The nurse is caring for a client who is 40-weeks gestation in active labor and has received epidural anesthesia.

What is the most important assessment for the nurse to conduct following the administration of epidural anesthesia?

Station of presenting part.

Maternal blood pressure.

Variability of fetal heart rate.

Level of pain sensation.

Answer and Explanation

The Correct Answer is B

Choice A rationale

While assessing the station of the presenting part is important during labor, it is not the most crucial assessment following the administration of epidural anesthesia.

Choice B rationale

Monitoring maternal blood pressure is the most important assessment following the administration of epidural anesthesia. Epidural anesthesia can cause a drop in blood pressure, which can lead to complications for both the mother and the baby.

Choice C rationale

Although assessing the variability of the fetal heart rate is important during labor, it is not the most crucial assessment following the administration of epidural anesthesia.

Choice D rationale

While assessing the level of pain sensation is important to evaluate the effectiveness of the epidural anesthesia, it is not the most crucial assessment following its administration.

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Correct Answer is ["25"]

Explanation

Answer and explanation

Step 1 is to convert the child’s weight from pounds to kilograms since the dosage is prescribed in mg/kg. We know that 1 kg is approximately 2.2 lbs. So, the child’s weight in kg is 55 lbs ÷ 2.2 = 25 kg (rounded to the nearest whole number for simplicity).

Step 2 is to calculate the total daily dosage. The prescription is for isoniazid 10 mg/kg/day. So, the total daily dosage in mg is 10 mg/kg/day × 25 kg = 250 mg/day.

Step 3 is to calculate the volume of the oral solution to administer. The bottle is labeled, “Isoniazid Oral Solution, USP 50 mg per 5 mL.”. So, the volume in mL to administer is (250 mg/day ÷ 50 mg) × 5 mL = 25 mL. Therefore, the nurse should administer 25 mL of the Isoniazid Oral Solution, USP 50 mg per 5 mL, once a day.

A. Prepare a vacuum. B. Apply suprapubic pressure. C. Apply fundal pressure. D. Prepare forceps. E. Prepare forceps.

Correct Answer is B

Explanation

Choice A rationale
Preparing a vacuum is not the first action to take in this situation. A vacuum-assisted delivery might be considered in some cases, but it’s not the immediate action when the fetal head retracts against the perineum.
Choice B rationale
Applying suprapubic pressure is the correct action. This situation describes shoulder dystocia, where the baby’s shoulder gets stuck behind the mother’s pelvic bone during delivery. Suprapubic pressure can help dislodge the baby’s shoulder and allow the delivery to proceed.
Choice C rationale
Applying fundal pressure is not recommended in this situation. Fundal pressure could potentially worsen shoulder dystocia and is generally avoided.
Choice D rationale
Preparing forceps is not the immediate action to take. Forceps may be used in some delivery situations, but in the case of shoulder dystocia, other maneuvers are tried first.

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The nurse is caring for a client who is 40-weeks gestation in active labor and has received epidural anesthesia. What is the most important assessment for the nurse to conduct following the administration of epidural anesthesia?

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A child who weighs 55 pounds receives a prescription for isoniazid 10 mg/kg/day by mouth (PO) once a day. The bottle is labeled, “Isoniazid Oral Solution, USP 50 mg per 5 mL.”. How many mL should the nurse administer? . .

Correct Answer is ["25"]

Explanation

Answer and explanation

A woman is in the second stage of labor where the fetal head has just been born and the nurse observes the immediate retraction of the head against the perineum. What action should the nurse expect to perform to assist the healthcare provider?

Correct Answer is B

Explanation

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The nurse is caring for a client who is 40-weeks gestation in active labor and has received epidural anesthesia.

What is the most important assessment for the nurse to conduct following the administration of epidural anesthesia?