Deck 14: Pain Management

Question 1

A first-time mother is concerned about the type of medications she will receive during labor.She is in a fair amount of pain and is nauseous.In addition,she appears to be very anxious.You explain that opioid analgesics often are used with sedatives because:

A)"The two together work the best for you and your baby."
B)"Sedatives help the opioid work better, and they also will assist you to relax and relieve your nausea."
C)"They work better together so you can sleep until you have the baby."
D)"This is what the doctor has ordered for you."

Answer 1

"Sedatives help the opioid work better, and they also will assist you to relax and relieve your nausea."

Question 2

If an opioid antagonist is administered to a laboring woman,she should be told that:

A)Her pain will decrease.
B)Her pain will return.
C)She will feel less anxious.
D)She will no longer feel the urge to push.

Answer 2

Her pain will return.

Question 3

To help clients manage discomfort and pain during labor,nurses should be aware that:

A)The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
B)Referred pain is the extreme discomfort between contractions.
C)The 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 second stage.

Answer 3

The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.

Question 4

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 intravenous fluid for a preprocedural bolus.She 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 the woman?

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

Question 5

The role of the nurse with regard to informed consent is to:

A)Inform the client about the procedure and have her sign the consent form.
B)Act as a client advocate and help clarify the procedure and the options.
C)Call the physician to see the client.
D)Witness the signing of the consent form.

Question 6

A laboring woman received an opioid agonist (meperidine)intravenously 90 minutes before she gave birth.Which medication should be available to reduce the postnatal effects of Demerol on the neonate?

A)Fentanyl (Sublimaze)
B)Promethazine (Phenergan)
C)Naloxone (Narcan)
D)Nalbuphine (Nubain)

Question 7

With regard to breathing techniques during labor,maternity nurses should understand that:

A)Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction.
B)By the time labor has begun, it is too late for instruction in breathing and relaxation.
C)Controlled breathing techniques are most difficult near the end of the second stage of labor.
D)The patterned-paced breathing technique can help prevent hyperventilation.

Question 8

Nursing care measures are commonly offered to women in labor.Which nursing measure reflects 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 9

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help clients.Nurses should know that _____ women may be stoic until late in labor,when they may become vocal and request pain relief.

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

Question 10

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 are experiencing more pain.
D)Levels of pain-mitigating b-endorphins are higher during a spontaneous, natural childbirth.

Question 11

The nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if:

A)The mother gives birth without any analgesic or anesthetic.
B)The mother and family's priorities and preferences are incorporated into the plan.
C)The primary health care provider decides the best pain relief for the mother and family.
D)The nurse informs the family of all alternative methods of pain relief available in the hospital setting.

Question 12

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing,which is about twice the normal adult breathing rate.She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling.The nurse should:

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

Question 13

With regard to a pregnant woman's anxiety and pain experience,nurses should be aware that:

A)Even mild anxiety must be treated.
B)Severe anxiety increases tension, which increases pain, which 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 14

A woman is experiencing back labor and complains of intense pain in her lower back.An effective relief measure would be to use:

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

Question 15

A woman in active labor receives an analgesic opioid agonist.Which medication relieves severe,persistent,or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease?

A)Meperidine (Demerol)
B)Promethazine (Phenergan)
C)Butorphanol tartrate (Stadol)
D)Nalbuphine (Nubain)

Question 16

In the current practice of childbirth preparation,emphasis is placed on:

A)The Dick-Read (natural) childbirth method.
B)The Lamaze (psychoprophylactic) method.
C)The Bradley (husband-coached) method.
D)Having expectant parents attend childbirth preparation in any or no specific method.

Question 17

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

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 for each individual.

Question 18

A woman in labor has just received an epidural block.The most important nursing intervention is to:

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 19

Nurses should be aware of the differences experience can make in labor pain such as:

A)Sensory pain for nulliparous women often is greater than for multiparous women during early labor.
B)Affective pain for nulliparous women usually is 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 20

Maternity nurses often have to answer questions about the many,sometimes unusual ways people have tried to make the birthing experience more comfortable.For instance,nurses should be aware that:

A)Music supplied by the support person has to 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 21

Many women seek alternative or complementary pain relief during labor to delay or avoid pharmacologic or invasive therapies. Evidence regarding the use of these modalities has been sparse, and so they remain underutilized. Published reviews of the best-known therapies identified the benefits of each modality for the woman in labor. Please match the alternative modality with the correct research finding.

Significantly decreased use of analgesia,shorter labor

A)Yoga
B)Massage
C)Acupuncture
D)Water immersion
E)Aromatherapy

Question 22

Many women seek alternative or complementary pain relief during labor to delay or avoid pharmacologic or invasive therapies. Evidence regarding the use of these modalities has been sparse, and so they remain underutilized. Published reviews of the best-known therapies identified the benefits of each modality for the woman in labor. Please match the alternative modality with the correct research finding.

