Question 1

A nurse is caring for a pregnant woman scheduled to have an epidural block.The nurse reviews the woman's admission laboratory results and finds the following: white blood count (WBC)6,500/ mm³,hemoglobin 14 mg/dL,hematocrit 38%,platelet count 98,000,and international normalized ratio (INR)4.2.What action by the nurse is best?

Accepted Answer

Contraindications to spinal/epidural blocks include maternal refusal,local or systemic infection,coagulopathies,actual or anticipated maternal hemorrhage,allergy to a specific agent being used,or lack of trained staff.This woman's platelet count is low and her INR is high,leading to concern about coagulopathies.The nurse should notify the health-care provider immediately.Documentation should always be thorough,but further action is needed.A signed consent form should be in the chart for an invasive procedure; however,this is not the priority at this point.An IV will probably be needed prior to delivery (depending on institutional protocol),but,again,this is not the priority in the setting of a patient with abnormal laboratory results.

Question 2

A woman received butorphanol (Stadol)IV for labor pain.Thirty minutes later,the patient's respiratory rate is 8 breaths/minute.What action by the nurse is best?

Accepted Answer

Butorphanol can cause both maternal and fetal respiratory depression.Naloxone is an opioid antagonist and will reverse the effects of opioids.This woman's respiratory rate is too low,and the nurse needs to administer naloxone per protocol.There is no need to call a perinatal RRT prior to administering the medication.The patient's medication regime should then be discussed with the provider.

Question 3

A pregnant woman is asking about a combined spinal-epidural analgesia for labor pain.What information about this method of analgesia should the nurse provide?

Accepted Answer

This method requires puncture of the dura and placement of a catheter in the epidural space,so it is associated with a higher incidence of infection and postprocedure headache than other methods.The other options are not associated with the combined analgesia.

Question 4

The perinatal nurse explains to the student nurse that the effects of the H? receptor antagonists include which of the following?

Accepted Answer

H? receptor antagonists are medications that block the action of histamines at the receptor sites.These medications produce sedative,antiparkinsonian,and antiemetic effects.They cause drowsiness and are often used during early labor to promote sleep and to decrease anxiety.Phenothiazines specifically cross the placenta readily and may produce decreased fetal heart rate beat-to-beat variability.

Question 5

A post-anesthesia care nurse is receiving a report on a patient who was delivered under general anesthesia.The operating room nurse states that the patient received a dose of metoclopramide (Reglan)IV in the operating room.The nurse explains to a student nurse the purpose of giving this drug is to do which of the following?

Accepted Answer

Reglan increases the speed of gastric emptying,which helps prevent the aspiration of gastric contents.Pregnant women are at a higher risk of gastric reflux than the general population.Rapid induction is facilitated with a short-acting barbiturate such as thiopental sodium (Pentothal).Muscle relaxation can be facilitated with succinylcholine (Anectine).Ranitidine hydrochloride (Zantac)or cimetidine (Tagamet)can be used to decrease gastric acid production.

Question 6

The perinatal nurse is directing a student nurse in giving intravenous fentanyl citrate (Sublimaze)to a woman in labor.Which actions by the student would require the registered nurse to intervene?

Accepted Answer

Sublimaze (and all opioid analgesics)should be administered during contractions so that the fetus has less exposure to the drug due to uterine vasoconstriction.There are five rights to medication administration (right patient,right drug,right dose,right route,right time).The medication should be injected slowly.The nurse should intervene if the student injects the medication between contractions,checks only three rights of medication administration,and injects the medication rapidly.

Question 7

A nursing faculty member is explaining potential complications from epidural anesthesia to a class of nursing students.Which information does the nurse include?

Accepted Answer

Potential complications from epidural anesthesia include bizarre behavior (if the medication is injected into the circulation),increased length of labor,increased need for oxytocin,and shiver response.Urinary retention,not incontinence,is another possible complication.

Question 8

The perinatal nurse assesses a patient who is immersed in a water-filled tub during active labor.The assessments that indicate the hydrotherapy has been effective include which of the following?

Accepted Answer

Hydrotherapy is effective when it provides relief from labor discomfort and pain by decreasing maternal catecholamines,prompting an increase in the release of oxytocin (stimulates uterine contractions)and endorphins (reduce the perception of pain).With decreased catecholamine release,blood pressure should remain stable or decrease.Of course the patient's report of lessened pain is the most valuable assessment.During immersion,the maternal temperature and fetal heart rate should remain stable.

Question 9

What nursing intervention would be most important for a postpartum woman who received spinal anesthesia?

Accepted Answer

Because spinal anesthesia can cause bladder atony,it is important for the nurse to monitor the postpartum woman's urine output.Assessing vital signs and promoting bonding are important for all new mothers.Nurses should promote breastfeeding if this is the woman's preference.

