Chapter 13: Pain Management During Childbirth Foundations of Maternal-Newborn & Women's Health Nursing, 7th Edition

Childbirth preparation can be considered successful if which of the following outcomes is achieved?

a. Labor was pain-free.

b. The birth experiences of friends and families were ignored.

c. Only nonpharmacologic methods for pain control were used.

d. The patient rehearsed labor and practiced skills to master pain.

d. The patient rehearsed labor and practiced skills to master pain.

A woman with a known heroin habit is admitted in early labor. Which drug is contraindicated with opiate-dependent patients?

a. Nalbuphine (Nubain)

b. Hydroxyzine (Vistaril)

c. Promethazine (Phenergan)

d. Diphenhydramine (Benadryl)

a. Nalbuphine (Nubain)

A patient is admitted to the labor and birth room in active labor; contractions are 4 to 5 minutes apart and last for 30 seconds. The nurse needs to perform a detailed assessment. When is the best time to ask questions or perform procedures?

a. After the contraction is over

b. When it is all right with the coach

c. During the increment of the next contraction

d. After administration of analgesic-anesthetic

a. After the contraction is over

Childbirth pain is different from other types of pain in that it is

a. less intense.

b. associated with a physiologic process.

c. more responsive to pharmacologic management.

d. designed to make one withdraw from the stimulus.

b. associated with a physiologic process.

Excessive anxiety during labor heightens the patient's sensitivity to pain by increasing

a. muscle tension.

b. the pain threshold.

c. blood flow to the uterus.

d. rest time between contractions.

a. muscle tension.

Which fetal position may cause the laboring patient increased back discomfort?

a. Left occiput anterior

b. Left occiput posterior

c. Right occiput anterior

d. Right occiput transverse

b. Left occiput posterior

A major advantage of nonpharmacologic pain management is

a. a more rapid labor is likely.

b. more complete pain relief is possible.

c. the woman remains fully alert at all times.

d. there are no side effects or risks to the fetus.

d. there are no side effects or risks to the fetus.

The best time to teach nonpharmacologic pain control methods to an unprepared laboring patient is during which stage?

a. Latent phase

b. Active phase

c. Second stage

d. Transition phase

a. Latent phase

The primary side effect of maternal narcotic analgesia in the newborn has

a. tachypnea.

b. bradycardia.

c. acrocyanosis.

d. respiratory depression.

d. respiratory depression.

The nerve block used in labor that provides anesthesia to the lower vagina and perineum is referred to as a(n)

a. local.

b. epidural.

c. pudendal.

d. spinal block.

c. pudendal.

The nurse is teaching a childbirth education class. Which information regarding excessive pain in labor should the nurse include in the session?

a. It usually results in a more rapid labor.

b. It has no effect on the outcome of labor.

c. It is considered to be a normal occurrence.

d. It may result in decreased placental perfusion.

d. It may result in decreased placental perfusion.

Which patient will most likely have increased anxiety and tension during labor?

a. Gravida 2 who refused any medication

b. Gravida 2 who delivered a stillborn baby last year

c. Gravida 1 who did not attend prepared childbirth classes

d. Gravida 3 who has two children younger than 3 years

b. Gravida 2 who delivered a stillborn baby last year

Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?

a. Narcotics

b. Spinal block

c. Epidural anesthesia

d. Breathing and relaxation techniques

d. Breathing and relaxation techniques

A laboring patient who imagines her body opening to let the baby out is using a mental technique called

a. imagery.

b. effleurage.

c. distraction.

d. dissociation.

a. imagery.

When administering a narcotic to a laboring patient, which statement explains why the nurse should inject the medication at the beginning of a contraction?

a. The medication will be rapidly circulated.

b. Less medication will be transferred to the fetus.

c. The maternal vital signs will not be adversely affected.

d. Full benefit of the medication is received during that contraction.

b. Less medication will be transferred to the fetus.

The method of anesthesia in labor that is considered the safest for the fetus is

a. epidural block.

b. pudendal block.

c. local infiltration.

d. spinal (subarachnoid) block.

c. local infiltration.

