Deck 17: Pain Management

Question 1

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

Answer 1

Severe anxiety increases tension,which increases pain,which in turn increases fear and anxiety,and so on

Question 2

In order to help clients 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

Answer 2

The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen

Question 3

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

Answer 3

Hispanic

Question 4

Nurses should be aware that all reputable childbirth methods attempt to meet all these goals except:

A)Increase the woman's sense of control
B)Prepare a support person to help in labor
C)Guarantee a pain-free childbirth
D)Learn distraction techniques

Question 5

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 6

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 7

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 8

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 nauseated.Additionally 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 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 9

A laboring woman received meperidine (Demerol)IV 90 minutes before she gave birth.Which medication should be available to reduce the postnatal effects of meperidine on the neonate?

A)Fentanyl (Sublimaze)
B)Promethazine (Phenergan)
C)Naloxone (Narcan)
D)Nalbuphine (Nubain)

Question 10

Nursing care measures are commonly offered to women in labor.Which nursing measure reflects application of the gate-control theory?

A)Massage the woman's back.
B)Change the woman's position.
C)Give the prescribed medication.
D)Encourage the woman to rest between contractions.

Question 11

If an opioid antagonist is administered to a laboring woman,she should be told:

A)Her pain will decrease
B)Her pain will return
C)She will feel less anxious
D)She will no longer feel the urge to push

Question 12

According to professional standards (AWHONN,2007)the nonanesthetist registered nurse caring for a woman with an epidural is permitted to perform all actions except:

A)Monitor the status of the woman and fetus
B)Initiate epidural anesthesia
C)Replace empty infusion bags with the same medication and concentrate
D)Stop the infusion and initiate emergency measures

Question 13

Your client is in early labor,and you are discussing the pain relief options she is considering.She states that she wants an epidural "no matter what!" Your best response is:

A)"I'll make sure you get your epidural."
B)"You may only have an epidural if your doctor allows it."
C)"You may only have any epidural if you are going to deliver vaginally."
D)"The type of analgesia or anesthesia used is determined in part by the stage of your labor and the method of birth."

Question 14

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

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

Question 15

A nurse should be aware that an effective plan to achieve adequate pain relief without maternal risk is most effective if:

A)The mother gives birth without any analgesic or anesthetic
B)The mother's priorities and preferences are incorporated into the plan
C)The primary health care provider decides the best pain relief for the mother and family
D)The nurse informs the family of all alternative methods of pain relief available in the hospital setting

Question 16

A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5 minutes.She is groaning and perspiring excessively;she states that she did not attend childbirth classes.The most important nursing action is to:

A)Notify the woman's health care provider
B)Administer the prescribed narcotic analgesic
C)Assure her that her labor will be over soon
D)Assist her with simple breathing and relaxation instructions

Question 17

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

Question 18

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,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 19

Breathing patterns are taught to laboring women.Which breathing pattern would the nurse support for the woman and her coach during the latent phase of the first stage of labor if the couple had attended Lamaze classes?

A)Slow-paced breathing
B)Deep abdominal breathing
C)Modified-paced breathing
D)Patterned-paced breathing

Question 20

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 IV fluid for a preprocedural bolus.Prior to initiation of the epidural the woman should be informed regarding the disadvantages of an epidural block.They include all except:

A)Ability to move freely is limited
B)Orthostatic hypotension and dizziness
C)Gastric emptying is not delayed
D)Higher rate of fever

Question 21

The nurse understands that approaches to relaxation in labor include (choose all that apply):

A)Aromatherapy
B)Massage
C)Hypnosis
D)Cesarean birth
E)Biofeedback

Question 22

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.Is this statement true or false?

Question 23

Conscious relaxation is associated with which method of childbirth preparation?

A)Grantly Dick-Read method
B)Lamaze method
C)Bradley method
D)Psychoprophylactic method

Question 24

Maternal hypotension is a potential side effect of regional anesthesia and analgesia.What nursing interventions could you use to raise the client's blood pressure? Choose all that apply.

A)Place the woman in a supine position.
B)Place the woman in a lateral position.
C)Increase IV fluids.
D)Administer oxygen.
E)Perform a vaginal examination.

Question 25

During anesthetic management of the morbidly obese woman in labor,the nurse must remain alert for complications specific to this type of client.Which is not a concern for the L&D nurse?

A)Failed epidural placement
B)Accidental dural puncture
C)Inadequate pain relief
D)Difficult intubation

Question 26

Opioids such as hydromorphone,fentanyl,and meperidine can cause excessive central nervous system (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.Is this statement true or false?

Question 27

Today's pregnant woman has a number of nonpharmacologic measures available 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 ________________.