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?

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?

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?

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?

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?

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.)

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?

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?

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?

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?

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?

Accepted Answer

The timing of administration of narcotics in labor is especially important. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, narcotics are preferably given when the mother is more than 3 hours away from birth.
This allows the peak action of the drug in the fetus to have passed by the time of birth. The nurse does not need to get permission from the physician. Pain medication can be provided when needed and not on a set schedule of every 4 hours. The patient is nearing delivery so 3 hours from the last dose will not influence the decision to provide more medication.

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.)

Accepted Answer

To ensure safe general anesthesia administration, specific drugs must be readily available, which include diazepam to control seizures, ephedrine to use if the blood pressure falls, and atropine sulfate to dry secretions and prevent aspiration.
Acetaminophen and lactated Ringer's solution are not specifically identified for use using general anesthesia.

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?

Accepted Answer

A typical prescription drug abused by women is hydrocodone/acetaminophen (Vicodin) because this is frequently prescribed for chronic back pain. The half-life of this drug is about 2 hours in addicted women. Even though it appears to have little effect on newborns, the newborn needs to be observed for both withdrawal and liver effects. The patient can receive other narcotic pain medication during labor. Other pain medication is not contraindicated for this patient. There are other, more safe pain medications that can be prescribed for the patient and fetus during labor.

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?

Accepted Answer

Any pain medication should have maximum effect for the patient and minimal effect on the fetus. The patient has the right to choose how much pain relief is wanted or used.
Pain relief should be provided only after labor is well established. Medication should not interfere with the ability of the uterus to contract during labor and delivery. All medication does not interfere with this ability.

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?

Accepted Answer

Naloxone hydrochloride (Narcan) is a narcotic antagonist that counteracts the effect of narcotic analgesics. It is used to counteract respiratory depression in newborns when a woman has received a narcotic analgesic during labor. Intravenous fluids, oxygen, a heated bassinet, or tactile stimulation will not counteract the effects of a narcotic analgesic given before delivery.

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