Question 1

The patient at 39 weeks' gestation is undergoing a Cesarean birth due to breech presentation. General anesthesia is being used. Which potential challenge is most relevant to the anesthesia care of this patient?

Accepted Answer

Pregnant patients, especially at term, have increased risk of difficult intubation due to airway edema and anatomical changes, making maternal intubation a relevant challenge during general anesthesia.

Question 2

Following spinal anesthesia for delivery of her baby, a woman reports an inability to void urine. As the nurse palpates the woman's bladder the woman says, "It's been five hours since I had my spinal and I still can't empty my bladder. Do I have nerve damage?" How should the nurse respond?

Accepted Answer

Spinal anesthesia can temporarily impair the sensation and control of the bladder due to the blockade of the nerves responsible for bladder control. This effect can last several hours until the anesthesia wears off, making it difficult for patients to void urine. This is a common and expected temporary side effect, not indicative of permanent nerve damage.

Question 3

The anesthesia provider has just administered an epidural anesthetic in a laboring patient and local anesthesia is continuously infusing via the epidural catheter. Suddenly, the patient asks, "Why are my ears ringing?" What is the most likely cause of the patient's complaint?

Accepted Answer

The patient's complaint of ringing in the ears (tinnitus) after the administration of an epidural anesthetic is a common symptom of local anesthetic systemic toxicity (LAST). This can occur if the local anesthetic enters the bloodstream in significant amounts, leading to systemic effects such as CNS and cardiovascular symptoms.

Question 4

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

Accepted Answer

General anesthesia is not usually recommended for a patient who delivers by way of cesarean section. Regional anesthesia, such as a spinal or epidural block, is the preferred method. Therefore, additional teaching is needed to correct this misconception.

Question 5

The laboring patient requests pain medication. Her contractions are lasting 20-30 seconds and are occurring every 8-20 minutes. The nurse would explain that analgesics given at this time would likely cause:

Accepted Answer

Analgesics given too early in labor, when contractions are infrequent and short, can lead to prolonged labor because they may slow down the progression of labor by reducing the strength and frequency of contractions.

Question 6

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

Accepted Answer

Maternal pain and stress can have a negative impact on the fetus, so it is important for the patient to understand that some amount of analgesia can be beneficial for both her and her baby. However, ultimately it is up to her to decide whether or not to pursue medication-free birth. The nurse should respect her wishes and provide support regardless of her decision.

Question 7

Which of the following nursing actions can prevent or detect common side effects of epidural anesthesia?

Accepted Answer

A) Preloading the patient with IV fluids can help prevent hypotension, a common side effect of epidural anesthesia, by increasing the patient's blood volume before the epidural is administered. C) Monitoring the fetal heart rate (FHR) for late decelerations and decreases in rate is important because epidural anesthesia can cause changes in blood pressure that may affect fetal oxygenation and circulation.

Question 8

The laboring patient has rated her pain at 9 on a scale of 1-10, and she requests IV pain medication. She has refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol) for administration to the patient. Which action should the nurse complete next?

Accepted Answer

The nurse should obtain informed consent from the patient before administering any medication, including butorphanol tartrate. The nurse should also educate the patient on the potential side effects and risks associated with the medication. While assessing maternal vital signs and FHR are important, obtaining consent for medication administration is the priority in this situation. The patient has already refused epidural anesthesia, so offering it again is not the best option at this time. Administering oxygen is not indicated based on the information provided.

Question 9

During admission, a laboring patient tells the nurse, "I'm so afraid I'll need a cesarean section. I don't want to be asleep for surgery when my baby is born!" Which of the following nursing responses is most appropriate?

Accepted Answer

Option A is the most appropriate response as it does not make any assumptions or provide false information, but rather acknowledges the patient's fears and provides reassurance that not all cesarean sections require general anesthesia. It also opens the possibility for further discussion and education about the different types of anesthesia used during surgery. Option B is incorrect as it presents a false assumption that all cesarean sections require general anesthesia. Option C is incorrect as it presents an unrealistic promise that the patient will deliver vaginally, which is not always possible or safe. Option D is incorrect as it presents a false assumption that the patient will be asleep for a prolonged period after surgery, which may cause unnecessary anxiety.

Question 10

During her hospital admission, the laboring patient explicitly refused all pain medications and a labor epidural. Once dilated to 5 cm, the patient complains of intolerable discomfort and asks the nurse, "If I have an epidural, how will you make sure it doesn't hurt my baby?" The best response by the nurse is:

Accepted Answer

This response provides accurate and reassuring information about how the baby will be monitored during and after the epidural is administered. It also acknowledges the patient's concern and provides a specific plan for addressing it. Option B is incorrect because there are potential side effects of epidural anesthesia, although they are generally rare and not typically harmful to the baby. Option C is incorrect because monitoring blood pressure alone is not enough to assess the effects of the epidural on the baby. Option D is incorrect because IV fluids are typically administered before epidural anesthesia as a routine measure to prevent low blood pressure, not to prevent harm to the baby.

Question 11

A laboring patient has received an order for epidural anesthesia. In order to prevent the most common complication associated with this procedure, the nurse would expect to do which of the following?

Accepted Answer

The most common complication associated with epidural anesthesia is hypotension, which can be prevented by administering intravenous fluids prior to the procedure. Therefore, the nurse would expect to rapidly infuse 500-1,000 ml of intravenous fluids. Observing fetal heart rate variability, placing the patient in semi-Fowler's position, and teaching the patient appropriate breathing techniques are not directly related to preventing complications associated with epidural anesthesia.

Question 12

The nurse is caring for a laboring patient who is receiving continuous epidural anesthesia via infusion. The maternal blood pressure decreases from 132/78 to 78/42. Which intervention should the nurse implement first?

Accepted Answer

The first intervention should be to increase the flow rate of the intravenous crystalloid solution to counteract the hypotension caused by the epidural anesthesia. This helps to increase blood volume and improve blood pressure.

Question 13

Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring patient in which of the following positions?

Accepted Answer

The best position for lumbar epidural anesthesia placement is sitting on the edge of the bed with the back slightly curved and the feet on a stool to open up the intervertebral spaces and provide a better view for the anesthesiologist.

Question 14

After receiving nalbuphine hydrochloride (Nubain), a woman's labor progresses rapidly, and the baby is born less than one hour later. The baby exhibits signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn?

Accepted Answer

Nalbuphine hydrochloride (Nubain) is a mixed opioid agonist-antagonist that can cause respiratory depression in both the mother and newborn. Naloxone (Narcan) is a reversal agent for opioids and should be readily available to treat respiratory depression in the newborn. The other options (A, B, and D) are all opioids and would further contribute to respiratory depression in the newborn.

Question 15

The charge nurse is reviewing the plans of care for four laboring patients. Which care plan requires immediate reconsideration for revision?

Accepted Answer

The answer of The charge nurse is reviewing the plans...

Quiz 20: Pharmacologic Pain Management