Deck 18: Pain Management During Labour

Question 1

Which should the nurse be aware of when helping patients manage discomfort and pain during labour?

A) The predominant pain of the first stage of labour is the visceral pain located in the lower portion of the abdomen.
B) Referred pain is the extreme discomfort between contractions.
C) The somatic pain of the second stage of labour is more generalized and related to fatigue.
D) Pain during the third stage is a somewhat milder version of the second stage.

Answer 1

The predominant pain of the first stage of labour is the visceral pain located in the lower portion of the abdomen.

Question 2

What should the labouring woman be taught if she is receiving an opioid antagonist?

A) Her pain will decrease.
B) Her pain will return.
C) She will feel less anxious.
D) She will no longer feel the urge to push.

Answer 2

Her pain will return.

Question 3

A first-time mother is concerned about the type of medications she will receive during labour.She is in a fair amount of pain and is nauseous.In addition,she appears to be very anxious.You explain that opioid analgesics often are used with sedatives for which reason?

A) The two together work best for the mother and baby.
B) Sedatives help the opioid work better and will help relax the mother and relieve nausea.
C) The two work better together so the woman can sleep until the baby is born.
D) These medication are what the doctor has ordered.

Answer 3

Sedatives help the opioid work better and will help relax the mother and relieve nausea.

Question 4

A labouring woman received fentanyl citrate (Sublimaze)intravenously 90 minutes before she gave birth.Which medication should be available to reduce the postnatal effects of Sublimaze on the neonate?

A) Meperidine (Demerol)
B) Promethazine (Phenergan)
C) Naloxone (Narcan)
D) Nalbuphine (Nubain)

Question 5

When is effleurage most effective?

A) First stage of labour
B) Transition phase of labour
C) Second stage of labour
D) Placental delivery

Question 6

Which should maternity nurses be aware of when answering questions about the many ways people have tried to make the birthing experience more comfortable?

A) Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine.
B) Women in labour can benefit from sitting in a bathtub,but they must limit immersion to no longer than 15 minutes at a time.
C) Effleurage is permissible,but counterpressure is almost always counterproductive.
D) Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

Question 7

Nursing care measures are commonly offered to women in labour.Which nursing measure reflects application of the gate-control theory?

A) Massaging the woman's back
B) Changing the woman's position
C) Giving the prescribed medication
D) Encouraging the woman to rest between contractions

Question 8

A woman in labour has just received an epidural block.What is the most important nursing intervention?

A) Limit parenteral fluids.
B) Monitor the fetus for possible tachycardia.
C) Monitor the maternal blood pressure for possible hypotension.
D) Monitor the maternal pulse for possible bradycardia.

Question 9

Nurses should be aware of which difference that experience can make in relation to labour pain?

A) Sensory pain for nulliparous women often is greater than for multiparous women during early labour.
B) Affective pain for nulliparous women usually is less than that for multiparous women throughout the first stage of labour.
C) Women with a history of substance use experience more pain during labour.
D) Multiparous women have more fatigue from labour and thus experience more pain.

Question 10

A woman in the active phase of the first stage of labour is using a shallow pattern of breathing,which is about twice the normal adult breathing rate.She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling.What should the nurse do?

A) Notify the woman's physician.
B) Tell the woman to slow the pace of her breathing.
C) Administer oxygen via a mask or nasal cannula.
D) Help her breathe into a paper bag.

Question 11

Where is the emphasis placed in the current practice of childbirth preparation?

A) The Dick-Read (natural)childbirth method
B) The Lamaze (psychoprophylactic)method
C) The Bradley (husband-coached)method
D) Attend childbirth preparation in any or no specific method

Question 12

What should the nurse be aware of with regard to a pregnant woman's anxiety and pain experience?

A) Even mild anxiety must be acknowledged and treated.
B) Excessive anxiety increases tension,which increases pain and fear.
C) Anxiety increases the perception of pain,but it does not affect the mechanism of labour.
D) Women who have had a painful labour will have less anxiety the second time because of increased familiarity.

Question 13

The nurse should be aware that a plan to achieve adequate pain relief without maternal risk is most effective if which occurs?

A) The mother gives birth without any analgesic or anaesthetic.
B) The mother and family's priorities and preferences are incorporated into the plan.
C) The primary health care provider determines the best pain relief for the mother and family.
D) The nurse informs the family of all alternative methods of pain relief available in the hospital setting.

Question 14

Nurses with an understanding of cultural differences regarding likely reactions to pain are better able to help patients.Women from which ethnic group would be most likely to be stoic in response to labour pain?

