A bone marrow aspiration and biopsy are needed on a school-age ...

[ap345]

A bone marrow aspiration and biopsy are needed on a school-age child. The most appropriate action to provide analgesia during the procedure is which?
 
  a. Administer TAC (tetracaine, adrenalin, and cocaine) 15 minutes before the procedure.
  b. Use a combination of fentanyl and midazolam for conscious sedation.
  c. Apply EMLA (eutectic mixture of local anesthetics) 1 hour before the procedure.
  d. Apply a transdermal fentanyl (Duragesic) patch immediately before the procedure.

Question 2

A patient at 41 weeks' gestation is undergoing an induction of labor with an IV administration of oxytocin (Pitocin). The fetal heart rate starts to demonstrate a recurrent pattern of late decelerations with moderate variability.
 
  What is the nurse's priority action?
 
  a. Stop the infusion of Pitocin.
  b. Reposition the patient from her right to her left side.
  c. Perform a vaginal exam to assess for a prolapsed cord.
  d. Prepare the patient for an emergency cesarean section.

[Jane]

Answer to Question 1

ANS: B
A bone marrow biopsy is a painful procedure. The combination of fentanyl and midazolam should be used to provide conscious sedation. TAC provides skin anesthesia about 15 minutes after it is applied to nonintact skin. The gel can be placed on a wound for suturing. It is not sufficient for a bone marrow biopsy. EMLA is an effective topical analgesic agent when applied to the skin 60 minutes before a procedure. It eliminates or reduces the pain from most procedures involving skin puncture. For this procedure, systemic analgesia is required. Transdermal fentanyl patches are useful for continuous pain control, not rapid pain control.

Answer to Question 2

ANS: A
There are multiple reasons for late decelerations. Address the probable cause first, such as uterine hyperstimulation with Pitocin, to alleviate the outcome of late decelerations. Repositioning can increase oxygenation to the fetus but does not address the cause of the problem. Variable decelerations are more often seen with a prolapsed cord. In the presence of moderate variability, the fetus continues to have adequate oxygen reserves. The presence of two or more nonreassuring fetal heart rate patterns increases the level of concern.

[ap345]

TYSM

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