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A nurse is caring for a client who is in active labor and requesting an epidural. Which of the following actions should the nurse take?

A.

Give ondansetron IV to the client.

B.

Administer IV fluid bolus to the client.

C.

Delay the epidural until the client is dilated to 7 cm.

D.

Initiate oxygen via nonrebreather to support patterned breathing

Answer and Explanation

The Correct Answer is B

A. Ondansetron is used to treat nausea but is not a routine pre-epidural intervention.
B.  Administering an IV fluid bolus before epidural anesthesia helps prevent hypotension caused by sympathetic blockade.
C. Epidurals can be administered earlier than 7 cm dilation based on maternal request and clinical assessment.
D. Oxygen administration is not routinely required before an epidural unless fetal distress or maternal hypoxia is present.


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Related Questions

Correct Answer is C

Explanation

A. The tape measure should be placed vertically, not horizontally, over the abdomen to measure fundal height accurately.
B. The client should be in a supine position, not left-lateral, during the measurement.
C. Fundal height is measured from the upper border of the symphysis pubis to the upper border of the uterine fundus.
D. A full bladder can distort the measurement, so the client should have an empty bladder before measuring fundal height.

Correct Answer is C

Explanation

A. The car seat should remain rear-facing until at least age 2, or until the child reaches the maximum height and weight limit specified by the manufacturer, not just until 12 months.
B. The retainer (chest) clip should be positioned at the level of the infant's armpits, not the abdomen, to ensure proper restraint.
C. Positioning the car seat at a 45° angle helps keep the infant’s airway open and reduces the risk of aspiration or airway obstruction.
D. For rear-facing seats, the harness straps should be at or below the baby's shoulders, not above.

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