The nurse is caring for a laboring client who is requesting an epidural.
As the nurse prepares to start an IV, the client asks why it is necessary.
What would be the nurse’s best response?
“You won’t be able to eat, and this provides nutrition to you and the baby during childbirth.”
“Don’t worry about the IV, I have placed many IVs before.”
“The IV is in place to give the medication for relaxation before the epidural is placed.”
“The IV bolus will help to minimize the side effects of the epidural.”
The Correct Answer is C
Choice A rationale:
It is true that a laboring client may not be able to eat, but this is not the primary reason for starting an IV. The client can receive fluids and electrolytes through the IV to maintain hydration and energy levels.
However, this response does not directly address the client's question about why the IV is necessary for the epidural.
It's important to provide a clear and accurate explanation to help the client understand the purpose of the intervention.
Choice B rationale:
This response is dismissive of the client's concerns and does not provide any information about why the IV is necessary.
It's important to acknowledge the client's concerns and provide them with the information they need to make informed decisions about their care.
Choice C rationale:
This is the correct response. The IV is necessary to administer medication for relaxation before the epidural is placed.
The epidural is a regional anesthetic that blocks pain signals from the lower body.
The medication for relaxation helps to reduce anxiety and discomfort, which can make it easier to place the epidural.
It also helps to prevent the client from moving during the procedure, which could lead to complications.
Choice D rationale:
This response is not accurate. An IV bolus is not typically given to minimize the side effects of the epidural.
Side effects of the epidural, such as hypotension and nausea, are usually managed with other medications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice C rationale:
It is a misconception that fetal movement decreases as delivery approaches. While the nature of the movements may change— becoming less like kicks and more like rolls or twists due to less space in the uterus—the frequency of movements should remain consistent. In fact, increased fetal movement can be a sign of labor approaching. Therefore, a pregnant client who believes that fetal movements will decrease closer to delivery needs further instruction to ensure they are aware of this important health indicator.
Here's a detailed explanation of why the other choices are correct:
Choice A: This statement is correct. Fetal kick counts can be performed at home, providing a convenient and comfortable way to monitor fetal well-being.
Choice B: This statement is also correct. A decrease in fetal movement, defined as less than 3 kicks in an hour, is a potential concern and warrants contacting a healthcare provider for further evaluation.
Choice D: This statement is accurate as well. Daily fetal kick counts are generally recommended to establish a baseline of the baby's usual activity pattern and to detect any significant changes that might indicate a problem.
Correct Answer is C
Explanation
Choice A rationale:
This statement suggests that the patient has some awareness of infertility treatments, but it does not necessarily indicate a full understanding of infertility itself.
It's important to consider that a few months of trying to conceive may not be indicative of infertility, as it can take up to a year for healthy couples to achieve pregnancy.
Jumping to fertility treatments without a proper evaluation could lead to unnecessary interventions and potential financial and emotional burdens.
Choice B rationale:
This statement is incorrect. Male factor infertility is a common cause of difficulty conceiving, accounting for about 40% of infertility cases.
It's essential to evaluate both partners when assessing fertility issues.
Choice C rationale:
This statement demonstrates the patient's understanding of the relationship between age and fertility.
Female fertility gradually declines with age, especially after the age of 35, due to a decrease in the number and quality of eggs.
This awareness indicates that the patient is realistic about her chances of conceiving and is prepared to seek appropriate help if needed.
Choice D rationale:
While family history can play a role in infertility, it's not a guarantee that someone will experience the same issues as their relatives.
Each case is unique, and multiple factors can contribute to infertility, including genetics, lifestyle, medical conditions, and environmental factors.
It's important to undergo a thorough evaluation to determine the specific causes of infertility in each individual.
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