In the context of developing a realistic birth plan with a pregnant client, what is a major advantage of nonpharmacologic pain management?

Choice A rationale:

Performing a vaginal exam is not the priority intervention for a client experiencing hypotension after an epidural. While a vaginal exam may be necessary to assess cervical dilation and fetal station, it does not address the underlying cause of the client's hypotension.

Additionally, a vaginal exam could potentially worsen the client's hypotension by stimulating the vagus nerve, which can lead to decreased heart rate and blood pressure.

Therefore, it is not the most appropriate initial response in this situation.

Choice B rationale:

Turning the client onto her side is the most appropriate initial response to hypotension after an epidural. This position helps to increase venous return to the heart, which can improve cardiac output and blood pressure.

It also helps to prevent aortocaval compression, which can occur when the pregnant uterus compresses the inferior vena cava, reducing blood flow back to the heart.

By turning the client onto her side, the nurse can quickly and easily address the underlying cause of the hypotension and help to improve the client's hemodynamic status.

Choice C rationale:

Catheterizing the client may be necessary if the client is unable to void spontaneously, but it is not the priority intervention for hypotension after an epidural.

Urinary retention can occur after an epidural, but it is not typically the cause of hypotension in this setting.

Therefore, catheterization would not be the most appropriate initial response.

Choice D rationale:

Decreasing the IV fluid rate may be necessary if the client is experiencing fluid overload, but it is not the priority intervention for hypotension after an epidural.

In fact, decreasing the IV fluid rate could potentially worsen the hypotension by reducing the circulating blood volume.

Therefore, it is not the most appropriate initial response.

The correct answer is C. The test results are normal.

Choice A rationale:

A biophysical profile (BPP) score of 8 does not necessarily indicate a need for immediate cesarean delivery.

Cesarean delivery is typically reserved for cases where there is a clear and urgent risk to the health of the mother or fetus, such as severe fetal distress or placental abruption.

A score of 8, while not the highest possible score, is still within the normal range and does not, by itself, constitute a reason for immediate surgical intervention.

Choice B rationale:

Additional tests may be considered in certain cases, such as when the BPP score is borderline or when there are other risk factors present.

However, a score of 8 is generally considered reassuring and does not typically warrant further testing.

It's essential to evaluate the BPP score in the context of the overall clinical picture, including the gestational age, maternal health, and fetal history.

Choice D rationale:

While an obstetric specialist may review the BPP results and discuss delivery options with the patient, this is not typically done within a week for a score of 8.

A score of 8 indicates reassuring fetal well-being, and there is usually no need for such urgent consultation or decision-making.

The timing of delivery discussions would depend on the overall clinical situation and the patient's individual preferences.

Choice C rationale:

A BPP score of 8 is considered normal.

It suggests that the fetus is well-oxygenated and has normal heart rate, breathing movements, muscle tone, and amniotic fluid levels.

This score does not raise immediate concerns about fetal well-being and does not typically require any immediate interventions.