A patient received epidural anesthesia during the first stage of ...

[nelaaney]

A patient received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This patient is at increased risk for which problem during the fourth stage of labor?
 
  1. Nausea
  2. Bladder distention
  3. Uterine atony
  4. Hypertension

Question 2

One day after giving birth vaginally, a patient develops painful vesicular lesions on her perineum and vulva. She is diagnosed with a primary herpes simplex 2 infection. The expected care for her neonate includes:
 
  1. Meticulous hand washing and antibiotic eye ointment administration.
  2. Intravenous acyclovir (Zovirax) and contact precautions.
  3. Cultures of blood and CSF and serial chest x-rays every 12 hours.
  4. Parental rooming-in and four intramuscular injections of penicillin.

[honnalora]

Answer to Question 1

2
Rationale 1: The epidural is discontinued after delivery, decreasing the likelihood of nausea.
Rationale 2: Bladder distention can be a result of decreased bladder sensation in the fourth stage.
Rationale 3: Uterine atony is not a result of epidurals.
Rationale 4: Hypotension, not hypertension, is an early side effect of epidurals.

Answer to Question 2

2
Rationale 1: Although meticulous hand washing by staff and parents is important, antibiotic eye ointment is used for conjunctivitis of gonorrhea or chlamydia.
Rationale 2: These are appropriate measures for an infant at risk for developing herpes simplex 2 infection.
Rationale 3: These cultures are appropriate, but chest x-rays are not indicated. Chest x-rays are obtained if the neonate is thought to have group B strep pneumonia.
Rationale 4: Parental rooming-in is encouraged, but penicillin does not treat viral illness.