What nursing intervention can reduce hypotension prior to epidural placement?

Correct Answer: B

Rationale: IV fluid bolus is the correct answer because it helps increase blood volume and preload, which can prevent or correct hypotension during epidural placement. When a person receives an epidural, their blood pressure can drop due to vasodilation caused by the medication. Providing a fluid bolus before the procedure helps maintain adequate circulating volume and blood pressure. Routine use of ephedrine (Choice A) is not recommended because it is a vasoconstrictor that can increase blood pressure. In the case of epidural placement, ephedrine may worsen hypertension and increase the risk of adverse effects. Insertion of an indwelling urinary catheter (Choice C) is not directly related to reducing hypotension before epidural placement. While maintaining proper bladder function is important during labor and delivery, it does not specifically address the issue of hypotension associated with epidural placement. Upright positioning of the laboring person (Choice D) may be helpful in preventing supine hypotensive syndrome, where pressure on the inferior vena cava can lead to decreased blood return to the heart. However, this is more relevant during labor and not specifically before epidural placement. Providing IV fluids is a more direct and effective intervention to address hypotension in this context.

Correct Answer: D

Rationale: During the second stage of labor, which is the pushing stage, the main focus is on the progress of fetal descent and the strength of contractions. A: Fetal heart rate monitoring is typically done throughout labor, not just during the second stage. It is important to monitor the baby's heart rate to ensure they are handling labor well, but it is not specific to the second stage. B: Fetal descent refers to the movement of the baby through the birth canal. This is a key indicator of progress during the second stage of labor and is typically monitored closely by healthcare providers. C: Bearing-down effort is the mother's pushing during the second stage of labor. While this is an important aspect of the second stage, it is not data that is collected but rather an action taken by the mother. D: Contraction strength is crucial during the second stage of labor as strong, effective contractions help move the baby down the birth canal. Monitoring the strength and frequency of contractions is essential in ensuring progress and a successful delivery. In conclusion, while all of these factors are important during the second stage of labor, the data specifically collected during this stage is the strength of contractions to ensure the baby is progressing through the birth canal effectively.

Correct Answer: B

Rationale: During open glottis pushing, the laboring person is instructed to push spontaneously while exhaling during contractions. This technique allows for gradual and controlled pushing, which can prevent issues such as perineal trauma and fetal hypoxia. Holding their breath and pushing for 10 seconds during each contraction (choice A) can increase intra-abdominal pressure, potentially leading to decreased placental perfusion and oxygen supply to the fetus. Exhaling slowly during contractions without pushing (choice C) may not provide enough force to assist with the descent of the baby. Performing deep breathing exercises between contractions (choice D) is not effective during the pushing phase, as it does not actively assist in the delivery process. Therefore, option B is the correct choice for open glottis pushing to ensure a safe and effective delivery.

Correct Answer: C

Rationale: The most reliable clinical indicator that the placenta has separated is the lengthening of the umbilical cord. This is because when the placenta separates from the uterine wall, the cord that connects the placenta to the baby will start to lengthen due to the lack of attachment. This is a clear and direct physical sign that the placenta has detached. Option A, a gush of clear amniotic fluid, is not a reliable indicator of placental separation because it could also be a sign of premature rupture of membranes or other complications during labor. Option B, uterine contractions every 2 to 3 minutes, while a common sign of labor, is not a specific indicator of placental separation. Uterine contractions can occur for various reasons during labor and may not necessarily indicate placental separation. Option D, maternal report of intense pain, is also not a reliable indicator of placental separation. While some women may experience pain during labor, it is not a specific or definitive sign of placental separation. In summary, the lengthening of the umbilical cord is the most reliable clinical indicator of placental separation because it is a direct physical sign that the placenta has detached from the uterine wall.

Correct Answer: A

Rationale: During the first hour of the fourth stage of labor, it is crucial for the nurse to closely monitor the mother's vital signs to detect any potential complications promptly. The correct answer is A: every 15 minutes. This frequency allows for early identification of any sudden changes in the mother's condition, such as postpartum hemorrhage or infection. Choice B, every 30 minutes, is not as optimal as every 15 minutes because it may delay the detection of complications that require immediate intervention. Waiting for 30 minutes between assessments could lead to a missed opportunity to address a potentially life-threatening situation. Choice C, not until after the first hour, is incorrect because vital signs need to be monitored more frequently during the critical period immediately following delivery. Waiting until after the first hour could result in a delay in recognizing and addressing any issues that arise during this crucial time. Choice D, once, then hourly, is also incorrect as it does not provide the necessary frequency of monitoring during the first hour of the fourth stage. While hourly assessments may be appropriate later on, the initial hour requires more frequent monitoring to ensure the mother's safety and well-being. In conclusion, assessing vital signs every 15 minutes during the first hour of the fourth stage of labor is the most appropriate choice to promptly identify and address any complications that may arise.