Which of the following is the most appropriate nursing action for a patient who has been administered an epidural block and is now experiencing hypotension?

Correct Answer: A

Rationale: The correct answer is A: Administer a bolus of IV fluids. Hypotension after an epidural block is often due to vasodilation caused by the block. Administering IV fluids can help increase blood volume and improve blood pressure. This action is crucial in maintaining perfusion to vital organs. Choice B: Placing the patient in a Trendelenburg position can potentially worsen hypotension by increasing venous return to the heart, leading to further vasodilation and reduced blood pressure. Choice C: Administering oxygen via mask may be important in some situations but is not the primary intervention for hypotension caused by epidural block. Choice D: Raising the head of the bed slightly is not the best option for treating hypotension as it does not address the underlying cause of vasodilation and decreased blood pressure.

Correct Answer: C

Rationale: The correct answer is C: Blood glucose levels. During labor, it is crucial to monitor the blood glucose levels of a patient with a history of gestational diabetes to prevent complications such as hyperglycemia or hypoglycemia. Fluctuations in blood glucose levels can impact both the mother and the baby's health. Monitoring maternal blood pressure (A) is important but not the most critical factor in this scenario. Fetal heart rate (B) is essential but does not directly address the specific needs of a patient with a history of gestational diabetes. Maternal temperature (D) is also important but does not take precedence over monitoring blood glucose levels in this case.

Correct Answer: A

Rationale: The correct answer is A: Pulmonary embolism. In a woman in labor experiencing severe chest pain and difficulty breathing, a pulmonary embolism should be suspected. This condition occurs when a blood clot travels to the lungs, causing chest pain and respiratory distress. Other choices are incorrect: B) Pre-eclampsia is characterized by high blood pressure and protein in the urine, not chest pain. C) Anxiety does not typically present with severe chest pain and difficulty breathing. D) Placental abruption involves separation of the placenta from the uterus, leading to vaginal bleeding and abdominal pain, not chest pain.

Correct Answer: D

Rationale: The correct answer is D: Prepare for delivery. At 38 weeks of gestation and in active labor, the most appropriate action is to prepare for delivery as the patient is likely to be close to giving birth. This involves ensuring that all necessary equipment and supplies are ready, notifying the healthcare team, and positioning the patient for delivery. Administering narcotic analgesics (choice A) may not be ideal at this stage as the priority is the imminent delivery. While emotional support and reassurance (choice B) are important, they should be provided alongside preparing for delivery. Assessing the fetal heart rate and contraction patterns (choice C) is crucial but should be done concurrently with preparing for delivery to ensure the safety of both the mother and baby.

Correct Answer: D

Rationale: The correct answer is D: Indirect obstetric death. In this scenario, the patient's death was not directly caused by the obstetric event of giving birth, but rather by a pre-existing condition (hypertension) that was exacerbated during delivery. Indirect obstetric deaths are those caused by pre-existing conditions or external factors that are aggravated by the physiological effects of pregnancy. In contrast, early maternal death (choice A) occurs within 42 days of termination of pregnancy but is directly related to the pregnancy process. Late maternal death (choice B) occurs between 43 days and 1 year after termination of pregnancy. Direct obstetric deaths (choice C) are deaths resulting from obstetric complications during pregnancy, delivery, or postpartum period.