Question 10

A woman is having a planned cesarean birth.The nurse explains to the student that which of the following would not be an appropriate choice of anesthesia for this woman?

Accepted Answer

Pudendal block is considered a local/regional anesthesia and would not provide sufficient anesthesia for an operative birth.The other options are all appropriate.

Question 11

The perinatal nurse is caring for a woman with a postdural puncture headache.What interventions does the nurse include in this woman's care plan?

Accepted Answer

Typically,the headache is intensified when the patient assumes an upright position and is relieved when she assumes a supine position.Interventions usually center on oral analgesics,bedrest in a darkened room,caffeine,and hydration.If these measures are not effective,an autologous epidural blood patch may be administered.

Question 12

A nurse receives a handoff report on a newborn who is jaundiced.The off-going nurse states that the mother received some sort of sedative during the intrapartum period.The nurse should check the mother's chart for what medication?

Accepted Answer

H? receptor antagonists are often used for sedation and relaxation in labor.Promethazine binds to bilirubin binding sites and may cause hyperbilirubinemia and jaundice in term infants exposed to the drug during the intrapartal period.The other medications do not cause this side effect.

Question 13

The perinatal nurse is assessing a 36-year-old woman at term who is in early labor.The nurse assesses for findings that indicate pain,including which of the following?

Accepted Answer

During the assessment,the nurse may identify physiological and psychological changes that are indicative of maternal pain.These include an increased pulse rate and blood pressure,changes in mood,increased anxiety and stress,marked agitation,confusion,decreased urine output,decreased intestinal motility,and guarding of the target area of discomfort.Frequent voiding in small amounts and a normal blood pressure are not findings consistent with labor pain.

Question 14

A nurse is caring for a woman who is going to have an epidural block.The physician orders that an IV be started.Which of the following solutions would be appropriate for the nurse to choose?

Accepted Answer

Most institutions use dextrose-free IV solutions for women in labor because dextrose can cause fetal hyperglycemia with rebound hypoglycemia in the few hours after birth.The other three options all contain dextrose.

Question 15

A nurse is teaching a woman about pain management strategies during labor.The woman expresses great fear about the experience.Which of the following statements by the nurse would help to ease the woman's fears?

Accepted Answer

Labor pain has some unique characteristics,including: (1)being part of a normal process,as opposed to being caused by illness or injury; (2)being anticipated,which allows for planning and preparation; and (3)having an end point with the birth of the baby.The nurse should inform the pregnant woman about these facts in a supportive,encouraging way.Stating "at least it's not from illness" is factual but dismissive of her fears.Stating that she has to expect some pain is also dismissive and gives the impression that wanting pain control is unreasonable.

Question 16

A woman is 1 hour postpartum with an epidural block and wishes to get up to go to the bathroom.What action by the nurse is most appropriate?

Accepted Answer

After an epidural block,the nurse must assess for intact sensation in the woman's lower extremities prior to allowing ambulation.This action ensures patient safety.The other options are not related to ambulating after an epidural block.

Question 17

A labor and delivery nurse explains to the student that the most common complication following a spinal anesthesia block is which of the following?

Accepted Answer

The most common complication seen with the use of spinal anesthesia blocks is maternal hypotension.The other options are less common complications.

Question 18

While providing a hospital tour,the perinatal nurse shows the compact disc player stored in the birthing room.The nurse explains that music is encouraged during labor because it does which of the following?

Accepted Answer

Music can help create a relaxing environment and boost spirits.During labor,music provides comfort and decreases maternal anxiety by stimulating the release of endorphins.Comforting music during labor promotes maternal relaxation,thereby increasing oxygen intake.Some women find that music enhances their ability to remain focused during contractions.Decreasing anxiety and pain will decrease oxygen requirements.

Question 19

A woman in labor receives a dose of hydromorphone hydrochloride (Dilaudid)at 11:30 a.m.She gives birth at 12:45 p.m.What action by the nurse takes priority?

Accepted Answer

With Dilaudid,if birth occurs within 1 to 4 hours after administration,the nurse must assess the neonate frequently for respiratory depression.The other options are appropriate,but not the priority for this situation.

Question 20

The OB clinic nurse is giving a pregnant woman information on different types of anesthesia and pain control for use during labor.What information does the nurse provide about spinal anesthesia block?

Accepted Answer

Benefits of spinal block anesthesia include: easy to administer,has immediate onset of action,requires a smaller volume of medication,produces excellent muscular relaxation,allows for maintenance of maternal consciousness,and is associated with minimal blood loss.However,because the woman will lose the ability to feel contractions,maternal pushing efforts are compromised,which increases the risk of an operative birth.

Quiz 13: Promoting Patient Comfort During Labor and Birth

A woman received butorphanol (Stadol) IV for labor pain.Thirty minutes later,the patient's respiratory rate is 8 breaths/minute.What action by the nurse is best?