Question 1

A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of anesthesia?

Accepted Answer

Spinal anesthesia typically requires a period of bed rest after administration to prevent complications such as spinal headaches.

Question 2

The laboring client brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 c m and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" What is the nurse's best response?

Accepted Answer

Epidurals are designed to provide pain relief to the mother without directly affecting the baby. While there can be indirect effects, such as a potential drop in the mother's blood pressure which can affect fetal heart rate, it is generally managed carefully by the healthcare team to minimize risks. The statement that it is unlikely an epidural will decrease the baby's heart rate directly addresses the mother's concern about the baby's well-being.

Question 3

After nalbuphine hydrochloride (Nubain) is administered, labor progresses rapidly, and the baby is born less than 1 hour later. The baby shows signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn?

Accepted Answer

Naloxone (Narcan) is used to reverse the effects of opioids, including respiratory depression in newborns caused by opioid administration to the mother during labor.

Question 4

Toward the end of the first stage of labor, a pudendal block is administered transvaginally. What will the nurse anticipate the client's care will include?

Accepted Answer

The answer of Toward the end of the first stage...

Question 5

The nurse knows that which of the following are advantages of spinal block?
Note: Credit will be given only if all correct answers and no incorrect answers are selected.

Accepted Answer

The answer of The nurse knows that which of the...

Question 6

The nurse is caring for a client in labor who has a history of physical dependence on narcotics. Which consideration should the nurse take with regard to the administration of naloxone (Narcan)?

Accepted Answer

Naloxone (Narcan) is an opioid antagonist that can precipitate withdrawal symptoms in individuals who are physically dependent on narcotics. Administering naloxone to a client with a history of narcotic dependence can lead to sudden and severe withdrawal symptoms.

Question 7

Narcotic analgesia is administered to a laboring client at 10:00 a.m. The infant is delivered at 12:30 p.m. What would the nurse anticipate that the narcotic analgesia could do?

Accepted Answer

Narcotic analgesia administered close to the time of delivery can cross the placental barrier and affect the newborn, potentially causing neonatal respiratory depression. This is because narcotics can depress the central nervous system, including the respiratory center in the brainstem, leading to decreased respiratory effort in the newborn.

Question 8

A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse suggest?

Accepted Answer

Given the description of the contractions (20-30 seconds long and occurring every 8-20 minutes), it suggests that the client is in early labor. Nonpharmacologic methods of pain relief, such as breathing techniques, position changes, massage, and warm baths, are often recommended during this stage to manage discomfort without the risks associated with medications or procedures.

Question 9

When general anesthesia is necessary for a cesarean delivery, what should the nurse be prepared to do?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Accepted Answer

Administering an antacid helps reduce the risk of acid aspiration, a potential complication during general anesthesia. Cricoid pressure is applied to prevent aspiration of stomach contents. Preoxygenation enriches the oxygen content in the patient's body before anesthesia, reducing the risk of hypoxia. Placing a Foley catheter is standard for cesarean deliveries to keep the bladder empty and out of the way of the surgical field. Placing a wedge under the client's thigh is not a standard preparation for general anesthesia in cesarean delivery; instead, a wedge under the right hip (not thigh) is used to prevent supine hypotensive syndrome by shifting the uterus off the inferior vena cava.

Question 10

Upon the client's admission to the birthing unit, the nurse performs a careful assessment to determine whether the client has a history of physical dependence on narcotics. For which complication related to analgesic administration is the nurse preparing?

Accepted Answer

Clients with a history of physical dependence on narcotics may have an increased risk of respiratory depression when given analgesics, as their tolerance and response to narcotics can be altered.

Question 11

Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which position?

Accepted Answer

The sitting position on the edge of the bed allows for optimal access to the lumbar area for the administration of epidural anesthesia, as it helps to open up the spaces between the vertebrae.

Question 12

Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do?

Accepted Answer

Itching on the face and neck can be a common side effect of medications used in epidural infusions, such as opioids. Administering an antihistamine like Benadryl, as per protocol, can help alleviate this symptom without needing to adjust or remove the epidural catheter.

Question 13

An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was effective?

Accepted Answer

Analgesic medications administered during labor are intended to reduce pain. If the client is able to doze or rest between contractions, it indicates that the pain is being effectively managed, as the client is comfortable enough to relax.

Question 14

What is the major adverse side effect of epidural anesthesia?

Accepted Answer

Maternal hypotension is a major adverse side effect of epidural anesthesia due to the blockade of sympathetic nerves, leading to vasodilation and decreased blood pressure.

Question 15

A client received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This client is at increased risk for which problem during the fourth stage of labor?

Accepted Answer

Epidural anesthesia can cause decreased sensation and muscle control, leading to difficulty in recognizing a full bladder, which can result in bladder distention during the fourth stage of labor.

Question 16

During a labor and delivery class, a client asks the nurse, "Why would I be placed under general anesthesia during delivery?" What should the nurse include in the response?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Accepted Answer

General anesthesia may be used during delivery if there is a perceived lack of time for regional anesthesia, contraindications for regional anesthesia, failure of regional anesthesia, or if the patient refuses regional anesthesia. Provider preference is not a valid reason for choosing general anesthesia over regional anesthesia.

Question 17

A client has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands which of the following?

Accepted Answer

Maternal pain and stress can negatively impact the fetus, and a small amount of analgesia may be beneficial in reducing these effects.

Question 18

A client dilated to 5 c m has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her B P?

Accepted Answer

Ephedrine is the preferred medication to increase blood pressure in this scenario because it is a vasopressor that can effectively treat hypotension, especially that associated with epidural anesthesia.

Question 19

The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed?

Accepted Answer

Local anesthetics are typically used for procedures such as episiotomies or laceration repairs after delivery, rather than for labor pain relief, which requires more potent or targeted methods like epidurals, spinals, or pudendal blocks.

Question 20

For what common side effects of epidural anesthesia should the nurse watch?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Accepted Answer

Elevated maternal temperature, urinary retention, nausea, and local itching are common side effects of epidural anesthesia.

Quiz 22: Pharmacologic Pain Management