Deck 15: Pain Management During Childbirth

Question 1

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.

Answer 1

local infiltration.

Question 2

When giving a narcotic to a laboring client, 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.

Answer 2

Less medication will be transferred to the fetus.

Question 3

A client 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 do procedures?

A) After the contraction is over
B) When it is all right with the coach
C) During increment of next contraction
D) After administration of analgesic-anesthetic

Answer 3

After the contraction is over

Question 4

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

A) local.
B) epidural.
C) pudendal.
D) spinal block.

Question 5

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

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

Question 6

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

A) Latent phase
B) Active phase
C) Second stage
D) Transition phase

Question 7

A nurse is teaching a childbirth education class. Which information about 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.

Question 8

Childbirth preparation can be considered successful if the outcome is described as which of the following?

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 client rehearsed labor and practiced skills to master pain.

Question 9

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

Question 10

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.

Question 11

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.

Question 12

A major advantage of nonpharmacologic pain management is that:

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.

Question 13

Which clinical effect can 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

Question 14

The primary side effect of maternal narcotic analgesia in the newborn is:

A) tachypnea.
B) bradycardia.
C) acrocyanosis.
D) respiratory depression.

Question 15

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)

Question 16

Which client 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

Question 17

A client received 25 mg of meperidine (Demerol) intravenously 1 hour before birth. Which drug should the nurse have readily available?

A) Naloxone (Narcan)
B) Butorphanol (Stadol)
C) Nalbuphine (Nubain)
D) Promethazine (Phenergan)

Question 18

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

A) muscle tension.
B) the pain threshold.
C) blood flow to the uterus.
D) rest time between contractions.

Question 19

Which fetal position may cause the laboring client more back discomfort?

A) Left occiput anterior
B) Left occiput posterior
C) Right occiput anterior
D) Right occiput transverse

Question 20

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

A) imagery.
B) effleurage.
C) distraction.
D) dissociation.

Question 21

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?

A) Perform a vaginal exam to denote progress.
B) Reposition the client to a side lying position.
C) Instruct the client to breathe into her cupped hands.
D) Notify the physician about current findings.

Question 22

You are preparing a client 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 client 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 client for hypertension in response to epidural insertion.

Question 23

Which of the following clients could be a candidate for a vaginal birth after cesarean section (VBAC)?

A) A 32-year-old gravida 2, para 1, who had a primary cesarean section for fetal distress
B) A 23-year-old gravida 3, para 2, who had two cesarean sections with classic incisions
C) An 18-year-old gravida 3, para 2, who had cesarean section for labor dystocia during second stage with birth of newborns who weighed 8 pounds 10 ounces, and 9 pounds, respectively
D) A 25-year-old gravida 1, para 0, who wants to have a scheduled cesarean section rather than go through the process of labor because she is very fearful of the pain associated with childbirth

Question 24

Which client 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

Question 25

The priority intervention for a client with epidural anesthesia whose blood pressure is 80/50 mm Hg is:

A) reposition to supine position.
B) administer ephedrine, 5 mg IV push.
C) maintain IV infusion rate at 150 mL/hr.
D) Notify anesthesia about maternal hypotension.

Question 26

Your laboring client has asked that you help her to use a cutaneous stimulation strategy for pain management, you would then:

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.

Question 27

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 priority action 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.

Question 28

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.

Question 29

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

Question 30

A client presents to the labor and birth area for emergent birth. Vaginal exam reveals that the client is fully dilated, vertex, +2 station, with ruptured membranes. The client 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 client assessment?

A) Use contact anesthesia for an epidural and prepare the client per protocol.
B) Tell the client 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 client with nonpharmacologic methods of pain distraction during this time as you prepare for vaginal birth.
D) Call the physician for admitting orders.

Question 31

A client 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.

Question 32

The process of labor places significant metabolic demands on the obstetric client. 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

Question 33

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.

Question 34

A labor client has brought in with her a picture 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.

Question 35

While developing an intrapartum care plan for the client in early labor, it is important that the nurse recognize that psychosocial factors may influence a woman's experience of pain. These include which of the following? (Select all that apply.)

A) Culture
B) Anxiety and fear
C) Support systems
D) Preparation for childbirth
E) Previous experiences with pain

Question 36

A client 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 client. Which priority intervention should be done by the nurse to help evaluate clinical response to treatment?

A) Obtain a pain scale response from the client 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.

Question 37

A labor client, 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

Question 38

A patient in active labor requests an epidural for pain management. What is the nurse's priority action for this patient?

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/hr over 30 minutes.

Question 39

A pregnant woman is in the second stage of labor and is actively pushing. What type of pain would she be most likely to experience?

A) Deep, poorly localized pain
B) Visceral pain
C) Slow, dull, aching pain
D) Somatic pain

Question 40

Meperidine (Demerol), 50 mg IV, has been ordered for a laboring patient. The patient is contracting every 3 minutes, with a duration of 45 to 60 seconds. What is the nurse's best plan for administering the IV medication?

A) Inject the medication between two contractions.
B) Inject the medication during and after a single contraction.
C) Inject the medication at the start of the next two contractions.
D) Inject the medication throughout the duration of a single contraction.

Question 41

The nurse is preparing a client for a cesarean section scheduled to be done 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)

Question 42

Match each term with the correct definition.

Focal point

A)Pressure applied to specific pressure points using hands, rollers, balls, or other equipment
B)Contraction and then release of specific muscle groups until all muscles are relaxed
C)Concentrating on something outside the body

Question 43

The nurse is administering fentanyl (Sublimaze) to a client in labor. The health care provider's prescription reads fentanyl (Sublimaze), 100 mcg IV stat. The medication vial reads fentanyl (Sublimaze), 50 mcg/mL. The nurse should prepare how many milliliters to administer the correct dose? Record your answer as a whole number.
_____ mL

Question 44

The health care provider's prescription reads diphenhydramine (Benadryl), 25 mg IV stat. The medication vial reads diphenhydramine (Benadryl), 50 mg/mL. The nurse should prepare how many milliliters to administer the correct dose? Record your answer to one decimal point.
_____ mL

Question 45

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

A) Encourage the client to drink fluids.
B) Place the client in a Trendelenburg position.
C) Administer a normal saline bolus as prescribed.
D) Administer oxygen at 8 to 10 L/min per face mask.
E) Administer IV ephedrine in 5- to 10-mg increments as prescribed.

Question 46

Match each term with the correct definition.

Acupressure

A)Pressure applied to specific pressure points using hands, rollers, balls, or other equipment
B)Contraction and then release of specific muscle groups until all muscles are relaxed
C)Concentrating on something outside the body

Question 47

Match each term with the correct definition.

Progressive relaxation

A)Pressure applied to specific pressure points using hands, rollers, balls, or other equipment
B)Contraction and then release of specific muscle groups until all muscles are relaxed
C)Concentrating on something outside the body