Deck 17: Maximizing Comfort for the Laboring Woman

Question 1

A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes.She is groaning and perspiring excessively;she states that she did not attend childbirth classes.What is the optimal intervention for the nurse to provide initially?

A) Notify the woman's health care provider.
B) Administer the prescribed narcotic analgesic.
C) Assure her that her labor will be over soon.
D) Assist her with simple breathing and relaxation instructions.

Answer 1

Assist her with simple breathing and relaxation instructions.

Question 2

A woman in labor is breathing into a mouthpiece just before the start of her regular contractions.As she inhales,a valve opens,and gas is released.She continues to inhale the gas slowly and deeply until the contraction starts to subside.When the inhalation stops,the valve closes.Which statement regarding this procedure is correct?

A) The application of nitrous oxide gas is not often used anymore.
B) An inhalation of gas is likely to be used in the second stage of labor,not during the first stage.
C) An application of nitrous oxide gas is administered for pain relief.
D) The application of gas is a prelude to a cesarean birth.

Answer 2

An application of nitrous oxide gas is administered for pain relief.

Question 3

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients.Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor,when they become more vocal and request pain relief?

A) Chinese
B) Arab or Middle Eastern
C) Hispanic
D) African-American

Answer 3

Hispanic

Question 4

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing,which is approximately twice the normal adult breathing rate.She starts to report feeling lightheaded and dizzy and states that her fingers are tingling.Which intervention should the nurse immediately initiate?

A) Contact the woman's health care provider.
B) Tell the woman to slow her pace of her breathing.
C) Administer oxygen via a mask or nasal cannula.
D) Help her breathe into a paper bag.

Question 5

A laboring woman has received meperidine intravenously (IV),90 minutes before giving birth.Which medication should be available to reduce the postnatal effects of meperidine on the neonate?

A) Fentanyl
B) Promethazine
C) Naloxone
D) Nalbuphine

Question 6

An 18-year-old pregnant woman,gravida 1,para 0,is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds.The client states,"My contractions are so strong,I don't know what to do." What should the nurse's first action be?

A) Assess for fetal well-being.
B) Encourage the woman to lie on her side.
C) Disturb the woman as little as possible.
D) Recognize that pain is personalized

Question 7

Maternity nurses often must answer questions about the many,sometimes unusual,ways people have tried to make the birthing experience more comfortable.Which information regarding nonpharmacologic pain relief is accurate?

A) Music supplied by the support person must be discouraged because it could disturb others or upset the hospital routine.
B) Women in labor can benefit from sitting in a bathtub,but they must limit immersion to no longer than 15 minutes at a time.
C) Effleurage is permissible,but counterpressure is almost always counterproductive.
D) Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

Question 8

A first-time mother is concerned about the type of medications she will receive during labor.The client is in a fair amount of pain and is nauseated.In addition,she appears to be very anxious.The nurse explains that opioid analgesics are often used along with sedatives.How should the nurse phrase the rationale for this medication combination?

A) "The two medications,together,reduce complications."
B) "Sedatives enhance the effect of the pain medication."
C) "The two medications work better together,enabling you to sleep until you have the baby."
D) "This is what your physician has ordered for you."

Question 9

Which breathing pattern should the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple has attended childbirth preparation classes?

A) Slow-paced breathing
B) Deep abdominal breathing
C) Modified-paced breathing
D) Patterned-paced breathing

Question 10

Nursing care measures are commonly offered to women in labor.Which nursing measure reflects the application of the gate-control theory?

A) Massaging the woman's back.
B) Changing the woman's position.
C) Giving the prescribed medication.
D) Encouraging the woman to rest between contractions.

Question 11

A woman has requested an epidural for her pain.She is 5 cm dilated and 100% effaced.The baby is in a vertex position and is engaged.The nurse increases the woman's IV fluid for a preprocedural bolus.The nurse reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl,hematocrit is 38%,platelets are 67,000,and white blood cells (WBCs)are 12,000/mm³.Which factor would contraindicate an epidural for this woman?

A) She is too far dilated.
B) She is anemic.
C) She has thrombocytopenia.
D) She is septic.

Question 12

Anxiety is commonly associated with pain during labor.Which statement regarding anxiety is correct?

A) Even mild anxiety must be treated.
B) Severe anxiety increases tension,increases pain,and then,in turn,increases fear and anxiety,and so on.
C) Anxiety may increase the perception of pain,but it does not affect the mechanism of labor.
D) Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

Question 13

The nurse should be aware of which physiologic effect of labor pain?

A) Predominant pain of the first stage of labor is visceral pain that is in the lower portion of the abdomen.
B) Referred pain is the extreme discomfort experienced between contractions.
C) Somatic pain of the second stage of labor is more generalized and related to fatigue.
D) Pain during the third stage is a somewhat milder version of the pain experienced during the second stage.

Question 14

Which alterations in the perception of pain by a laboring client should the nurse understand?

