A nurse is attending to a patient in labor who has received an epidural anesthesia block. The patient’s blood pressure reads 80/40 mm Hg and the fetal heart rate is 140/min.
What should be the nurse’s immediate course of action?
Monitor vital signs every 5 minutes.
Elevate the patient’s legs.
Notify the healthcare provider.
Position the patient laterally.
Position the patient laterally.
The Correct Answer is D
If a patient in labor who has received an epidural anesthesia block has a blood pressure reading of 80/40 mm Hg, the nurse’s immediate course of action should be to position the patient laterally. This helps to maximize venous return and cardiac output, thereby improving maternal blood pressure and fetal perfusion.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Cervical dilation is a key sign that a patient is in labor. As labor progresses, the cervix dilates to allow the baby to pass through the birth canal. Other signs of labor can include regular contractions, rupture of membranes (amniotic fluid present in the vaginal vault), and changes in vaginal discharge.
Correct Answer is A
Explanation
Choice A rationale
Methylergonovine is a medication that is primarily used to prevent or treat excessive bleeding after childbirth. It works by increasing the rate and strength of contractions and the stiffness of the uterus muscles, which helps to decrease bleeding. This medication is given in a hospital or clinic setting. Therefore, the nurse should inform the client that this medication is intended to prevent postpartum hemorrhage.
Choice B rationale
While preventing postpartum infection is important, methylergonovine is not specifically used for this purpose. Postpartum infection is typically prevented and treated with antibiotics and good hygiene practices.
Choice C rationale
Thromboembolic events, such as blood clots, can be a risk after childbirth. However, methylergonovine is not used to prevent these events. Anticoagulant medications are typically used to prevent thromboembolic events.
Choice D rationale
Methylergonovine is not used to prevent hypertension. In fact, it can cause increased blood pressure as a side effect. Therefore, it would not be used as a preventative measure for hypertension.
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