A nurse in assessing a client who is in labor and has received epidural analgesia. Which of the following findings should the nurse recognize and document as an adverse effect of epidural analgesia?
Fetal heartrate 152/min
Hypotension
polyuria
Maternal temperature of 37.4 C (99.4 F)
The Correct Answer is B
A. Fetal heart rate 152/min: Fetal heart rate is not typically considered an adverse effect of epidural analgesia. The focus of epidural analgesia is on providing pain relief for the mother rather than directly affecting the fetal heart rate.
B. Hypotension: Hypotension (low blood pressure) is a common adverse effect of epidural analgesia. Epidural anesthesia can cause vasodilation, leading to a decrease in blood pressure. The nurse should monitor the client's blood pressure closely and administer interventions as needed, such as IV fluids or medications to address hypotension.
C. Polyuria: Polyuria (excessive urination) is not a direct adverse effect of epidural analgesia. Epidural analgesia primarily affects pain sensation rather than urinary function.
D. Maternal temperature of 37.4 C (99.4 F): A slightly elevated maternal temperature is not a common adverse effect of epidural analgesia. However, the nurse should monitor for signs of infection or other complications and report any significant temperature changes to the healthcare provider.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Human papillomavirus (HPV): The HPV vaccine is generally not administered during pregnancy. It is recommended for routine vaccination before sexual activity begins to provide protection against certain types of HPV that can lead to cervical cancer and genital warts.
B. Varicella (chickenpox): The varicella vaccine is also typically not administered during pregnancy. If a woman is not immune to varicella and is planning pregnancy, vaccination is recommended before conception.
C. Rubella : The rubella vaccine is crucial for individuals who have not been immunized against rubella during childhood, especially in the context of pregnancy. Rubella (German measles) is a viral infection that can cause serious congenital abnormalities, known as congenital rubella syndrome, if a pregnant woman becomes infected. Administering the rubella vaccine during pregnancy is not appropriate, but vaccination before conception or in the postpartum period is recommended to prevent future rubella infections.
D.The tetanus vaccine is safe to administer during pregnancy, typically given as part of the Tdap (tetanus, diphtheria, and pertussis) vaccine. It is recommended during pregnancy, preferably between 27 and 36 weeks of gestation, to protect the newborn from pertussis.
Correct Answer is D
Explanation
A. This test determines if your baby is at risk for developing hypoglycemia after birth: The indirect Coombs' test is not related to assessing the risk of hypoglycemia in the baby. It specifically focuses on Rh sensitization.
B. The test will determine the amount of amniotic fluid around the fetus: The indirect Coombs' test does not assess the amount of amniotic fluid around the fetus. It is specifically aimed at detecting antibodies in the maternal blood.
C. The test studies blood flow in the fetus and placenta using ultrasound waves: This description is more indicative of a Doppler ultrasound or other tests that assess blood flow. The indirect Coombs' test is a blood test and does not involve ultrasound waves.
D. This test will detect the presence of Rh-positive antibodies in your blood
The indirect Coombs' test is performed during pregnancy to detect the presence of Rh antibodies in the maternal bloodstream. Rh antibodies can develop if an Rh-negative mother is carrying an Rh-positive baby, and there is a risk of hemolytic disease of the newborn (HDN) in subsequent pregnancies. The test helps identify if the mother has developed antibodies against Rh-positive blood, which could potentially affect the fetus.
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