decelerations.
Choice D rationale
Increasing IV fluids expands the maternal circulating blood volume, which can improve placental perfusion. This increase in intravascular fluid volume leads to a rise in maternal cardiac output and blood pressure, thereby increasing the flow of oxygenated blood to the intervillous spaces of the placenta, addressing the root cause of late decelerations.
Choice E rationale
Applying a non-rebreather oxygen mask to the mother at a flow rate of 8 to 10 liters per minute increases the oxygen saturation of the maternal blood. This higher concentration of oxygen is then delivered to the placenta, increasing the oxygen available for transfer to the fetus and thereby addressing the fetal hypoxemia that is causing the late decelerations. .
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