I took exam last week. I only got 3 questions wrong out of 50, but there was one question I got wrong and the instructor cannot tell me why. So today, I went to the maternity book and now confirmed my answer was right.
The question was about a woman who received Epidural, and her blood pressure dropped from 150/70 to 90/56 and what would the nurse do.
A. Administer Oxygen
B. Turn her to L side or raise her legs
C. Contact the physician
D. Document
According to Pilitteri, a woman receiving Epidural should remain on her side. If hypotension does occur, raising the woman's legs and administer oxygen. I know option B is partial correct, but my answer was A, and that is correct. I know left side is usually with uteroplacental insuffiency (deceleration) or epidural anesthesia, not injection.
I still wish nursing test questions were more precise though. If the point of the question is to evaluate a student's prioritization skills, then the question should ask flat out which of the following appropriate nursing actions should be done FIRST.
If the point is to identify what *immediate* actions need to be taken in this scenario, then this should be a "choose all that apply" question to test if the student remembers BOTH patient positioning and the administration of oxygen are important.
Student do make mistakes regarding ABC and priority. Base on the question what would be your initial action before giving oxygen is to position the patient on her left side while given oxygen is a premature action and again you need physician order before you can give oxygen. Even in an emergency patent airway with patient position laterally to avoid aspiration. hope my point make sense.
From the 4 options I am very sure of option B. Because if hypotention is notice from administration of Epidural, the first initial action is to position the pt on her left side, then notify the physician and the physician right an order for administaion of oxygen. you as a nurse can not administer oxygen without an order. All the option listed are priority but the first is POSITION. Do hope i make sense with this suggestion. Thanks
As Jolie mentioned, O2 administration in an emergency is almost always part of any unit's standing orders or their policy and procedure. You take care of this critical need first and worry about getting a more formal order later. And that only makes sense. No decent doc on the planet wants his patient turning blue while you look up the phone number to get that order.
That said, I would have chosen B. That option actually supports the ABCs better and faster than applying O2 as it can immediately redirect the blood supply to where it's needed and the improved perfusion will deliver additional oxygen all by itself.
I got the extra two points....she cannot argue with Pilliteri textbook...that's why I always read the book...I got a 96%!!!
I will remember though, in the Nclex...turn pt to the L side. The instructor actually had another question with Variable Decelarations, when Turn to the L was the answer and I did get it right.
And the book that you are mentioning again, mentions turning the patient first as well. Oxygen is not going to do any good if patient is hypotensive and on their back and has an epidural in place. This is what we are trying to explain and what the book that you are quoting also states to do.
Not all beds have O2 set-up and ready to go, they should but they do not. Chances are that you still have to get the cannula and place it in her nose of geta mask, hook it to the O2 and then turn it on. Always much faster to turn the patient first. Even fi you gave the O2, without the patient being turned, it would not help the baby and that is what your goal should be. What if you needed to page RT to bring a set-up; would you leave the patient on their back and wait for the oxygen first? I do hope not.
Nursing is more common sense than anything else. And a question should not even have to use the word priority in it. All of those choices were things that actually would need to be done, the order of them is what is important. And a baby's life is going to depend on it.
Look at it from the other way:
G-d forbid there were any types of issues that happened when this infant was born and someone decided to sue, they would go after the patient's records from the hospital and check to see what was done in what order. Turning the patient so that you get better blood supply and oxygen to the baby/fetus is going to be your #1 goal and anything less, you are open to a lawsuit. Same thing for how you would handle decels. What are you going to do to get the heart rae back up on the infant even if the mother does not have an epidural?
Anytime that you are going to be caring for a patient for your entire career: You are always going to need to prioritize, what would you do first, who would you see first. This is not any different and a question does not need to state that.
If you had a question like this on the NCLEX exam and used A as your answer, then you would not be getting credit for it.
Just so you know...you can administer Oxygen if it is an emergency situation, in which this one is. You will just inform the Dr. that you administered it and he will write the order afterward. No Dr. is going to disagree with your decision because it was an emergency. I know they teach us that it has to be a Dr.'s order, but in the real world, our instructor told us otherwise.
Pillitteri, A. (2007). Maternal & child health nursing: Care of the childbearing and childrearing family. (5th edition). Philadelphia: Lippincott, Williams, & Wilkins (Epidural Injection), page 552
jjjoy, LPN
2,801 Posts
Suzanne, your explanations make sense.
I still wish nursing test questions were more precise though. If the point of the question is to evaluate a student's prioritization skills, then the question should ask flat out which of the following appropriate nursing actions should be done FIRST.
If the point is to identify what *immediate* actions need to be taken in this scenario, then this should be a "choose all that apply" question to test if the student remembers BOTH patient positioning and the administration of oxygen are important.