A woman in active labor requests an epidural for pain management. She is currently 5 cm dilated and 100% effaced. The anesthesiologist is evaluating whether the client is an appropriate candidate for epidural anesthesia.
Which maternal condition would be a contraindication to receiving an epidural at this time?
She is septic.
She has thrombocytopenia.
She is too far dilated.
She is anemic.
The Correct Answer is B
Choice A rationale
Sepsis is a generalized infection, and while any systemic infection is a relative contraindication to an epidural due to the risk of spreading the infection to the central nervous system, local site infection is the primary concern, and sepsis is not the most common or specific hematological contraindication.
Choice B rationale
Thrombocytopenia, characterized by a platelet count below the normal range of 150,000 to 450,000/microL, significantly increases the risk of epidural hematoma formation at the puncture site, which can lead to spinal cord compression and permanent neurological damage, making it a critical contraindication for epidural placement.
Choice C rationale
The extent of cervical dilation is not an absolute contraindication for an epidural, as it can be placed even in active labor (4-7 cm) or occasionally later, although the effectiveness may be reduced if placed very close to delivery; a 5 cm dilation is generally an acceptable time for placement.
Choice D rationale
Anemia, defined as a low red blood cell count or hemoglobin level (normal Hgb for pregnant women is >11 g/dL in the first and third trimesters, >10.5 g/dL in the second), does not affect the risk of hemorrhage or neurological complications associated with epidural insertion and is therefore not a specific contraindication.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Oxytocics are primarily smooth muscle stimulants that act on the uterine fundus to cause firm, sustained contractions. While a contracted uterus helps prevent bacterial entry into open blood vessels, the primary purpose of oxytocics after birth is mechanical, not antimicrobial, and therefore they are not administered to prevent infection.
Choice B rationale
Oxytocics stimulate intense uterine contractions, which can be uncomfortable or painful for the woman. They are administered for physiological necessity, not to facilitate rest or relaxation; analgesics or other supportive measures are used for those goals.
Choice C rationale
Oxytocin stimulates powerful contractions of the myometrium, which causes the uterus to clamp down on the blood vessels that supplied the placenta. This contraction is vital for mechanically compressing the uterine blood vessels at the placental site, which prevents or controls postpartum hemorrhage due to uterine atony.
Choice D rationale
Oxytocin administration causes strong uterine cramping as the uterus contracts, which can actually increase postpartum pain. Pain relief is managed through methods like analgesics, not through the administration of an oxytocic agent, which is a key pharmacological intervention to reduce bleeding.
Correct Answer is A
Explanation
Choice A rationale
Fetal well-being is primarily assessed by evaluating the fetal heart rate (FHR) pattern, particularly its relationship to uterine contractions (UCs). The FHR response, including the presence of accelerations, moderate variability, and the absence of concerning decelerations, reflects the fetus's ability to tolerate the physiologic stress of labor.
Choice B rationale
An FHR above 110 beats/min alone does not confirm well-being; the normal range is 110 to 160 beats/min, and rates above this may indicate fetal tachycardia. The pattern of the FHR, including variability and periodic changes, is more critical than a single rate value for assessing well-being.
Choice C rationale
Maternal pain control is important for the woman's comfort and ability to cope with labor, but it is not a direct measure of fetal well-being or oxygenation status. Fetal assessment relies on objective measures of the fetal physiologic response to the stress of labor.
Choice D rationale
While the absence of late decelerations is a reassuring component, well-being requires a comprehensive assessment of the entire FHR tracing. This includes evaluating the baseline rate (110-160 beats/min), variability (moderate is ideal, 6 to 25 beats/min), and the presence of accelerations or non-reassuring decelerations.
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