Labor Pain Mgt and Fetal Assessment_EAQ

A laboring client expresses concern about the effect that an intravenous analgesic may have on her fetus. What is the best response by the nurse to reassure the client?

Correct3 "It will be administered during a contraction, when the uterine blood vessels are constricted." Giving the medication during a contraction, when the uterine vessels are constricted, keeps the medication within the maternal vascular system for several seconds and decreases the impact on the fetus. The other options are incorrect because none of these responses involves administration during a contraction.

A nurse is observing the electronic fetal monitor as a client in labor enters the second stage. The nurse identifies early decelerations of the fetal heart rate with a return to the baseline at the end of each contraction. What does this fetal heart rate pattern usually indicate?

Correct4 Fetal head compression Early decelerations are expected occurrences as the fetal head passes through the birth canal; the fetal heart rate returns to baseline quickly, indicating fetal well-being. The data do not indicate that the mother has diabetes. Variable decelerations occur with umbilical cord compression, not prolapse. Maternal hypotension will cause late decelerations because of fetal hypoxia. Test-Taking Tip: Avoid spending excessive time on any one question. Most questions can be answered in 1 to 2 minutes.

While caring for a client in labor, the nurse notes that during a contraction there is a 15-beat-per-minute acceleration of the fetal heart rate above the baseline. What is the nurse's most appropriate action at his time?

Correct3 Record the fetal response to contractions and continue to monitor the heart rate. Periodic accelerations are the most reassuring of fetal heart rate indicators, regardless of the cause. This increase in the fetal heart rate does not require intervention by the practitioner at this time. Turning the mother on her left side to increase venous return is done when a fetal heart rate deceleration occurs. This is not a fetal heart rate abnormality and does not require a specific amount of time for observation; if the interventions are effective, monitoring should continue as before.

The nurse is preparing a client for epidural anesthesia. Which client statement would cause the nurse to stop the placement of the epidural catheter?

Correct1 "I'm not exactly sure how an epidural works." A description of the various anesthetic techniques and what they entail is essential to informed consent, even if the woman received information about analgesia and anesthesia earlier in her pregnancy. Nurses play a significant role in the informed consent process by clarifying and describing procedures or by acting as the woman's advocate and asking the primary healthcare provider for further explanation. There are three essential components of an informed consent. First, the procedure and its advantages and disadvantages must be thoroughly explained. Second, the woman must agree with the plan of labor pain management as explained to her. Third, her consent must be given freely without coercion or manipulation from the healthcare provider. Test-Taking Tip: Make educated guesses when necessary.

A woman at 40 weeks' gestation is admitted in active labor. When the client reaches 5 centimeters dilation, the woman asks for and receives epidural analgesia. Once the epidural catheter has been inserted, which assessments and interventions should be performed? Select all that apply.

Correct1 Maintaining intravenous fluid administration Correct2 Having oxygen available in case of hypotension Correct3 Checking the bladder for distention every 2 hours Correct5 Monitoring fetal heart rate and labor progress per hospital protocol Hypotension is a common problem in the client receiving epidural analgesia. Intravenous fluids can help counter this problem and also provide a vehicle for emergency drug administration. Oxygen should be available in case of hypotension as a result of the epidural block or as emergency care should the anesthetic agent migrate upward. Because sensation below the waist will be compromised, the client may be unaware of bladder distention, a situation that can occur with labor, possibly resulting in trauma to the bladder. Fetal heart tones and the progress of labor should be monitored. The client should be positioned on her side to prevent vena cava syndrome. Labor may be slowed by the epidural, but it is not essential that a woman receiving an epidural have oxytocin to maintain the labor pattern.

Late decelerations are present on the monitor strip of a client who received epidural anesthesia 20 minutes ago. What should the nurse do immediately?

Correct1 Reposition the client from supine to left lateral Hypotension is a common side effect of epidural anesthesia that results in decreased placental perfusion and late decelerations on the fetal monitor. The priority intervention is repositioning the client to relieve compression of the vena cava and increase venous return, which in turn increases placental perfusion. Administering oxygen and increasing the flow rate are correct interventions, but neither is the priority because these interventions would not be effective until compression of the vena cava has been relieved and placental perfusion increased. Assessing the maternal blood pressure for a systolic pressure below 100 mm Hg only provides data and does not correct the late deceleration. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions.

An internal fetal monitor is applied while a client is in labor. What should the nurse explain to the client regarding positioning while the monitor is in place?

Correct1 The most comfortable position may be assumed. Because electrodes are placed internally (on the fetal scalp, not on the mother's abdomen), position does not affect the monitor. Although the supine position does not affect the monitor, it should be discouraged because the pressure of the gravid uterus inhibits venous return, leading to reduced cardiac output. The side-lying position is recommended because it promotes maternal-fetal circulation. It is not the position but the internal placement of electrodes on the fetal scalp that ensures accurate monitoring. Constant monitoring provides continuous ongoing assessment of fetal status; there is no reason to detach the leads.

Select the priority intervention for a pregnant client whose monitor strip shows fetal heart rate decelerations characterized by a rapid descent and ascent to and from the lowest point of the deceleration.

Correct2 Repositioning the client from side to side A deceleration with a rapid descent and ascent to and from the lowest point of the deceleration is a variable deceleration caused by cord compression. Changing the client's position from side to side promotes release of the compression. Elevating the legs and increasing the rate of intravenous fluid administration are interventions for placental perfusion problems and do not affect cord compression. Oxygen given while the cord remains compressed will not provide fetal oxygenation.

A client in active labor has requested epidural anesthesia for pain management. The anesthetist has completed an evaluation, and the nurse has initiated an intravenous fluid bolus. The client's partner asks why this is necessary. What is the best explanation?

Correct2 There is a risk of hypotension, and the large amount of IV fluid reduces this risk. Once an epidural is initiated there is a risk of hypotension (low blood pressure), which may result in fetal distress. This risk is reduced by the administration of 500 to 2000 mL. Epidural medication is administered through a catheter placed by the anesthetist. Quoting institutional policy does not provide the explanation for administering the solution. Providing 500 mL of fluid is useful in counteracting the risk of hypotension; however, it is not given as a means of determining that the line is patent before the administration of medication.

At 38 weeks' gestation a client is admitted to the birthing unit in active labor, and an external fetal monitor is applied. Late fetal heart rate decelerations begin to appear when her cervix is dilated 6 cm, and her contractions are occurring every 4 minutes and lasting 45 seconds. What is the likely cause of these late decelerations?

Correct2 Uteroplacental insufficiency Late decelerations are indicative of uteroplacental insufficiency and, left uncorrected, lead to fetal hypoxia, fetal myocardial depression, or both. The imminence of birth cannot be determined from fetal heart rate decelerations, only from cervical dilation. Birth occurs after the cervix has dilated to 10 cm and the fetus has passed through the birth canal. Nonprogressive labor cannot be determined from fetal heart rate decelerations, only from cervical dilation. Late decelerations are not expected, are not reassuring, and must not be ignored.