Which is an opioid medication administered by the intrathecal or epidural route that can provide prolonged pain relief but does not interfere with movement or sensation?

Correct Answer: B

Rationale: The correct answer is B: Preservative-free morphine (Duramorph). When administered intrathecally or epidurally, preservative-free morphine can provide prolonged pain relief by acting on opioid receptors in the spinal cord without affecting movement or sensation due to its selective action at the spinal level. Meperidine (A) is not commonly used for epidural or intrathecal administration. Fentanyl (C) and remifentanil (D) are potent opioids that may affect movement and sensation when administered via these routes.

Correct Answer: A

Rationale: The correct first action is to increase intravenous fluids (Choice A). This will help improve the patient's blood volume and subsequently increase blood pressure. Trendelenburg position (Choice B) is not recommended due to potential complications. Administering oxygen (Choice C) may be helpful but doesn't directly address the hypotension. Notifying the physician (Choice D) is important but addressing hypotension promptly is the priority. Increasing fluids helps address the underlying cause of hypotension in this scenario.

Correct Answer: A

Rationale: The correct answer is A: Fetal malpresentation. This is a risk factor for cesarean section because the baby's position can impact the ability to deliver vaginally. If the baby is in a breech or transverse position, a cesarean section may be necessary to ensure a safe delivery. Choice B, spontaneous labor, is not a risk factor for cesarean section as it is a natural part of childbirth. Choice C, low maternal age, is also not a risk factor as age alone does not determine the need for a cesarean section. Choice D, no previous pregnancies, is not a risk factor as it does not directly impact the likelihood of needing a cesarean section.

Correct Answer: A

Rationale: The correct answer is A: Administer an epidural block. In the active phase of labor, the pain is typically intense and continuous. Administering an epidural block can provide effective pain relief by blocking nerve signals, allowing the patient to rest and conserve energy for the pushing phase. It does not affect the ability to push and can improve maternal satisfaction. Non-pharmacological methods (B) may not provide sufficient relief at this stage. Narcotic analgesics (C) can cross the placenta and affect the baby's respiratory system. Encouraging the patient to push (D) is appropriate during the second stage of labor, not the active phase.

Correct Answer: A

Rationale: The correct answer is A: Uterine rupture. The most important factor to monitor in a woman with a history of previous cesarean section is the risk of uterine rupture during labor. Uterine rupture is a serious complication that can lead to life-threatening hemorrhage for both the mother and the baby. Monitoring for signs such as sudden onset of severe abdominal pain, abnormal fetal heart rate patterns, and cessation of contractions is crucial. Maternal hypotension (Choice B) is important but not as critical as uterine rupture. Fetal malpresentation (Choice C) and prolonged labor (Choice D) are important factors to monitor but do not pose the same level of immediate risk as uterine rupture in this situation.