To improve placental blood flow immediately after the injection of an epidural anesthetic, the nurse should

a. give the woman oxygen.

b. turn the woman to the right side.

c. decrease the intravenous infusion rate.

d. place a wedge under the woman's right hip.

d. place a wedge under the woman's right hip.

Which physiologic effect may occur in the presence of increased maternal pain perception during labor?

a. Increase in uterine contractions in response to catecholamine secretion

b. Decrease in blood pressure in response to alpha receptors

c. Decreased perfusion to the placenta in response to catecholamine secretion

d. Increased uterine blood flow, causing increase in maternal blood pressure

c. Decreased perfusion to the placenta in response to catecholamine secretion

Which of the following factors would affect pain perception or tolerance for the laboring patient?

a. Right occiput posterior fetal position during labor

b. Bishop score of 10 prior to the induction of labor

c. Gynecoid pelvis

d. Absence of Ferguson's reflex

a. Right occiput posterior fetal position during labor

A patient in labor is approaching the transition stage and already has an epidural in place. An additional dose of medication has been prescribed and administered to the patient. Which priority intervention should be performed in order to evaluate the clinical response to treatment?

a. Obtain a pain scale response from the patient based on a 0 to 10 scale.

b. Document maternal blood pressure and fetal heart rates following medication administration and observe for any variations.

c. Document intake and output on the electronic health record (EHR).

d. Increase the flow rate of prescribed parenteral fluid to maintain hydration.

b. Document maternal blood pressure and fetal heart rates following medication administration and observe for any variations.

The process of labor places significant metabolic demands on the obstetric patient. Which physiologic findings would be expected?

a. Decreased maternal blood pressure as a result of stimulation of alpha receptors

b. Uterine vasoconstriction as a result of stimulation of beta receptors

c. Increased maternal demand for oxygen

d. Increased blood flow to placenta because of catecholamine release

c. Increased maternal demand for oxygen

A labor patient, gravida 2, para 1, at term has received meperidine (Demerol) for pain control during labor. Her most recent dose was 15 minutes ago and birth is now imminent. Maternal vital signs have been stable and the EFM tracing has not shown any baseline changes. Which medication does the nurse anticipate would be required in the birth room for administration?

a. Oxytocin (Pitocin)

b. Naloxone (Narcan)

c. Bromocriptine (Parlodel)

d. Oxygen

b. Naloxone (Narcan)

Which statement is true with regard to the type of pain associated with childbirth experience?

a. Pain is constant throughout the labor experience.

b. Labor pain during childbirth is considered to be an abnormal response.

c. Pain associated with childbirth is self-limiting.

d. Pain associated with childbirth does not allow for adequate preparation.

c. Pain associated with childbirth is self-limiting.

A patient in labor reports a feeling of burning pain during the second stage of labor. This type of pain is associated with

a. visceral pain.

b. tissue ischemia.

c. somatic pain.

d. cervical dilation.

c. somatic pain.

A patient presents to the labor and birth area for emergent birth. Vaginal exam reveals that the patient is fully dilated, vertex, +2 station, with ruptured membranes. The patient is extremely apprehensive because this is her first childbirth experience and asks for an epidural to be administered now. What is the priority nursing response based on this patient assessment?

a. Use contact anesthesia for an epidural and prepare the patient per protocol.

b. Tell the patient that she will not need any pain medication because the birth will be over in a matter of minutes and the pain will stop.

c. Assist the patient with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth.

d. Call the physician for admitting orders.

c. Assist the patient with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth.

A labor patient has brought in a photograph of her two children and asks the nurse to place it on the wall so that she can look at it during labor contractions. This is an example of

a. focal point.

b. distraction.

c. effleurage.

d. relaxation.

a. focal point.

A pregnant woman in labor is quite anxious and has been breathing rapidly during contractions. She now complains of a tingling sensation in her fingers. What is the priority nursing intervention at this time?

a. Perform a vaginal exam to denote progress.

b. Reposition the patient to a side lying position.

c. Instruct the patient to breathe into her cupped hands.

d. Notify the physician about current findings.

c. Instruct the patient to breathe into her cupped hands.

