Question 1

When entering the second phase of labor, a patient tells the nurse that the pain is severe and is unsure if pain medication should be used. Which nursing diagnosis should the nurse use to guide the care of the patient at this time?

A) Pain related to labor contractions
B) Powerlessness related to the duration and intensity of labor
C) Decision conflict related to the use of analgesia during labor
D) Anxiety related to lack of knowledge about normal labor processes

Decision conflict related to the use of analgesia during labor

Accepted Answer

The patient is in conflict regarding whether or not to use pain medication during labor at this time. This is an example of decisional conflict. The patient's need is much more than experiencing pain during labor contractions. There is no enough information to support that the patient is experiencing powerlessness. The patient is not demonstrating anxiety related to the labor process.

Question 2

A patient in labor is prescribed transcutaneous electrical nerve stimulation (TENS) to help with pain relief during labor. How should the nurse explain the process of pain relief with this method?&#10;A) Counterirritation stimulation blocks pain from traveling to the spinal cord.&#10;B) Needles are inserted along meridians to release endorphins and control pain.&#10;C) A machine is used to measure the patient's ability to relax during contractions.&#10;D) Small injections of sterile saline reduce are used to reduce the amount of back pain.

Accepted Answer

Transcutaneous electrical nerve stimulation (TENS) works to relieve pain by applying counterirritation to nociceptors. Low-intensity electrical stimulation blocks the afferent fibers, preventing pain from traveling to the spinal cord synapses from the uterus.
Needles being inserted along meridians to release endorphins explain acupuncture. A machine to measure the patient's ability to relax during contractions explains biofeedback. Small injections of saline to reduce back pain explain intracutaneous nerve stimulation.

Question 3

The health care provider is reluctant to provide pain medication to a patient delivering a preterm fetus. What should the nurse explain to the patient as the reason for the preterm fetus being more affected by medication?

A) Affinity of the preterm fetus to fat-soluble drugs
B) Inability of the immature liver to metabolize or inactivate drugs
C) Affinity of the preterm fetus to drugs that are strongly bound to protein
D) Inability of the preterm fetus to use drugs with a molecular weight over 1,000

Inability of the immature liver to metabolize or inactivate drugs

Accepted Answer

A preterm fetus, which has an immature liver and is unable to metabolize or inactivate drugs, is generally more affected by drugs than a term fetus. A preterm fetus does not have an affinity to drugs that are fat soluble or strongly bound to protein. The preterm fetus is not able to metabolize drugs because of an immature liver, which has nothing to do with the molecular weight of the medication.

Question 4

When teaching the pregnant patient about self-medicating for pain during labor, why did the nurse instruct the patient to avoid taking acetylsalicylic acid?&#10;A) Development of respiratory depression in the newborn&#10;B) Interference with the ability to concentrate on contractions&#10;C) Interference with blood coagulation with increased risk of bleeding in mother or infant&#10;D) Competition with bilirubin-binding sites in fetal circulation increases risk of kernicterus.

Accepted Answer

The nurse should caution the pregnant patient not to take acetylsalicylic acid (aspirin) for pain in labor because aspirin interferes with blood coagulation, increasing the risk for bleeding in the newborn or patient. Aspirin does not cause respiratory depression in the newborn, interfere with contractions, or compete with bilirubin-binding cites in fetal circulation.

Question 5

The nurse is preparing materials to instruct a pregnant patient about the use of a local anesthetic to block specific nerve pathways. About which type of pain reduction technique will the nurse instruct the patient?

A) General anesthesia
B) Pressure anesthesia
C) Regional anesthesia
D) Pudendal nerve block

Accepted Answer

Regional anesthesia is the injection of a local anesthetic to block specific nerve pathways. This achieves pain relief by blocking sodium and potassium transport in the nerve membrane so the nerve is unable to conduct sensations. General anesthesia is rarely used and is not referred to as being general anesthesia. Pressure anesthesia results from the fetal head pressing against the stretched perineum. A pudendal nerve block is the injection of a local anesthetic through the vagina to anesthetize the pudendal nerve.

Question 6

The nurse caring for pregnant patients is identifying interventions to support the 2020 National Health Goals regarding pain relief during labor. Which interventions support these goals? (Select all that apply.)

A) Encourage pregnant patients to prepare for childbirth by attending classes.
B) Discuss the advantages of using epidural or spinal anesthesia during labor.
C) Review the various opioid analgesics that can be used to control the pain of labor.
D) Review the different breathing techniques that help with pain control during labor.
E) Explain the various complementary and alternative therapies to help with pain control.

Accepted Answer

Nurses can help the nation achieve the 2020 National Health Goals regarding pain relief during labor by educating women about the advantages of preparing for childbirth and helping them to use breathing patterns or other complementary and alternative therapies and techniques during labor so they need a minimum of analgesia and anesthesia. These goals would not be achieved by discussing the use of epidural or spinal anesthesia or by reviewing the various opioid analgesics available for use during labor.

