A patient in labor has just received an epidural block.
What is the most important nursing intervention?
Monitor the maternal pulse for possible bradycardia.
Monitor the fetus for possible tachycardia.
Monitor the maternal blood pressure for possible hypotension.
Limit parenteral fluids.
The Correct Answer is C
Choice A rationale
Bradycardia, or a slow heart rate, is not a typical immediate side effect of an epidural block. The primary cardiovascular risk is vasodilation below the level of the block, which can cause a sudden decrease in systemic vascular resistance and a drop in blood pressure. Bradycardia is more commonly associated with other conditions, not as a direct primary effect of epidural administration.
Choice B rationale
Fetal tachycardia is not an expected or most important immediate adverse effect of an epidural block. While maternal fever and subsequent fetal tachycardia can occur later with epidural use, the most critical immediate maternal side effect that requires vigilant monitoring is hypotension, which can lead to decreased placental perfusion and subsequent fetal distress.
Choice C rationale
The most important nursing intervention following an epidural block is to monitor the patient's blood pressure for hypotension. The epidural causes vasodilation of the blood vessels below the level of the block, leading to a decrease in systemic vascular resistance and venous return. This can cause a sudden and significant drop in blood pressure, which can decrease placental perfusion and compromise fetal oxygenation.
Choice D rationale
Limiting parenteral fluids is not an appropriate intervention; in fact, the opposite is true. A bolus of intravenous fluids is often administered before the epidural to expand the maternal blood volume and help mitigate the risk of hypotension. Limiting fluids would exacerbate the risk of hypotension and its associated complications for both the mother and fetus. *.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
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.
Correct Answer is D
Explanation
Choice A rationale
Polyhydramnios, an excessive amount of amniotic fluid, is associated with an increased risk of premature rupture of membranes and umbilical cord prolapse. While it can cause uterine overdistention, leading to hypotonic dysfunction, it is not a primary risk factor for uterine rupture. The excess fluid does not directly weaken the uterine wall.
Choice B rationale
Gestational diabetes can lead to macrosomia, a fetus with a birth weight greater than 4.0 kg. While a large fetus can cause a difficult delivery and increase the risk for shoulder dystocia, the primary risk for uterine rupture is related to a scarred uterus from a previous cesarean section, not fetal size alone.
Choice C rationale
Hypotonic uterine dysfunction is characterized by weak, infrequent, or ineffective contractions during active labor. The uterine muscle is not contracting with sufficient force to cause cervical change. This condition primarily prolongs labor but does not increase the risk of uterine rupture, as the uterine wall is not under excessive strain.
Choice D rationale
Uterine rupture is a serious complication, and the risk is significantly elevated with oxytocin induction, especially in patients with a history of a previous cesarean section. Oxytocin stimulates powerful uterine contractions, and if the dose is not carefully titrated, it can overstimulate the uterus, potentially causing the old scar to tear under the intense pressure.
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