A laboring patient has asked the nurse to assist her in utilizing a cutaneous stimulation strategy for pain management. The nurse would

a. assist her into the shower.

b. apply a heat pack to lower back.

c. help her to create a relaxing mental scene.

d. encourage cleansing breaths and slow-paced breathing.

b. apply a heat pack to lower back.

To relieve a mild postdural puncture headache, the nurse should encourage the intake of

a. milk.

b. orange juice.

c. tea or coffee.

d. beef or chicken bouillon.

c. tea or coffee.

Which patient will be most receptive to teaching about nonpharmacologic pain control methods?

a. Gravida 1, para 0, in transition

b. Gravida 2, para 1, admitted at 8 cm

c. Gravida 1, para 0, dilated 2 cm, 80% effaced

d. Gravida 3, para 2, complaining of intense perineal pressure

c. Gravida 1, para 0, dilated 2 cm, 80% effaced

The nurse is providing care to a patient in the active phase of the first stage of labor. The patient is crying out loudly with each contraction. What is the nurse's most respectful approach for this patient?

a. Ask the patient's labor coach if this is a usual expression of pain for her.

b. Refer to the patient's chart to determine any orders for pain medication.

c. Tell the patient that she is disturbing the other laboring patients on the unit.

d. Encourage the patient to try to suppress her noisiness during contractions.

a. Ask the patient's labor coach if this is a usual expression of pain for her.

A multipara's labor plan includes the use of jet hydrotherapy during the active phase of labor. What is the priority patient assessment prior to assisting the patient with this request?

a. Maternal pulse

b. Maternal temperature

c. Maternal blood pressure

d. Maternal blood glucose level

b. Maternal temperature

A patient in active labor requests an epidural for pain management. What is the nurse's most appropriate intervention at this juncture?

a. Assess the fetal heart rate pattern over the next 30 minutes.

b. Take the patient's blood pressure every 5 minutes for 15 minutes.

c. Determine the patient's contraction pattern for the next 30 minutes.

d. Initiate an IV infusion of lactated Ringer's solution at 2000 mL/hour over 30 minutes.

d. Initiate an IV infusion of lactated Ringer's solution at 2000 mL/hour over 30 minutes.

You are preparing a patient for epidural placement by a nurse anesthetist in the LDR. Which interventions should be included in the plan of care? (Select all that apply.)

a. Administer a bolus of 500 to 1000 mL of D5 normal saline prior to catheter placement.

b. Have ephedrine available at bedside during catheter placement.

c. Monitor blood pressure of patient frequently during catheter insertion and for the first 15 minutes of epidural administration.

d. Insert a Foley catheter prior to epidural catheter placement.

e. Monitor the patient for hypertension in response to epidural insertion.

b. Have ephedrine available at bedside during catheter placement.

c. Monitor blood pressure of patient frequently during catheter insertion and for the first 15 minutes of epidural administration.

Which method of pain management would be safest for a gravida 3, para 2, admitted at 8 cm cervical dilation?

a. Narcotics

b. Spinal block

c. Epidural anesthesia

d. Breathing and relaxation techniques

d. Breathing and relaxation techniques

The nurse detects hypotension in a laboring patient after an epidural. Which actions should the nurse plan to implement? (Select all that apply.)

a. Encourage the patient to drink fluids.

b. Place the patient in a Trendelenburg position.

c. Administer a normal saline bolus as prescribed.

d. Administer oxygen at 8 to 10 L/minute per face mask.

e. Administer IV ephedrine in 5- to 10-mg increments as prescribed.

c. Administer a normal saline bolus as prescribed.

d. Administer oxygen at 8 to 10 L/minute per face mask.

e. Administer IV ephedrine in 5- to 10-mg increments as prescribed.

The nurse is preparing a patient for a cesarean birth scheduled to be performed under general anesthesia. Which should the nurse plan to administer, if ordered by the health care provider, to prevent aspiration of gastric contents? (Select all that apply.)

a. Citric acid (Bicitra)

b. Ranitidine (Zantac)

c. Hydroxyzine (Vistaril)

d. Glycopyrrolate (Robinul)

e. Promethazine (Phenergan)

a. Citric acid (Bicitra)

b. Ranitidine (Zantac)

d. Glycopyrrolate (Robinul)