Deck 25: Pain Management During Labor

Question 1

The nurse is assessing a patient before administering an analgesic. What are some of the factors the nurse should consider?

A) The patient is willing to receive medication after being advised about it.
B) The patient's vital signs are stable.
C) The partner agrees to use of the medication.
D) The patient has no known allergies to the medication.
E) The patient is aware of side effects of the medication.

Answer 1

The patient is willing to receive medication after being advised about it.
The patient's vital signs are stable.
The patient has no known allergies to the medication.
The patient is aware of side effects of the medication.

Question 2

A patient is having contractions that last 20-30 seconds and occur every 8-20 minutes. The patient 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 of pain relief.

Answer 2

Nonpharmacologic methods of pain relief.

Question 3

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

A) Observe fetal heart rate variability.
B) Rapidly infuse 500-1000 ml of intravenous fluids.
C) Place the patient in the semi-Fowler's position.
D) Teach the patient appropriate breathing techniques.

Answer 3

Rapidly infuse 500-1000 ml of intravenous fluids.

Question 4

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

A) "An epidural can be continuous or can be given in one dose."
B) "A spinal is usually used for a cesarean birth."
C) "Pudendal blocks are effective when a vacuum is needed."
D) "Local anesthetics provide good labor pain relief."

Question 5

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

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

Question 6

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

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

Question 7

A woman in active labor is given nalbuphine hydrochloride (Nubain) 14 mg IV for pain relief. Half an hour later, her respirations are at 8 per minute. The physician would likely order which medication for this patient?

A) Narcan
B) Reglan
C) Benadryl
D) Vistaril

Question 8

A patient in labor is requesting pain medication. The nurse assesses her labor status first, focusing on:

A) The contraction pattern.
B) The amount of cervical dilatation.
C) When the labor began.
D) Whether the membranes are intact or ruptured.
E) The fetal presenting part.

Question 9

A patient has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. 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 10

Which 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) Using intermittent FHR monitoring so the patient can use the birthing ball
E) Keeping the patient NPO after receiving the epidural

Question 11

The laboring patient brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 cm and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" The best response by the nurse is:

A) "The narcotic in the epidural will make both you and the baby sleepy."
B) "It is unlikely that an epidural will decrease your baby's heart rate."
C) "Epidurals tend to cause low blood pressure in babies after birth."
D) "I can't get you an epidural, because of your birth plan."

Question 12

After nalbuphine hydrochloride (Nubain) is administered, 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 13

Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring patient 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

Question 14

After administration of an epidural anesthetic to a patient in active labor, it is most important to assess the mother immediately for:

A) Hypotension.
B) Headache.
C) Urinary retention.
D) Bradycardia.

Question 15

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

A) Remove the epidural catheter and apply a Band-Aid to the injection site.
B) Offer the patient 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.

Question 16

The laboring patient has rated her pain at 9 on a scale of 1-10, and requests IV pain medication. Which statement is most important for the nurse to make? "Narcotic medications:

A) "Can make you unsteady. You need to ask for help when you get up."
B) "Have a very rapid onset and begin to work in 2-3 minutes."
C) "Are metabolized by your body, so they don't last as long as an epidural."
D) "Can cause sleepiness in the baby that can be reversed with Narcan."

Question 17

The nurse is caring for two postoperative patients who have had caesarean sections. One had surgery under spinal anesthesia and the other under epidural anesthesia. What are some important differences the nurse should be aware of when caring for these two patients? Note: Credit will be given only if all correct answers and no incorrect answers are selected. Standard Text:

A) The level of pain relief is lower with spinals.
B) Placement of the needle is higher with epidurals.
C) Epidurals do not fully sedate motor nerves.
D) Spinal patients complain of nausea and vomiting.
E) Spinal anesthesia patients complain of headache if they sit up too soon.

Question 18

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

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

Question 19

A patient had an epidural inserted 2 hours ago. It is functioning well, the patient is stable, and labor is progressing. Which parts of the assessment have the highest priority?

A) Assess blood pressure every hour.
B) Assess the pulse rate every hour.
C) Palpate the bladder.
D) Auscultate the lungs.
E) Assess the reflexes.

