A nurse is positioning a client for a cesarean birth. To prevent a compromise in placental blood flow during the intraoperative period, which of the following actions should the nurse take?
Insert a pillow under the client's knees.
Assist the client into the lithotomy position,
Place a wedge under one of the client's hips.
Position the client in reverse Trendelenburg.
The Correct Answer is C
A) Insert a pillow under the client's knees: While placing a pillow under the knees may promote comfort, it can lead to increased pressure on the lower back and may not effectively address potential compression of the vena cava, which is crucial in maintaining optimal placental blood flow during surgery.
B) Assist the client into the lithotomy position: The lithotomy position can increase pressure on the abdominal vessels, potentially compromising blood flow to the placenta. This position should be used cautiously, especially in clients with concerns regarding blood flow.
C) Place a wedge under one of the client's hips: This action is appropriate as it helps to displace the uterus laterally, reducing pressure on the inferior vena cava. This maneuver improves venous return and maintains placental perfusion, which is critical during cesarean delivery.
D) Position the client in reverse Trendelenburg: Although this position elevates the upper body, it does not specifically address the potential for vena cava compression caused by the weight of the uterus. It is less effective than placing a wedge under the hips in terms of preserving placental blood flow.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A) Fetal anemia:Fetal anemia typically causes tachycardia (increased heart rate) rather than bradycardia (decreased heart rate). It is not a common cause of fetal bradycardia.
B) Maternal hypoglycemia:Maternal hypoglycemia can lead to decreased glucose availability for the fetus, resulting in fetal bradycardia. It is important to monitor and manage maternal blood glucose levels to ensure adequate fetal oxygenation and prevent bradycardia.
C) Chorioamnionitis:Chorioamnionitis, an infection of the amniotic fluid and membranes, usually causes fetal tachycardia rather than bradycardia. It is associated with an increased fetal heart rate due to the inflammatory response.
D) Maternal fever:Maternal fever is more likely to cause fetal tachycardia due to the increased metabolic rate and oxygen demand. It is not typically associated with fetal bradycardia.
Correct Answer is D
Explanation
A. Face: While jaundice can sometimes be observed on the face, it is not the most reliable area for assessment in clients with dark skin, as changes may be less visible due to pigmentation.
B. Palms of the hands: The palms can show signs of jaundice, but they may not be the best area to assess for this condition in clients with darker skin tones. Jaundice is typically more detectable in areas with less pigmentation.
C. Shoulders: The shoulders do not provide a reliable assessment area for jaundice, as skin tone can vary widely and may obscure subtle changes in color.
D. Sclera: The sclera (the white part of the eye) is the most appropriate area to assess for jaundice, regardless of skin color. Yellowing of the sclera is a classic sign of jaundice and can be easily observed in clients with dark skin.
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