No difference when compared with placebo

A)Yoga
B)Massage
C)Acupuncture
D)Water immersion
E)Aromatherapy

Question 23

Many women seek alternative or complementary pain relief during labor to delay or avoid pharmacologic or invasive therapies. Evidence regarding the use of these modalities has been sparse, and so they remain underutilized. Published reviews of the best-known therapies identified the benefits of each modality for the woman in labor. Please match the alternative modality with the correct research finding.

Less pain intensity,decreased use of analgesia,fewer instrumental births

A)Yoga
B)Massage
C)Acupuncture
D)Water immersion
E)Aromatherapy

Question 24

Maternal hypotension is a potential side effect of regional anesthesia and analgesia.What nursing interventions could you use to raise 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 intravenous (IV) fluids.
D)Administer oxygen.
E)Perform a vaginal examination.

Question 25

The laboring woman who imagines her body opening to let the baby out is using a mental technique called:

A)Dissociation.
B)Effleurage.
C)Imagery.
D)Distraction.

Question 26

The obstetric nurse is preparing the patient for an emergency cesarean birth,with no time to administer spinal anesthesia.The nurse is aware and prepared for the greatest risk of administering general anesthesia to the patient.This risk is:

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

Question 27

While developing an intrapartum care plan for the patient in early labor,it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain.These include (Select all that apply):

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

Question 28

With regard to systemic analgesics administered during labor,nurses should be aware that:

A)Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier.
B)Effects on the fetus and newborn can include decreased alertness and delayed sucking.
C)Intramuscular administration (IM) is preferred over intravenous (IV) administration.
D)IV patient-controlled analgesia (PCA) results in increased use of an analgesic.

Question 29

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called:

A)An epidural.
B)A pudendal.
C)A local.
D)A spinal block.

Question 30

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.This procedure is:

A)Not used much anymore.
B)Likely to be used in the second stage of labor but not in the first stage.
C)An application of nitrous oxide.
D)A prelude to cesarean birth.

Question 31

Many women seek alternative or complementary pain relief during labor to delay or avoid pharmacologic or invasive therapies. Evidence regarding the use of these modalities has been sparse, and so they remain underutilized. Published reviews of the best-known therapies identified the benefits of each modality for the woman in labor. Please match the alternative modality with the correct research finding.

Less pain and anxiety during the first stage of labor

A)Yoga
B)Massage
C)Acupuncture
D)Water immersion
E)Aromatherapy

Question 32

With regard to spinal and epidural (block)anesthesia,nurses should know that:

A)This type of anesthesia is commonly used for cesarean births but is not suitable for vaginal births.
B)A high incidence of after-birth headache is seen with spinal blocks.
C)Epidural blocks allow the woman to move freely.
D)Spinal and epidural blocks are never used together.

Question 33

Which method of pain management is safest for a gravida 3 para 2 admitted at 8 cm cervical dilation?

A)Epidural anesthesia
B)Narcotics
C)Spinal block
D)Breathing and relaxation techniques

Question 34

It is important for the nurse to develop a realistic birth plan with the pregnant woman in her care.The nurse can explain that a major advantage of nonpharmacologic pain management is:

A)Greater and more complete pain relief is possible.
B)No side effects or risks to the fetus are involved.
C)The woman remains fully alert at all times.
D)A more rapid labor is likely.

Question 35

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.Signs of opioid/narcotic withdrawal in the mother would include (Select all that apply):

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

Question 36

After change-of-shift report the nurse assumes care of a multiparous client in labor.The woman is complaining of pain that radiates to her abdominal wall,lower back,and buttocks and down her thighs.Before implementing a plan of care,the nurse should understand that this type of pain is:

A)Visceral.
B)Referred.
C)Somatic.
D)Afterpain.

Question 37

To assist the woman after delivery of the infant,the nurse knows that the blood patch is used after spinal anesthesia to relieve:

A)Hypotension.
B)Headache.
C)Neonatal respiratory depression.
D)Loss of movement.

Question 38

With regard to nerve block analgesia and anesthesia,nurses should be aware that:

A)Most local agents are related chemically 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)A pudendal nerve block is designed to relieve the pain from uterine contractions.
D)A pudendal nerve block, if done correctly, does not significantly lessen the bearing-down reflex.

Question 39

In assessing a woman for pain and discomfort management during labor,a nurse most likely would:

A)Have the woman use a visual analog scale (VAS) to determine her level of pain.
B)Note drowsiness as a sign that the medications were working.
C)Interpret a woman's fist clenching as an indication that she is angry at her male partner and the physician.
D)Evaluate the woman's skin turgor to see whether she needs a gentle oil massage.

Question 40

The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is:

A)Respiratory depression.
B)Bradycardia.
C)Acrocyanosis.
D)Tachypnea.

Question 41

Many women seek alternative or complementary pain relief during labor to delay or avoid pharmacologic or invasive therapies. Evidence regarding the use of these modalities has been sparse, and so they remain underutilized. Published reviews of the best-known therapies identified the benefits of each modality for the woman in labor. Please match the alternative modality with the correct research finding.

Reduced length of labor,increased satisfaction of pain relief

A)Yoga
B)Massage
C)Acupuncture
D)Water immersion
E)Aromatherapy