A) Sensory pain for nulliparous women is often greater than for multiparous women during early labor.
B) Affective pain for nulliparous women is usually less than for multiparous women throughout the first stage of labor.
C) Women with a history of substance abuse experience more pain during labor.
D) Multiparous women have more fatigue from labor and therefore experience more pain.

Question 15

A woman in labor has just received an epidural block.What is the most important nursing intervention at this time?

A) Limit parenteral fluids.
B) Monitor the fetus for possible tachycardia.
C) Monitor the maternal blood pressure for possible hypotension.
D) Monitor the maternal pulse for possible bradycardia.

Question 16

A client is experiencing back labor and reports intense pain in her lower back.Which measure provided by the woman's labor coach would best support this woman in labor?

A) Counterpressure against the sacrum
B) Pant-blow (breaths and puffs)breathing techniques
C) Effleurage
D) Conscious relaxation or guided imagery

Question 17

The nurse should be aware of which important information regarding nerve block analgesia and anesthesia?

A) Most local agents are chemically related to cocaine and end in the suffix -caine.
B) Local perineal infiltration anesthesia is effective when epinephrine is added,but it can be injected only once.
C) Pudendal nerve block is designed to relieve the pain from uterine contractions.
D) Pudendal nerve block,if performed correctly,does not significantly lessen the bearing-down reflex.

Question 18

Which statement correctly describes the effects of various pain factors?

A) Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth.
B) Upright positions in labor increase the pain factor because they cause greater fatigue.
C) Women who move around trying different positions experience more pain.
D) Levels of pain-mitigating beta-endorphins are higher during a spontaneous,natural childbirth.

Question 19

According to professional standards which action cannot be performed by the non-anesthetist registered nurse who is caring for a woman with epidural anesthesia?

A) Monitoring the status of the woman and fetus
B) Initiating epidural anesthesia
C) Replacing empty infusion bags with the same medication and concentrate
D) Stopping the infusion,and initiating emergency measures

Question 20

A client is in early labor,and her nurse is discussing the pain relief options she is considering.The client states that she wants an epidural "no matter what!" What is the nurse's best response?

A) "I'll make sure you get your epidural."
B) "You may only have an epidural if your physician allows it."
C) "You may only have an epidural if you are going to deliver vaginally."
D) "The type of analgesia or anesthesia used is determined,in part,by the stage of your labor and the method of birth."

Question 21

What is the rationale for the use of a blood patch after spinal anesthesia?

A) Preventing related hypotension
B) Minimizing the risk of a spinal headache
C) Eliminating neonatal respiratory depression
D) Limiting the loss of movement

Question 22

Which alternative approaches to relaxation have proven successful when working with the client in labor? (Select all that apply. )

A) Aromatherapy
B) Massage
C) Hypnosis
D) Cesarean birth
E) Biofeedback

Question 23

The obstetric nurse is preparing the client for an emergency cesarean birth,with no time to administer spinal anesthesia,general anesthesia will be used.What is the greatest risk of administering general anesthesia to the client.?

A) Respiratory depression
B) Uterine relaxation
C) Inadequate muscle relaxation
D) Aspiration of stomach contents

Question 24

The class of drugs known as opioid analgesics (butorphanol,nalbuphine)is not suitable for administration to women with known opioid dependence.The antagonistic activity could precipitate withdrawal symptoms (abstinence syndrome)in both mothers and newborns.Which signs would indicate opioid withdrawal in the mother? (Select all that apply. )

A) Yawning,runny nose
B) Increase in appetite
C) Chills or hot flashes
D) Constipation
E) Irritability,restlessness

Question 25

What is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum?

A) Epidural
B) Pudendal
C) Local
D) Spinal block

Question 26

Maternal hypotension is a potential side effect of regional anesthesia and analgesia.What nursing interventions could the nurse use to increase the client's blood pressure? (Select all that apply. )

A) Place the woman in a supine position.
B) Place the woman in a lateral position.
C) Increase IV fluids.
D) Administer oxygen.
E) Perform a vaginal examination.

Question 27

A woman has requested an epidural block for her pain.She is 5 cm dilated and 100% effaced.The baby is in a vertex position and is engaged.The nurse increases the woman's IV fluid for a preprocedural bolus.Before the initiation of the epidural,the woman should be informed regarding the disadvantages of an epidural block.Which concerns should the nurse share with this client? (Select all that apply. )

A) Ability to move freely is limited.
B) Orthostatic hypotension and dizziness may occur.
C) Gastric emptying is not delayed.
D) Higher body temperature may occur.
E) Blood loss is not excessive.

Question 28

While developing an intrapartum care plan for the client in early labor,which psychosocial factors would the nurse recognize upon the client's pain experience? (Select all that apply. )

A) Culture
B) Anxiety and fear
C) Previous experiences with pain
D) Intervention of caregivers
E) Support systems