After an amniotomy, which action by the nurse takes priority?

The question is about a client who has been in the latent phase of labor for 12 hours and wants some medication to help her rest. The nurse has to predict which medication the healthcare provider will prescribe. The choices are:. • A. Fentanyl: a synthetic opioid that is used for pain relief and sedation. It is fast-acting and potent, but can cause respiratory depression and nausea. • B. Meperidine: a synthetic opioid that is used for pain relief and sedation. It is less potent than fentanyl, but can cause seizures and serotonin syndrome. • C. Morphine: a natural opioid that is used for pain relief and sedation. It is less potent than fentanyl, but can cause respiratory depression and itching. • D. Secobarbital: a barbiturate that is used for sedation and anesthesia. It is not an opioid, but can cause respiratory depression and addiction.

Choice A reason:

The cord is still pulsating. This is not the first thing a nurse must ensure when the head comes out because the cord normally pulsates until the placenta is delivered. The pulsation indicates that the cord is still functioning and transferring blood and oxygen between the baby and the placenta. However, this does not mean that the cord is free from any complications that could endanger the baby's life, such as a nuchal cord (a cord wrapped around the neck) or a prolapsed cord (a cord that slips out before the baby). • Choice B reason:

The cord is intact. This is not the first thing a nurse must ensure when the head comes out because the cord is usually intact until it is clamped and cut after the delivery of the baby. The cord can be ruptured by excessive traction or twisting, which can cause bleeding and shock in the baby. However, this is a rare occurrence and does not pose an immediate threat to the baby's life as long as the cord is still attached to the placenta. • Choice C reason:

No part of the cord is encircling the baby's neck. This is the correct answer because a nuchal cord can cause compression of the cord and reduce blood flow and oxygen to the baby, leading to fetal distress, hypoxia, and brain damage. A nuchal cord occurs in about 10 to 30 percent of deliveries and can be detected by feeling for a loop of cord around the neck as the head emerges. If a nuchal cord is present, it should be gently slipped over the head or clamped and cut before delivery of the shoulders. • Choice D reason:

The cord is still attached to the placenta. This is not the first thing a nurse must ensure when the head comes out because the cord is always attached to the placenta until it separates from the uterine wall and is expelled after the delivery of the baby. The placenta provides nourishment and oxygen to the baby through the cord. However, this does not mean that the cord is free from any complications that could endanger the baby's life, such as a nuchal cord or a prolapsed cord.