Deck 18: Pain Management for Childbirth

Question 1

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 1

Local infiltration

Question 2

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

Answer 2

Aspiration of stomach contents

Question 3

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

Answer 3

Left occiput posterior

Question 4

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 5

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 6

It is important for the nurse to develop a realistic birth plan with the pregnant woman.The nurse can explain 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 7

To improve placental blood flow immediately after the injection of an epidural anesthetic,the nurse should

A) Turn the woman to the right side.
B) Place a wedge under the woman's right hip.
C) Give the woman oxygen.
D) Decrease the intravenous infusion rate.

Question 8

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 9

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 10

The most important 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 11

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)

Question 12

Which method of pain management is safest 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 13

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 14

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.

Question 15

The most important nursing intervention after the injection of epidural anesthesia is monitoring

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

Question 16

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 17

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

A) Labor was pain-free.
B) Birth experiences of friends and families were discredited.
C) The woman rehearsed labor and practiced skills to master pain.
D) Only nonpharmacologic methods for pain control were used.

Question 18

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 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

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 21

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 22

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 23

Which intervention may be most helpful for the patient experiencing most of her labor pain in her back?

A) Lying supine with head slightly elevated
B) Having the support person apply firm pressure to the sacrum
C) Sitting upright with the legs straight
D) Having the nurse massage the upper back during a contraction

Question 24

A newborn infant weighing 8 lb (3632 g)needs naloxone (Narcan).This infant should receive approximately _____ mg.

A) 0.36
B) 3.6
C) 0.03
D) 0.3

Question 25

Today the pregnant woman has a number of non-pharmacologic measures available to her to assist with pain relief in labor.One such measure involves the application of heat,cold,or pressure to specific areas of the body and is known as _________.

Question 26

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.

Question 27

The nurse is caring for a laboring patient who develops a fever after she has had her epidural initiated.Fever with no apparent infection may occur in women who have epidural analgesia.The neonate's temperature may be elevated as well,possibly leading to unnecessary treatment for neonatal sepsis.Possible explanations for epidural associated fever without infection include (select all that apply)

A) Bladder distention
B) Maternal hypotension
C) Reduction of heat dissipation
D) Vasodilation
E) Shivering

Question 28

To assist the woman after delivery of the infant,the nurse knows that the blood patch is used after spinal anesthesia to relieve

A) Hypotension
B) Headache
C) Neonatal respiratory depression
D) Loss of movement

Question 29

The Joint Commission has recognized that pain management is an essential part of care in all health care settings.Since many women may desire an un-medicated birth,the pain management standards set by The Joint Commission do not apply in a labor setting.Is this statement true or false?

Question 30

What is the first type of breathing technique used in labor?

A) Slow-paced
B) Modified-paced
C) Patterned-paced
D) Pant-blow

Question 31

Which type of cutaneous stimulation involves massage of the abdomen?

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

Question 32

To provide optimal care to the intrapartum woman,the nurse understands that the least favorable maternal position for labor is

A) Supine
B) Sitting
C) Lying on the side
D) Standing

Question 33

The use of hydrotherapy is an important nonpharmacologic modality to promote relaxation in labor.The nurse should offer the woman in labor a warm bath or shower (if no contraindications exist).The mild nipple stimulation that occurs in the water may intensify her contractions.Is this statement true or false?

Question 34

Many methods of nonpharmacologic pain control become less effective after prolonged use.This is a process called _________.

Question 35

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