Question 7

The spouse of a pregnant patient is concerned about the risk of paralysis from an epidural block being used during labor. What should the nurse respond to the spouse's concern?&#10;A) &#34;I have never read or heard of this happening.&#34;&#10;B) &#34;The injection is given in the space outside the spinal cord.&#34;&#10;C) &#34;An injury is unlikely because of expert professional care given.&#34;&#10;D) &#34;The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem.&#34;

Accepted Answer

An anesthetic agent placed inside the ligamentum flavum in the epidural space is epidural anesthesia. An epidural is placed in the space at the L4-L5, L3-L4, or L2-L3 areas to block the spinal nerve roots in the space and the sympathetic nerve fibers that travel with them. The nurse should not minimize the spouse's concern because the nurse has never read or heard of this occurring. An injury can occur with any invasive procedure.

Question 8

A pregnant patient nearing her due date expresses anxiety over the labor and delivery process. Which outcome should the nurse select as appropriate for the patient during the delivery process?&#10;A) Patient requests pain medication throughout the labor process.&#10;B) Patient uses breathing techniques to control anxiety and pain during labor.&#10;C) Patient tolerates the use of sanitary napkins to absorb vaginal secretions during labor.&#10;D) Patient refuses complementary and alternative techniques to control pain during labor.

Accepted Answer

An outcome that indicates that the patient has less anxiety during labor and delivery would be the use of breathing techniques to control anxiety and pain during labor. Requesting pain medication, using sanitary napkins, and refusing complementary and alternative pain management techniques are not appropriate outcomes for labor and delivery.

Question 9

Immediately following an epidural block, a pregnant patient's blood pressure suddenly falls to 90/50 mmHg. What action should the nurse do first?&#10;A) Place the patient supine.&#10;B) Raise the head of the bed.&#10;C) Ask the patient to take deep breaths.&#10;D) Turn onto the left side or raise the legs.

Accepted Answer

To help prevent supine hypotension syndrome, place the pregnant patient on the left side after an epidural block. If hypotension should occur, the patient's legs should be raised in addition to providing oxygen, intravenous fluids, and medication. The supine position encourages hypotension syndrome. Raising the head of the bed and deep breathing are not interventions to help with hypotension syndrome.

Question 10

During labor, a pregnant patient's doula uses therapeutic touch and massage. Which outcome indicates that these approaches have been effective?&#10;A) The patient is not complaining of leg cramps.&#10;B) The patient is not requesting pain medication.&#10;C) The patient is focusing on a painting during contractions.&#10;D) The patient asks for a cold compress at the end of a contraction.

Accepted Answer

Touch and massage work to relieve pain by increasing the release of endorphins. Both techniques may also work because they serve as forms of distraction. Many women find massage helpful in the first and second stages of labor. The use of therapeutic touch and massage for the patient in labor is not used to reduce leg cramp. Focusing on a painting during contractions is a form of distraction. Asking for a cold compress at the end of a contraction is not directly related to the use of therapeutic touch and massage during labor.

Question 11

A patient in labor who is dilated 7 cm reports that narcotic pain medication given 3 hours ago has worn off and is asking for another dose. How should the nurse respond to this request?&#10;A) &#34;I will get permission from your doctor.&#34;&#10;B) &#34;Your stage of labor makes giving another dose unsafe.&#34;&#10;C) &#34;It is too early as the medication should be given only every 4 hours.&#34;&#10;D) &#34;Since it has been over 3 hours, you should be able to have more of the medication.&#34;

Accepted Answer

The answer of A patient in labor who is dilated...

Question 12

The physician of a patient in labor decides that an emergency cesarean birth is required to safely deliver the fetus. When preparing the operating room suite for this procedure, which medications should the nurse ensure are available for possible use? (Select all that apply.)

A) Diazepam
B) Ephedrine
C) Acetaminophen
D) Atropine sulfate
E) Lactated Ringer's solution

Accepted Answer

The answer of The physician of a patient in labor...

Question 13

A patient in labor with chronic back pain tells the nurse about taking a dose of hydrocodone/acetaminophen (Vicodin) for labor pain prior to coming to the hospital. What should the nurse prepare to do once the fetus is delivered?

A) Evaluate the fetus for withdrawal symptoms.
B) Inform the physician so that liver effects can be monitored.
C) Suggest that no additional narcotic pain medication be provided during labor.
D) Coach the patient in breathing techniques because other pain medication is contraindicated.
E) Request that the physician prescribe the same medication to be used for pain during labor.

Accepted Answer

The answer of A patient in labor with chronic back...

Question 14

A pregnant patient planning for labor is asking questions about pain control options. What should the nurse explain about pain control during labor?&#10;A) The physician will decide how much pain relief is needed during labor.&#10;B) Pain medication should be started immediately when contractions are thought to begin.&#10;C) Any medication should have maximum effect for the patient and minimal effect on the fetus.&#10;D) Any medication will interfere with the ability of the uterus to contract during labor and delivery.

Accepted Answer

The answer of A pregnant patient planning for labor is...

Question 15

A pregnant patient received a narcotic analgesic 2 hours before delivery. The newborn is lethargic and difficult to arouse. What should the nurse prepare to do to help this newborn?&#10;A) Administer intravenous fluids.&#10;B) Apply oxygen and place in a heated bassinet.&#10;C) Administer naloxone hydrochloride (Narcan).&#10;D) Provide tactile stimulation to encourage crying.

Accepted Answer

The answer of A pregnant patient received a narcotic analgesic...

Deck 16: The Nursing Role in Providing Comfort During Labor and Birth