Deck 16: Management of Discomfort

Question 1

If an opioid antagonist is administered to a laboring woman,she should be told that:

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 1

Her pain will return.

Question 2

A woman is experiencing back labor and complains of intense pain in her lower back. An effective relief measure would be to use:

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

Answer 2

Counterpressure against the sacrum.

Question 3

A woman in the active phase of the first stage of labor 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. The nurse should:

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

Answer 3

Help her breathe into a paper bag

Question 4

A woman in active labor 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)Butorphanol tartrate (Stadol)
D)Nalbuphine (Nubain)

Question 5

In the current practice of childbirth preparation,emphasis is placed on:

A)The Dick-Read (natural) childbirth method.
B)The Lamaze (psychoprophylactic) method.
C)The Bradley (husband-coached) method.
D)Getting expectant parents to attend childbirth preparation in any or no specific method.

Question 6

A woman in labor has just received an epidural block. The most important nursing intervention is to:

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 7

A first-time mother is concerned about the type of medications she will receive during labor. 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 because:

A)"The two together work the best for you and your baby."
B)"Sedatives help the opioid work better,and they also will help relax you and relieve your nausea."
C)"They work better together so you can sleep until you have the baby."
D)"This is what the doctor has ordered for you."

Question 8

With regard to breathing techniques during labor,maternity nurses should be aware that:

A)Breathing techniques in the first stage of labor are designed to increase the size of the abdominal cavity to reduce friction.
B)By the time labor has begun,it is too late for instruction in breathing and relaxation.
C)Controlled breathing techniques are most difficult near the end of the second stage of labor.
D)The patterned-paced breathing technique can help prevent hyperventilation.

Question 9

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 labor 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 b-endorphins are higher during a spontaneous,natural childbirth.

Question 10

The role of the nurse with regard to informed consent is to:

A)Inform the client about the procedure and have her sign the consent form.
B)Act as a client advocate and help clarify the procedure and the options.
C)Call the physician to see the client.
D)Witness the signing of the consent form.

Question 11

Nursing care measures are commonly offered to women in labor. 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 12

An 18-year-old pregnant woman,gravida 1,is admitted to the labor 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." The nurse should:

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 13

To help clients 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)Referred 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 14

Nurses should be aware of the differences experience can make in labor pain such as:

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

Question 15

A laboring woman received meperidine (Demerol) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Demerol on the neonate?

A)Fentanyl (Sublimaze)
B)Promethazine (Phenergan)
C)Naloxone (Narcan)
D)Nalbuphine (Nubain)

Question 16

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help clients. Nurses should know that _____ women may be stoic until late in labor,when they may become vocal and request pain relief.

A)Chinese
B)Arab or Middle Eastern
C)Hispanic
D)African-American

Question 17

With regard to a pregnant woman's anxiety and pain experience,nurses should be aware that:

A)Even mild anxiety must be treated.
B)Severe anxiety increases tension,which increases pain,which in turn increases fear and anxiety,and so on.
C)Anxiety may increase the perception of pain,but it does not affect the mechanism of labor.
D)Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

Question 18

Maternity nurses often have to answer questions about the many,sometimes unusual ways people have tried to make the birthing experience more comfortable. For instance,nurses should be aware that:

A)Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine.
B)Women in labor 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 19

A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the woman's intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the woman's hemoglobin is 12 g/dl,hematocrit is 38%,platelets are 67,000,and white blood cells (WBCs) are 12,000/mm³. Which factor would contraindicate an epidural for the woman?

A)She is too far dilated.
B)She is anemic.
C)She has thrombocytopenia.
D)She is septic.

Question 20

The nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if:

A)The mother gives birth without any analgesic or anesthetic.
B)The mother and family's priorities and preferences are incorporated into the plan.
C)The primary health care provider decides 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 21

Today the pregnant woman has a number of nonpharmacologic 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 22

With regard to spinal and epidural (block) anesthesia,nurses should know that:

A)This type of anesthesia is commonly used for cesarean 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 23

With regard to nerve block analgesia and anesthesia,nurses should be aware that:

A)Most local agents are related chemically to cocaine and end in the suffix -caine.
B)Local perineal infiltration anesthesia 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 24

After change-of-shift report the nurse assumes care of a multiparous client in labor. The woman is complaining of pain that radiates to her abdominal wall,lower back,and buttocks and down her thighs. Before implementing a plan of care,the nurse should understand that this type of pain is:

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

Question 25

Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What nursing interventions could you use to raise the client's blood pressure? Choose all that apply.

A)Place the woman in a supine position.
B)Place the woman in a lateral position.
C)Increase intravenous (IV) fluids.
D)Administer oxygen.
E)Perform a vaginal examination.

Question 26

A woman in labor 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. This procedure is:

A)Not used much anymore.
B)Likely to be used in the second stage of labor but not in the first stage.
C)An application of nitrous oxide.
D)A prelude to cesarean birth.

Question 27

In assessing a woman for pain and discomfort management during labor,a nurse most likely would:

A)Have the woman use a visual analog scale (VAS) to determine her level of pain.
B)Note drowsiness as a sign that the medications were working.
C)Interpret a woman's fist clenching as an indication that she is mad at her male partner and the physician.
D)Evaluate the woman's skin turgor to see whether she needs a gentle oil massage.

Question 28

With regard to systemic analgesics administered during labor,nurses should be aware that:

A)Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier.
B)Effects on the fetus and newborn can include decreased alertness and delayed sucking.
C)Intramuscular administration (IM) is preferred over intravenous (IV) administration.
D)IV patient-controlled analgesia (PCA) results in increased use of an analgesic.