Deck 20: Pharmacologic Pain Management

Question 1

The patient at 39 weeks' gestation is undergoing a Cesarean birth due to breech presentation. General anesthesia is being used. Which potential challenge is most relevant to the anesthesia care of this patient?

A)Hypotension due to the intense blockade of sympathetic fibers
B)Difficulty with maternal intubation
C)Broad ligament hematoma
D)Fetal depression that is fetal depression inversely proportional to maternal anesthetic depth and duration

Answer 1

Difficulty with maternal intubation

Question 2

Following spinal anesthesia for delivery of her baby, a woman reports an inability to void urine. As the nurse palpates the woman's bladder the woman says, "It's been five hours since I had my spinal and I still can't empty my bladder. Do I have nerve damage?" How should the nurse respond?

A)"Spinal anesthesia can sometimes cause nerve damage."
B)"It may be several hours before you're able to control your urination."
C)"You should be able to control your bladder by now.I'll ask the anesthesia provider to visit with you."
D)"You are probably dehydrated.Please increase your water intake."

Answer 2

"It may be several hours before you're able to control your urination."

Question 3

The anesthesia provider has just administered an epidural anesthetic in a laboring patient and local anesthesia is continuously infusing via the epidural catheter. Suddenly, the patient asks, "Why are my ears ringing?" What is the most likely cause of the patient's complaint?

A)Hypotension
B)Allergic reaction
C)Dehydration
D)Local anesthetic toxicity

Answer 3

Local anesthetic toxicity

Question 4

The nurse has presented a teaching session on pain relief options to a prenatal class. Which patient statement indicates that additional teaching is needed?

A)"An epidural can be continuous or one dose."
B)"General anesthesia is usually recommended for a patient who delivers by way of cesarean section."
C)"Narcotics can be given through a patient's epidural infusion catheter."
D)"A pudendal block usually works well to control pain during episiotomy repair."

Question 5

The laboring patient requests pain medication. Her contractions are lasting 20-30 seconds and are occurring every 8-20 minutes. The nurse would explain that analgesics given at this time would likely cause:

A)Fetal respiratory depression.
B)Decreased analgesic effectiveness at the end of labor.
C)Maternal hypotension.
D)Prolonged labor.

Question 6

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

A)In order 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 patient to rest and be less fatigued.
D)Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

Question 7

Which of the following nursing actions can prevent or detect common side effects of epidural anesthesia?

A)Preloading the patient with a rapid infusion of IV fluids
B)Continuing the patient on p.o.fluids only to prevent hypotension
C)Monitoring the FHR for late deceleration and decrease in rate
D)Use of intermittent FHR monitoring so the patient can use the birthing ball

Question 8

The laboring patient has rated her pain at 9 on a scale of 1-10, and she requests IV pain medication. She has refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol) for administration to the patient. Which action should the nurse complete next?

A)Advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.
B)Offer the woman epidural anesthesia once more and describe the effectiveness of this method of labor pain control.
C)Obtain maternal vital signs and assess the fetal heart rate (FHR).
D)Administer oxygen via face mask at 6 to 10 liters per minute.

Question 9

During admission, a laboring patient tells the nurse, "I'm so afraid I'll need a cesarean section. I don't want to be asleep for surgery when my baby is born!" Which of the following nursing responses is most appropriate?

A)"If a cesarean section is needed, that doesn't necessarily mean you'll need to go to sleep for surgery."
B)"Your anesthesia provider will require that you go to sleep for surgery."
C)"We'll do our best to make sure you deliver vaginally, so you don't need to have a cesarean section."
D)"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 10

During her hospital admission, the laboring patient explicitly refused all pain medications and a labor epidural. Once dilated to 5 cm, the patient complains of intolerable discomfort and asks the nurse, "If I have an epidural, how will you make sure it doesn't hurt my baby?" The best response by the nurse is:

A)"We'll monitor your baby continuously so we can recognize and treat any changes that may be related to the epidural."
B)"Epidural anesthesia is very safe and there are no potential side effects that can affect your baby."
C)"We'll assess your blood pressure every 15 minutes to make sure the epidural is not having any negative effects on your baby."
D)Before your epidural is placed, we'll administer IV fluid to you in order to prevent the epidural from causing you problems."

Question 11

A laboring patient has received an order for epidural anesthesia. In order to prevent the most common complication associated with this procedure, the nurse would expect to do which of the following?

A)Observe fetal heart rate variability.
B)Rapidly infuse 500-1,000 ml of intravenous fluids.
C)Place the patient in the semi-Fowler's position.
D)Teach the patient appropriate breathing techniques.

Question 12

The nurse is caring for a laboring patient who is receiving continuous epidural anesthesia via infusion. The maternal blood pressure decreases from 132/78 to 78/42. Which intervention should the nurse implement first?

A)Increase the flow rate of infusion of intravenous crystalloid solution.
B)Verify the patient is positioned to promote left uterine displacement.
C)Administer oxygen.
D)Administer ephedrine 5 to 10 mg intravenously.

Question 13

Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring patient in which of the following positions?

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

Question 14

After receiving nalbuphine hydrochloride (Nubain), a woman's labor progresses rapidly, and the baby is born less than one hour later. The baby exhibits 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 15

The charge nurse is reviewing the plans of care for four laboring patients. Which care plan requires immediate reconsideration for revision?

A)Administration of epidural anesthesia to a woman who is in the first stage of labor and has a shellfish allergy
B)Administration of a spinal anesthetic to a woman who is scheduled for vaginal delivery of her baby
C)Administration of epidural anesthesia to a woman with a history of vomiting secondary to hyperemesis gravidarum
D)Administration of a spinal anesthetic to a woman with a history of irritable bowel syndrome (IBS)