Deck 20: Pharmacologic Pain Management

Question 1

Prior to receiving lumbar epidural anesthesia,the nurse would anticipate placing the laboring client in which position?

A)On her right side in the center of the bed,with her back curved
B)Lying prone,with a pillow under her chest
C)On her left side,with the bottom leg straight and the top leg slightly flexed
D)Sitting on the edge of the bed,with her back slightly curved and her feet on a stool

Answer 1

Sitting on the edge of the bed,with her back slightly curved and her feet on a stool

Question 2

A cesarean section is ordered.Because the client is to receive general anesthesia,the primary danger with which the nurse is concerned is:

A)Fetal depression.
B)Vomiting.
C)Maternal depression.
D)Uterine relaxation.

Answer 2

Fetal depression.

Question 3

Two hours after an epidural infusion has begun,a client complains of itching on the face and neck.The nurse should:

A)Remove the epidural catheter and place a Band-Aid at the injection site.
B)Offer the client a cool cloth and let her know the itching is temporary.
C)Recognize that this is a common side effect,and follow protocol for administration of diphenhydramine (Benadryl).
D)Call the anesthesia care provider to re-dose the epidural catheter.

Answer 3

Recognize that this is a common side effect,and follow protocol for administration of diphenhydramine (Benadryl).

Question 4

Narcotic analgesia is administered to a laboring client at 10:00 a.m.The infant is delivered at 12:30 p.m.The nurse would anticipate that the narcotic analgesia could:

A)Be used in place of preoperative sedation.
B)Result in neonatal respiratory depression.
C)Prevent the need for anesthesia with an episiotomy.
D)Enhance uterine contractions.

Question 5

A laboring client has received an order for epidural anesthesia.To prevent the most common complication associated with this procedure,the nurse would expect to:

A)Observe fetal heart rate variability.
B)Rapidly infuse 500-1000 ml of intravenous fluids.
C)Place the client in a right lateral position.
D)Teach the client appropriate breathing techniques.

Question 6

An analgesic medication has been administered intramuscularly to a client in labor.The nurse would evaluate the medication as effective if:

A)The client dozes between contractions.
B)The client is moaning with contractions.
C)The contractions decrease in intensity.
D)The contractions decrease in frequency.

Question 7

When general anesthesia is necessary for a cesarean delivery,the nurse should be prepared to: (Select all that apply. )

A)Administer an antacid to the client.
B)Place a wedge under the left hip.
C)Apply cricoid pressure during anesthesia intubation.
D)Preoxygenate for 3-5 minutes before anesthesia.

Question 8

A nurse is checking the postpartum orders.The doctor has prescribed bedrest for 6-12 hours.The nurse knows this is an appropriate order if the client had which type of anesthesia?

A)Spinal
B)Pudendal
C)General
D)Epidural

Question 9

A primigravida dilated to 5 cm has just received an epidural for pain.She complains of feeling lightheaded and dizzy within 10 minutes after the procedure.Her blood pressure before the procedure was 120/80 and is now 80/5 2.In addition to the bolus of fluids she has been given,which medication is preferred to use to increase her BP?

A)Epinephrine
B)Terbutaline
C)Ephedrine
D)Epifoam

Question 10

Toward the end of the first stage of labor,a pudendal block is administered transvaginally.The nurse anticipates the client's care to include:

A)Monitoring for hypotension every 15 minutes.
B)Monitoring FHR every 15 minutes.
C)Monitoring for bladder distention.
D)No additional assessments.

Question 11

After receiving nalbuphine hydrochloride (Nubain),labor progresses rapidly and the baby is born less than 1 hour later.The baby shows signs of respiratory depression.Which medication should the nurse be prepared to administer to the newborn?

A)Fentanyl (Sublimaze)
B)Butorphanol tartrate (Stadol)
C)Naloxone (Narcan)
D)Pentobarbital (Nembutal)

Question 12

A client is having contractions that are lasting 20-30 seconds and occurring every 8-20 minutes.The client is requesting something to help relieve the discomfort of contractions.The nurse should suggest:

A)That a mild analgesic be administered.
B)An epidural.
C)A local anesthetic block.
D)Nonpharmacologic methods for pain relief.

Question 13

A client has just been admitted to Labor and Delivery.She is having mild contractions every 15 minutes lasting 30 seconds.The client wants to have a medication-free birth.When discussing medication alternatives,the nurse should be sure that the client understands that:

A)To respect her wishes,no medication will be given.
B)Pain relief will allow a more enjoyable birth experience.
C)The use of medications allows the client to rest and be less fatigued.
D)Maternal pain and stress can have an adverse effect on the fetus.

Question 14

Which are common side effects of epidural anesthesia? Select all that apply.

A)Elevated maternal temperature
B)Urinary retention
C)Nausea
D)Long-term back pain

Question 15

A client received epidural anesthesia during the first stage of labor.The epidural is discontinued immediately after delivery.This client is at increased risk for which problem during the fourth stage of labor?

A)Nausea
B)Bladder distention
C)Uterine atony
D)Hypertension