83. A client, who is gravida 1, para 0, is at 39 weeks' gestation. She has an uncomplicated prenatal history. Her recent cervical examination reveals that she is 4 to 5 cm dilated, 100% effaced, and at a +1 station. She is asking for an epidural for labor pain control. Which order should a nurse anticipate to prevent hypotension in this client?
. Administer a 500-to 2,000-mL bolus of IV fluid.
. Administer oxygen at 12 L/min via face mask.
. Place the client in high Fowler's position.
. Administer epinephrine to raise her blood pressure.
Test-Taking Tip
The key word in this question is "prevent." Preventing a side effect is different than treating the condition. An IV fluid bolus prevents hypotension; epinephrine treats hypotension after it has developed.
Content Area: Maternity, Intrapartum; Integrated Process: Nursing Process, Planning; Cognitive Level: Application; Client Need/Subneed: Physiological Integrity/Pharmacological and Parenteral Therapies/Expected Effects/Outcomes
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Answer 1 is correct because administering a fluid bolus before beginning the epidural can prevent hypotension that is associated with anesthesia administration. Answer 2 is incorrect because administering oxygen can assist in providing additional oxygen to the fetus, but does not prevent hypotension. Answer 3 is incorrect because placing the client in high Fowler's position will not prevent hypotension, and may actually decrease the effectiveness of the epidural anesthesia by decreasing the dermatome level. Answer 4 is incorrect because administering epinephrine is not an appropriate prevention measure. It is used to treat, not prevent, hypotension.