A nurse is collecting data from a client who is receiving epidural anesthesia.Which of the following findings indicates an adverse effect of this method of pain management?
Hypertension.
Tachypnea.
Tachycardia.
Fever.
The Correct Answer is D
Choice A rationale
Hypertension is not a common adverse effect of epidural anesthesia. In fact, epidurals can cause hypotension due to the blockade of sympathetic nerves.
Choice B rationale
Tachypnea is not typically associated with epidural anesthesia. Common side effects include low blood pressure and headache.
Choice C rationale
Tachycardia is not a common adverse effect of epidural anesthesia. More common side effects include low blood pressure and urinary retention.
Choice D rationale
Fever is a known adverse effect of epidural anesthesia. It can occur due to the body’s response to the epidural procedure.
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Correct Answer is B
Explanation
Choice A rationale
Not wanting to call the baby by name until the baby is born can be a cultural or personal preference and does not necessarily indicate effective adaptation to the new role. It may reflect a cautious approach to the pregnancy but does not provide evidence of active preparation or involvement.
Choice B rationale
Starting to paint the baby’s room is a proactive behavior that indicates the partner is preparing for the baby’s arrival. It shows that the partner is taking steps to create a welcoming environment for the baby, which is a positive sign of adaptation to the new role.
Choice C rationale
Looking forward to sharing hobbies with the child in the future is a positive indication of the partner’s excitement and anticipation for the baby’s growth and development. However, it does not directly reflect immediate preparation or involvement in the pregnancy.
Choice D rationale
Waiting until the baby is born to share the news with coworkers may reflect a cautious approach to the pregnancy but does not indicate active involvement or preparation for the baby’s arrival. It may be a personal preference but does not demonstrate effective adaptation to the new role.
Correct Answer is C
Explanation
Choice A rationale
Verifying that the newborn is Rh-negative is not necessary for administering Rh(D) immune globulin. The medication is given to Rh-negative mothers to prevent Rh sensitization, regardless of the newborn’s Rh status.
Choice B rationale
A positive Coombs test indicates that the mother has already been sensitized to Rh-positive blood cells, making Rh(D) immune globulin ineffective in preventing sensitization.
Choice C rationale
Administering Rh(D) immune globulin within 72 hours after birth is crucial to prevent Rh sensitization in future pregnancies. This timing ensures that the mother’s immune system does not produce antibodies against Rh-positive blood cells.
Choice D rationale
Rh(D) immune globulin is typically administered intramuscularly, not into the abdomen. The preferred sites are the deltoid muscle or the anterolateral aspect of the thigh.