Deck 10: Management of Discomfort

Question 1

Benzodiazepines (Valium, Ativan), when given in conjunction with opioid analgesia, appear to enhance pain relief and reduce nausea and vomiting. Because of the positive effects of this combination, benzodiazepines are frequently used during labor.

Answer 1

False

Question 2

Opioids such as hydromorphone, fentanyl, and meperidine can cause excessive CNS depression in both the mother and newborn. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects, especially respiratory depression. The RN should use caution in administering naloxone to opioid dependent women in labor.

Answer 2

True

Question 3

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

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

Answer 3

Act as a patient advocate and help clarify the procedure and the options.

Question 4

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 5

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) 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 6

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 7

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 8

After change-of-shift report, the nurse assumes care of a multiparous patient 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 9

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help patients. 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 10

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 11

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.

Question 12

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 13

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 14

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 ?-endorphins are higher during a spontaneous, natural childbirth.

Question 15

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 16

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 17

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 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

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 classes for any (no specific) method.