What is the most important nursing intervention for a laboring person with an epidural who has a low blood pressure?

Correct Answer: A

Rationale: The correct answer is A: increase the IV fluid rate. This intervention helps to increase blood volume and improve blood pressure, addressing hypotension commonly caused by epidural anesthesia. Administering an epidural bolus (B) can worsen hypotension. Administering an analgesic (C) is not the priority in this situation. Increasing monitoring frequency (D) is important but addressing the underlying cause of low blood pressure is crucial.

Correct Answer: A

Rationale: The correct answer is A: Fever. In the first 24 hours postpartum, fever is the most concerning finding as it can indicate infection, such as endometritis or mastitis. Fever is a common early sign of infection and requires immediate assessment and intervention. Redness and swelling at the site (B) could be normal postpartum findings. Increased heart rate (C) may be a nonspecific response to stress or dehydration. Fatigue (D) is common postpartum but not typically indicative of infection in the first 24 hours. Fever warrants prompt attention due to the risk of serious complications if left untreated.

Correct Answer: A

Rationale: The correct action is to perform uterine massage. This helps to prevent postpartum hemorrhage by promoting uterine contraction and reducing uterine atony. It stimulates the release of endogenous oxytocin, aiding in the expulsion of clots and reducing bleeding. Administering uterotonic medications (choice B) would be the next step if uterine massage alone is ineffective. Perineal massage (choice C) is unrelated to managing a boggy uterus. Administering oral pain relief (choice D) does not address the root cause of the issue.

Correct Answer: A

Rationale: The primary purpose of assessing cervical dilation during labor is to evaluate the progress of labor. Cervical dilation indicates how far the labor has advanced and helps determine if the labor is proceeding normally. Monitoring dilation helps healthcare providers make informed decisions about the timing of interventions and the overall management of labor. It does not directly assess the need for interventions (choice B), complications (choice C), or fetal position (choice D). These factors can be assessed through other means, but the main focus of assessing cervical dilation is to track the progression of labor.

Correct Answer: B

Rationale: The correct answer is B: provide skin-to-skin contact. This is the most appropriate intervention because it promotes bonding, regulates the baby's temperature, and enhances breastfeeding success by stimulating the baby's natural instincts. Assisting with latching (choice A) may be necessary but providing skin-to-skin contact should be prioritized. Educating on breast care (choice C) and postpartum care (choice D) are important, but the immediate need is to establish successful breastfeeding through skin-to-skin contact.