A) Chinese women
B) Arab or Middle Eastern women
C) Indigenous women
D) African-Canadian women

Question 15

A woman is experiencing intense labour pain in her lower back.Which would be an effective relief measure for this woman?

A) Counterpressure against the sacrum
B) Pant-blow (breaths and puffs)breathing techniques
C) Effleurage
D) Conscious relaxation or guided imagery

Question 16

Which reflects the role of the nurse with regard to informed consent?

A) Inform the patient about the procedure and have her sign the consent form.
B) Act as a patient advocate and provide clarification.
C) Call the physician to see the patient.
D) Witness the signing of the consent form.

Question 17

Which is a women who receives an epidural during labour at increased risk of experiencing?

A) Hypertension
B) Hypotension
C) Decreased oxytocin requirements
D) Decreased oxygen requirements

Question 18

An 18-year-old pregnant woman,gravida 1,is admitted to the labour and birth unit with moderate contractions every 5 minutes that last 40 seconds.The woman states,"My contractions are so strong that I don't know what to do." What should the nurse do?

A) Assess for fetal well-being.
B) Encourage the woman to lie on her side.
C) Disturb the woman as little as possible.
D) Recognize that pain is personalized for each individual.

Question 19

A woman in active labour receives an analgesic,an opioid agonist.Which medication relieves severe,persistent,or recurrent pain;creates a sense of well-being;overcomes inhibitory factors;and may even relax the cervix but should be used cautiously in women with cardiac disease?

A) Meperidine (Demerol)
B) Promethazine (Phenergan)
C) Sufentanil citrate (Sufenta)
D) Nalbuphine (Nubain)

Question 20

Which statement correctly describes the effects of various pain factors?

A) Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth.
B) Upright positions in labour increase the pain factor because they cause greater fatigue.
C) Women who move around trying different positions are experiencing more pain.
D) Levels of pain-mitigating ®-endorphins are higher during a spontaneous,natural childbirth.

Question 21

After a change-of-shift report the nurse assumes care of a multiparous patient in labour.The woman is complaining of pain that radiates to her abdominal wall,lower back,and buttocks and down her thighs.Which type of pain is the woman experiencing?

A) Visceral
B) Referred
C) Somatic
D) Afterpain

Question 22

What should nurses be aware of with regard to nerve block analgesia and anaesthesia?

A) Most local agents are chemically related to cocaine and end in the suffix -caine.
B) Local perineal infiltration anaesthesia is effective when epinephrine is added,but it can be injected only once.
C) A pudendal nerve block is designed to relieve the pain from uterine contractions.
D) A pudendal nerve block,if done correctly,does not significantly lessen the bearing-down reflex.

Question 23

A woman in labour is breathing into a mouthpiece just before the start of her regular contractions.As she inhales,a valve opens,and gas is released.She continues to inhale the gas slowly and deeply until the contraction starts to subside.When the inhalation stops,the valve closes.Which statement is accurate in relation to this scenario?

A) This method is not used much anymore.
B) This method is likely to be used only in the second stage of labour.
C) This describes an application of nitrous oxide.
D) This describes a preparation for Caesarean birth.

Question 24

What should the nurse be cognizant of with regard to spinal and epidural anaesthesia?

A) It is commonly used for Caesarean births but is not suitable for vaginal births.
B) A high incidence of after-birth headache is seen with spinal blocks.
C) Epidural blocks allow the woman to move freely.
D) Spinal and epidural blocks are never used together.

Question 25

Maternal hypotension is a potential adverse effect of regional anaesthesia and analgesia.Which nursing intervention would the nurse use to raise the patient's blood pressure?

A) Place the woman in a supine position.
B) Perform a vaginal examination.
C) Increase intravenous (IV)fluids.
D) Implement continuous electronic fetal heart monitoring.

Question 26

Which interventions are appropriate when caring for a woman with maternal hypotension who has a spinal anaesthesia? Select all that apply.Express answer with small letters,followed by a comma and a space-e.g. ,a,b,C

A) High-Fowler's position
B) Increase IV infusion rate.
C) Increase the rate of the spinal anaesthesia as ordered.
D) Administer IV vasopressor as ordered.
E) Monitor fetal heart rate every 30 minutes.
F) Administer oxygen at 10 to 12 L/min via face mask.

Question 27

What should nurses be aware of with regard to systemic analgesics administered during labour?

A) Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier.
B) Effects on the fetus include absent or minimal fetal heart rate (FHR)variability.
C) Intramuscular (IM)administration is preferred over intravenous (IV)administration.
D) IV patient-controlled analgesia (PCA)results in increased use of an analgesic.