Deck 18: Pain Management for Childbirth

Question 1

Which statement is true about the physiologic effects of pain in labor?

A) It usually results in a more rapid labor.
B) It is considered to be a normal occurrence.
C) It may result in decreased placental perfusion.
D) It has no effect on the outcome of labor.

Answer 1

It may result in decreased placental perfusion.

Question 2

A woman received 50 mcg of fentanyl intravenously 1 hour before delivery.What drug should the nurse have readily available?

A) Promethazine (Phenergan)
B) Nalbuphine (Nubain)
C) Butorphanol (Stadol)
D) Naloxone (Narcan)

Answer 2

Naloxone (Narcan)

Question 3

The method of anesthesia in labor considered the safest for the fetus is the

A) pudendal block.
B) epidural block.
C) spinal (subarachnoid) block.
D) local infiltration.

Answer 3

local infiltration.

Question 4

In order to help patients 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) somatic 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.

Question 5

One of the greatest risks to the mother during administration of general anesthesia is

A) respiratory depression.
B) uterine relaxation.
C) inadequate muscle relaxation.
D) aspiration of stomach contents.

Question 6

A woman received an epidural anesthetic and now her blood pressure is 88/64 mm Hg.What action by the nurse takes priority?

A) Turn the woman to the left side.
B) Place a wedge under the woman's right hip.
C) Call the provider or nurse-anesthetist immediately.
D) Decrease the intravenous infusion rate.

Question 7

The registered nurse explains to the student that when giving a narcotic to a laboring woman,the nurse should inject the medication at the beginning of a contraction so that

A) full benefit of the medication is received during that contraction.
B) less medication will be transferred to the fetus.
C) the medication will be rapidly circulated.
D) the maternal vital signs will not be adversely affected.

Question 8

Childbirth preparation can be considered successful if the outcome is described as follows:

A) Labor and delivery were pain-free.
B) The woman's partner participated eagerly.
C) The woman rehearsed labor and practiced skills to master pain.
D) Only nonpharmacologic methods for pain control were used.

Question 9

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 10

The nurse working with a pregnant woman explains that a major advantage of nonpharmacologic pain management is that

A) 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 11

Which method of pain management does the nurse plan 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 12

The best time to teach nonpharmacologic pain control methods to an unprepared laboring woman is during which phase?

A) Latent phase
B) Active phase
C) Transition phase
D) Second stage

Question 13

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called a(n)

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

Question 14

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 15

A laboring woman has been given an injection of epidural anesthesia.Which assessment by the nurse takes priority?

A) Urinary output
B) Contraction pattern
C) Maternal blood pressure
D) Intravenous infusion rate

Question 16

The priority nursing intervention for the patient who has received an epidural narcotic is

A) monitoring respiratory rate hourly.
B) administering analgesics as needed.
C) monitoring blood pressure every 4 hours.
D) assessing the level of anesthesia.

Question 17

When providing labor support,the nurse knows that which fetal position might cause the laboring woman more back discomfort?

A) Right occiput anterior
B) Left occiput anterior
C) Right occiput transverse
D) Left occiput posterior

Question 18

Which woman will most likely have increased anxiety and tension during her labor?

A) Gravida 1 who did not attend prepared childbirth classes
B) Gravida 2 who refused any medication
C) Gravida 2 who delivered a stillborn baby last year
D) Gravida 3 who has two children younger than 3 years

Question 19

The nurse caring for women in labor understands that childbirth pain is different from other types of pain in that it is

A) more responsive to pharmacologic management.
B) associated with a physiologic process.
C) designed to make one withdraw from the stimulus.
D) less intense.

Question 20

Excessive anxiety in labor heightens the woman's sensitivity to pain by increasing

A) muscle tension.
B) blood flow to the uterus.
C) the pain threshold.
D) rest time between contractions.

Question 21

A newborn infant weighing 8 lb needs naloxone (Narcan).This infant should receive approximately _____ mg.

Question 22

What statement by the woman after a childbirth education class demonstrates that she needs more information?

A) "I'm having a pudendal block so control my labor pain."
B) "I may get a headache after a subarachnoid block."
C) "I don't want IV opioids as they may cause breathing problems."
D) "Some anesthetic agents may cause itching but it can be treated."

Question 23

A woman is experiencing most of her labor pain in her back.What action by the nurse is best?

A) Positioning the woman lying supine with head slightly elevated
B) Showing the support person how to apply firm pressure to the sacrum
C) Assisting the woman to sit upright with the legs straight
D) Massaging her upper back during a contraction

Question 24

A woman had an epidural place an hour ago and is now complaining of severe itching.What action by the nurse is most appropriate?

A) Discontinue the epidural infusion at once.
B) Notify the anesthesia provider.
C) Prepare to administer diphenhydramine (Benedryl).
D) Prepare to administer promethazine (Phenergan).

Question 25

Which patient is most likely to experience pain during labor?

A) Gravida 2 who has not attended childbirth preparation classes
B) Gravida 2 who is anxious because her last labor was difficult
C) Gravida 1 whose fetus is in a breech presentation
D) Gravida 3 who is using Lamaze breathing techniques

Question 26

The nurse teaching a childbirth preparation class teaches the participants that the first type of breathing technique used in labor is called

A) slow-paced.
B) modified-paced.
C) patterned-paced.
D) pant-blow.

Question 27

A woman had spinal anesthesia for delivery.Now she complains of a pounding headache rated 7/10.What action by the nurse is most appropriate?

A) Prepare to assist with a blood patch procedure.
B) Give the woman IV opioid pain medications.
C) Increase the rate of her nonadditive IV fluids.
D) Place a cool cloth on her forehead and dim the room lights.

Question 28

Which type of cutaneous stimulation involves massage of the abdomen?

A) Thermal stimulation
B) Imagery
C) Mental stimulation
D) Effleurage

Question 29

A nurse admits a woman to the labor and delivery unit who has a history of IV drug abuse.In planning care for this patient,the nurse explains to the student that which pain control plan is contraindicated for this woman?

A) Epidural anesthesia
B) Bolus administration of butorphanol (Stadol)
C) Promethazine (Phenergan) for opioid-induced nausea
D) Naloxone (Narcan) if needed for respiratory depression

Question 30

When instructing the woman in early labor,the nurse teaches her that an important aspect of proper breathing technique is

A) breathing no more than three times the normal rate.
B) beginning and ending with a cleansing breath.
C) holding the breath no longer than 10 seconds.
D) adhering exactly to the techniques as they were taught.

Question 31

A woman has received an epidural block.What action by the nurse takes priority?

A) Instruct her to call for help when getting out of bed.
B) Assess the woman for a post-procedure headache.
C) Determine type and time of last oral intake.
D) Administer metoclopramide within the first hour.

Question 32

The nurse is caring for a laboring patient who develops a fever after she has had her epidural initiated.What actions by the nurse are appropriate? (Select all that apply.)

A) Palpate the woman's bladder distention.
B) Assess the woman's blood pressure.
C) Observe the woman for shivering.
D) Check the skin for color and warmth.
E) Prepare to assist with a blood patch.

Question 33

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 34

The student nurse is working with a laboring woman.What action by the student requires the registered nurse to intervene?

A) Placing the woman in a supine position
B) Assisting the woman to a sitting position
C) Turning the woman to a side-lying position
D) Providing safety while the woman labors while standing

Question 35

Which technique could the support person use when the laboring woman appears to be losing control?

A) Have the nurse take over the role of support.
B) Tell the woman that she is causing stress to her baby and herself.
C) Wait for the contraction to end and discuss the problem with her.
D) Make eye contact with the woman and breathe along with her.