Deck 19: Pharmacologic Pain Management

Question 1

The charge nurse is reviewing the plans of care for four clients in labor. Which care plan requires additional information before implementing?
1) Administration of a spinal anesthetic to a client who is scheduled for a vaginal delivery
2) Administration of a spinal anesthetic to a client with a history of irritable bowel syndrome (IBS)
3) Administration of epidural anesthesia to a client who is in the first stage of labor and has a shellfish allergy
4) Administration of epidural anesthesia to a client with a history of vomiting secondary to hyperemesis gravidarum

Answer 1

4

Question 2

A client in labor who is requesting an epidural asks if the baby will be harmed. How should the nurse respond?
1) "Epidural anesthesia is very safe and there are no potential side effects that can affect your baby."
2) "We'll monitor your baby continuously so we can recognize and treat any changes that may be related to the epidural."
3) "We'll assess your blood pressure every 15 minutes to make sure the epidural is not having any negative effects on your baby."
4) "Before your epidural is placed, we'll administer IV fluid to you in order to prevent the epidural from causing you problems."

Answer 2

2

Question 3

A client at 39 weeks' gestation is having a cesarean birth with general anesthesia. Which potential challenge is most relevant to the anesthesia care of this client?
1) Broad ligament hematoma
2) Difficulty with maternal intubation
3) Hypotension due to the intense blockade of sympathetic fibers
4) Fetal depression that is inversely proportional to maternal anesthetic depth and duration

Answer 3

2

Question 4

A client in labor wants to have a medication-free birth. What should the nurse include when discussing alternatives to pain medication with this client?
1) Emphasize that no medication will be given.
2) Review that the use of medications allows for rest and less fatigue.
3) Explain that pain relief will allow a more enjoyable birth experience.
4) Summarize how maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

Question 5

A client experiencing contractions every 8 to 20 minutes that last 20 to 30 seconds requests pain medication. What should the nurse state as the effect of analgesics given at this time?
1) Prolonged labor
2) Maternal hypotension
3) Fetal respiratory depression
4) Decreased analgesic effectiveness at the end of labor

Question 6

A client in labor is concerned about needing a cesarean section and being asleep during the birth of her baby. Which nursing response is most appropriate?
1) "Your anesthesia provider will require that you go to sleep for surgery."
2) "If a cesarean section is needed, that does not necessarily mean you will need to go to sleep for surgery."
3) "We will do our best to make sure you deliver vaginally, so you do not need to have a cesarean section."
4) "If you need a cesarean section, the anesthesia provider will awaken you as soon as possible after delivery so that you can see your baby quickly."

Question 7

A postpartum client who received spinal anesthesia for the delivery has not voided for 5 hours and is concerned about nerve damage. How should the nurse respond about this concern?
1) "Spinal anesthesia can sometimes cause nerve damage."
2) "You are probably dehydrated. Please increase your water intake."
3) "It may be several hours before you're able to control your urination."
4) "You should be able to control your bladder by now. I'll ask the anesthesia provider to visit with you."

Question 8

The blood pressure of a client receiving continuous epidural anesthesia for labor has changed from 132/78 mmHg to 78/42 mmHg. What action should the nurse perform first?
1) Administer oxygen.
2) Administer ephedrine 5 to 10 mg intravenously.
3) Verify the client is positioned to promote left uterine displacement.
4) Increase the flow rate of infusion of intravenous crystalloid solution.

Question 9

A client in labor is being prepared for epidural anesthesia. What should the nurse expect to perform in order to prevent the most common complication associated with this anesthesia?
1) Observe fetal heart rate variability.
2) Place the client in the semi-Fowler position.
3) Teach the client appropriate breathing techniques.
4) Rapidly infuse 500 to 1000 mL of intravenous fluids.

Question 10

Prior to receiving lumbar epidural anesthesia, in which position should the nurse place the client in labor?
1) Lying prone with a pillow under the chest
2) On the right side in the center of the bed with the back curved
3) On the left side with the bottom leg straight and the top leg slightly flexed
4) Sitting on the edge of the bed with the back slightly curved and feet on a stool

Question 11

A client in labor received a dose of meperidine (Demerol) for pain control. Which assessment findings should the nurse suspect are adverse effects of this medication? Select all that apply.

A) Nausea
B) Pruritus
C) Sedation
D) Bradycardia
E) Hypotension

Question 12

Which nursing action can prevent or detect common side effects of epidural anesthesia? Select all that apply.
1) Preloading the client with a rapid infusion of IV fluids
2) Continuing the client on oral fluids only to prevent hypotension
3) Assisting the client to empty the bladder before the anesthesia is started
4) Use of intermittent fetal heart rate (FHR) monitoring so the client can use the birthing ball
5) Monitoring the fetal heart rate (FHR) for late deceleration and decrease in rate

Question 13

A client in labor who rates pain as 9 on a scale from 1 to 10 requests pain medication after refusing epidural anesthesia. What action should the nurse take prior to administering butorphanol tartrate (Stadol) as prescribed?
1) Offer epidural anesthesia again.
2) Administer oxygen via face mask at 6 to 10 L per minute.
3) Obtain maternal vital signs and assess the fetal heart rate (FHR).
4) Instruct on the actions and contraindications associated with the medication.

Question 14

The newborn of a client who received nalbuphine hydrochloride (Nubain) for pain control was born less than an hour after the medication was given and is exhibiting signs of respiratory depression. Which medication should the nurse prepare to administer to the newborn?
1) Naloxone (Narcan)
2) Fentanyl (Sublimaze)
3) Pentobarbital (Nembutal)
4) Butorphanol tartrate (Stadol)

Question 15

A client in labor is having a pudendal block. For which adverse effects should the nurse assess this client? Select all that apply.
1) Infection
2) Spinal headache
3) Perforated rectum
4) Sciatic nerve trauma
5) Broad ligament hematoma

Question 16

A client in labor who is receiving a continuous infusion of a local anesthetic through an epidural catheter asks if ear ringing is supposed to occur. What is the most likely cause of the client's complaint?
1) Dehydration
2) Hypotension
3) Allergic reaction
4) Local anesthetic toxicity

Question 17

The newborn of a client who received butorphanol tartrate (Stadol) 20 minutes before delivery is demonstrating respiratory depression. The infant, weighing
9)9 lb, is prescribed naloxone (Narcan)
0)1 mg/kg. How many milliliters of the medication should the nurse administer to the newborn? (Calculate to the hundredth decimal point.)

Question 18

A client in labor needs an emergency cesarean section. What should the nurse include when preparing this client for rapid induction of labor? Select all that apply.
1) Place a wedge under the right hip.
2) Insert an indwelling urinary catheter.
3) Insert an intravenous infusion catheter.
4) Provide a bolus of 1 L of intravenous fluid.
5) Preoxygenate with 3 to 5 minutes of 100% oxygen.

Question 19

The nurse is preparing a client in labor for an emergency cesarean section. Which medication should the nurse expect to be prescribed to prevent the effects of aspirated gastric contents? Select all that apply.
1) Famotidine (Pepcid)
2) Cimetidine (Tagamet)
3) Omeprazole (Prilosec)
4) Pantoprazole (Protonix)
5) Metoclopramide (Reglan)

Question 20

The nurse has presented a teaching session on pain relief options to a prenatal class. Which client statement indicates that additional teaching is needed?
1) "An epidural can be continuous or one dose."
2) "General anesthesia is usually recommended for a cesarean section."
3) "Narcotics can be given through a client's epidural infusion catheter."
4) "A pudendal block usually works well to control pain during episiotomy repair."