Immediately following administration of epidural anesthesia to the patient, the nurse must monitor the mother for which of the following?
Increase in her central venous pressure.
Fetal heart rate accelerations.
Paresthesia in her feet and legs.
Decrease in her blood pressure.
The Correct Answer is D
Choice A rationale
Epidural anesthesia involves injecting a local anesthetic into the epidural space, causing sympathetic blockade. This blockade leads to peripheral vasodilation and subsequent trapping of blood in the lower extremities, which will cause a decrease in central venous pressure (CVP), not an increase. A drop in CVP contributes to the common complication of hypotension.
Choice B rationale
The primary initial adverse effect of maternal hypotension following epidural administration is reduced placental perfusion, which often manifests on the fetal monitor as late decelerations, indicating uteroplacental insufficiency, or potentially bradycardia, not fetal heart rate accelerations, which are typically a sign of fetal well-being.
Choice C rationale
Paresthesia, or a sensation of prickling or tingling, is expected to occur in the lower extremities as the local anesthetic begins to take effect and block nerve impulses, which is a sign of the successful progression of the blockade. However, the most life-threatening or immediate complication to monitor is the systemic effect of hypotension.
Choice D rationale
Sympathetic nerve fibers are blocked by the anesthetic agent in the epidural space, leading to widespread vasodilation below the level of the block, which causes venous pooling and a resulting decrease in venous return to the heart. This decrease in preload results in decreased cardiac output and a significant and rapid drop in maternal blood pressure.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","C"]
Explanation
Choice A rationale
Nausea and vomiting during pregnancy, often called morning sickness, are frequently worse in the morning due to an empty stomach and low blood sugar. Consuming a small amount of easily digestible carbohydrates, such as dry toast or crackers, along with non-irritating fluid like water, before rising can help stabilize blood glucose levels and decrease gastric acid production, thus alleviating the uncomfortable symptoms.
Choice B rationale
Limiting fluid intake is contraindicated as adequate hydration is crucial during pregnancy to maintain plasma volume and prevent dehydration, which can exacerbate nausea and vomiting symptoms, especially if vomiting is severe. Instead, fluids should be consumed frequently between meals, not with meals, to avoid distending the stomach and worsening nausea.
Choice C rationale
Eating small, frequent meals throughout the day, approximately every two to three hours, helps maintain a relatively constant level of glucose in the bloodstream and prevents the stomach from becoming overly full or completely empty. This consistent, low-volume intake reduces gastric irritation and minimizes the triggers for nausea and subsequent vomiting episodes.
Choice D rationale
High-fat foods are generally harder and slower to digest, which can prolong gastric emptying time. This prolonged presence of food in the stomach can actually increase the feeling of fullness, leading to gastric distention and potentially worsening the symptoms of nausea and vomiting in a pregnant woman.
Correct Answer is E
Explanation
Choice A rationale
The third stage of labor, which begins after the baby is born and ends with the delivery of the placenta, is too late to discuss options for pharmacologic pain relief for the active process of contractions and birth, as the painful part of labor is nearly over.
Choice B rationale
Attempting to discuss complex choices like pharmacologic pain relief options during a uterine contraction is counterproductive because the patient will be focused on coping with the pain and is unlikely to comprehend or process new information effectively.
Choice C rationale
While discussing options between contractions is better than during, the latent phase upon admission offers the most relaxed and appropriate time for comprehensive discussion of the birth plan and pain management choices before labor intensifies significantly.
Choice D rationale
The second stage of labor, which involves pushing and the birth of the baby, is too late for the initial detailed discussion and informed consent process required for most pharmacologic pain relief methods, as the urgency of delivery is paramount.
Choice E rationale
Upon admission during the latent phase of labor (cervical dilation 0-6 cm), contractions are mild and the patient is relatively comfortable, providing a calm window for the nurse to review the birth plan, ensure informed consent, and discuss all available pharmacologic options thoroughly.
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