Question 20

Narcotic analgesia is administered to a laboring patient 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 21

When general anesthesia is necessary for a cesarean delivery, the nurse should be prepared to:

A) Administer an antacid to the patient.
B) Place a wedge under the left hip.
C) Apply cricoid pressure during anesthesia intubation.
D) Preoxygenate for 3-5 minutes before anesthesia.
E) Place a Foley catheter in the patient's bladder.

Question 22

The patient at 39 weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate intervention?

A) The baby's hands and feet are blue at 1 minute after birth.
B) The fetal heart rate is 70 prior to making the skin incision.
C) Clear fluid is obtained from the baby's oropharynx.
D) The neonate cries prior to delivery of the body.

Question 23

To reduce possible side effects from a cesarean section under general anesthesia, patients are routinely given which type of medication?

A) Antacids
B) Tranquilizers
C) Antihypertensives
D) Anticonvulsants

Question 24

The patient with a normal pregnancy had an emergency cesarean birth under general anesthesia 2 hours ago. The patient now has a respiratory rate of 30, pale blue nailbeds, a pulse rate of 110, and a temperature of 102.6°F, and is complaining of chest pain. The nurse understands that the patient most likely is experiencing:

A) Pulmonary embolus.
B) Pneumococcal pneumonia.
C) Pneumonitis.
D) Gastroesophageal reflux disease.

Question 25

A cesarean section is ordered. Because the patient 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.

Question 26

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

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

Question 27

A patient with an internal fetal monitor catheter has received IV stadol for pain relief. Which changes on the monitor should the nurse expect?

A) Early decelerations
B) Late decelerations
C) Diminished short- and long-term variability
D) Accelerations after contractions

Question 28

The nurse is inducing the labor of a patient with severe preeclampsia. As labor progresses, fetal intolerance of labor develops. The induction medication is turned off, and the patient is prepared for cesarean birth. Which statement should the nurse include in her preoperative teaching? "Because of your preeclampsia:

A) "You are at higher risk for hypotension after an epidural anesthesia."
B) "You might develop hypertension after a spinal anesthesia."
C) "Your baby might have decreased blood pressure after birth."
D) "Your husband will not be allowed into the operating room."

Question 29

For what common side effects of epidural anesthesia should the nurse watch?

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

Question 30

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 was 120/80 before the procedure and is now 80/ 52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her BP?

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

Question 31

The primary physician orders a narcotic analgesic for a patient in labor. Which situations would lead the nurse to hold the medication?

A) Contraction pattern every 3 minutes for 60 seconds
B) Fetal monitor tracing showing late decelerations
C) Patient sleeping between contractions
D) Blood pressure 150/90
E) Blood pressure 80/42

Question 32

An anesthesiologist informs the nurse that a patient scheduled for a caesarean section will be having general anesthesia with postoperative self-controlled analgesia. For which patients would a general anesthesia be recommended?

A) The patient with a history of drug addiction
B) The patient who has had a lower back fusion
C) The patient who is 13 years old
D) The patient who is allergic to morphine sulfate
E) The patient who has had surgery for scoliosis

Question 33

The nurse is caring for a laboring patient with thrombocytopenia. During labor, it is determined that the patient requires a cesarean delivery. The nurse is preparing the patient for surgery, and should instruct the patient that the recommended method of anesthesia is:

A) General anesthesia.
B) Epidural anesthesia.
C) Spinal anesthesia.
D) Regional anesthesia.

Question 34

The nurse is providing preoperative teaching to a patient for whom a cesarean birth under general anesthesia is scheduled for the next day. Which statement by the patient indicates that she requires additional information? "General anesthesia:

A) "Can be accomplished with inhaled gases."
B) "Usually involves administering medication into my IV."
C) "Will provide good pain relief after the birth."
D) "Takes effect faster than an epidural."

Question 35

A cesarean section is ordered for the laboring patient with whom the nurse has worked all shift. The patient will receive general anesthesia. The nurse knows that potential complications of general anesthesia include:

A) Fetal depression that is directly proportional to the depth and duration of the anesthesia.
B) Poor fetal metabolism of anesthesia, which inhibits use with preterm infants.
C) Uterine relaxation that causes increased blood loss.
D) Increased gastric motility that causes increased appetite.
E) Itching of the face and neck.