Deck 17: Maximizing Comfort for the Laboring Woman

Question 1

What is the role of the nurse as it applies to informed consent?

A) Inform the client about the procedure, and ask her to 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.

Answer 1

Act as a client advocate, and help clarify the procedure and the options.

Question 2

A first-time mother is concerned about the type of medications she will receive during labor.The client is in a fair amount of pain and is nauseated.In addition,she appears to be very anxious.The nurse explains that opioid analgesics are often used along with sedatives.How should the nurse phrase the rationale for this medication combination?

A) "The two medications, together, reduce complications."
B) "Sedatives enhance the effect of the pain medication."
C) "The two medications work better together, enabling you to sleep until you have the baby."
D) "This is what your physician has ordered for you."

Answer 2

"Sedatives enhance the effect of the pain medication."

Question 3

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.Which statement regarding this procedure is correct?

A) The application of nitrous oxide gas is not often used anymore.
B) An inhalation of gas is likely to be used in the second stage of labor, not during the first stage.
C) An application of nitrous oxide gas is administered for pain relief.
D) The application of gas is a prelude to a cesarean birth.

Answer 3

An application of nitrous oxide gas is administered for pain relief.

Question 4

Nursing care measures are commonly offered to women in labor.Which nursing measure reflects the 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 5

The nurse should be cognizant of which physiologic effect of pain?

A) Predominant pain of the first stage of labor is visceral pain that is located in the lower portion of the abdomen.
B) Referred pain is the extreme discomfort experienced between contractions.
C) 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 pain experienced during the second stage.

Question 6

Maternity nurses often have to answer questions about the many,sometimes unusual,ways people have tried to make the birthing experience more comfortable.Which information regarding nonpharmacologic pain relief is accurate?

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 7

The nurse should be cognizant of which important information regarding nerve block analgesia and anesthesia?

A) Most local agents are chemically related 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) Pudendal nerve block is designed to relieve the pain from uterine contractions.
D) Pudendal nerve block, if performed correctly, does not significantly lessen the bearing-down reflex.

Question 8

A client is in early labor,and her nurse is discussing the pain relief options she is considering.The client states that she wants an epidural "no matter what!" What is the nurse's best response?

A) "I'll make sure you get your epidural."
B) "You may only have an epidural if your physician allows it."
C) "You may only have an 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 9

A laboring woman has received meperidine (Demerol)intravenously (IV),90 minutes before giving 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

What should the laboring client who receives an opioid antagonist be told to expect?

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 11

Conscious relaxation is associated with which method of childbirth preparation?

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

Question 12

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

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

Question 13

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 experience more pain.
D) Levels of pain-mitigating beta-endorphins are higher during a spontaneous, natural childbirth.

Question 14

Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help their clients.Which clients may initially appear very stoic but then become quite vocal as labor progresses until late in labor,when they become more vocal and request pain relief?

A) Chinese
B) Arab or Middle Eastern
C) Hispanic
D) African-American

Question 15

A woman in labor has just received an epidural block.What is the most important nursing intervention at this time?

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 16

Which statement is not an expected outcome for the client who attends a reputable childbirth preparation program?

A) Childbirth preparation programs increase the woman's sense of control.
B) Childbirth preparation programs prepare a support person to help during labor.
C) Childbirth preparation programs guarantee a pain-free childbirth.
D) Childbirth preparation programs teach distraction techniques.

Question 17

According to professional standards (the Association of Women's Health,Obstetric and Neonatal Nurses [AWHONN],2007),which action cannot be performed by the nonanesthetist registered nurse who is caring for a woman with epidural anesthesia?

A) Monitoring the status of the woman and fetus
B) Initiating epidural anesthesia
C) Replacing empty infusion bags with the same medication and concentrate
D) Stopping the infusion, and initiating emergency measures

Question 18

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.What is the optimal intervention for the nurse to provide at this time?

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 19

Anxiety is commonly associated with pain during labor.Which statement regarding anxiety is correct?

A) Even mild anxiety must be treated.
B) Severe anxiety increases tension, increases pain, and then, 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 20

An 18-year-old pregnant woman,gravida 1,para 0,is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds.The client states,"My contractions are so strong,I don't know what to do." Before making a plan of care,what should the nurse's first action be?

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 21

What is the rationale for the use of a blood patch after spinal anesthesia?

A) Hypotension
B) Headache
C) Neonatal respiratory depression
D) Loss of movement

Question 22

A woman in the active phase of the first stage of labor is using a shallow pattern of breathing,which is approximately twice the normal adult breathing rate.She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling.Which intervention should the nurse immediately initiate?

A) Contact the woman's physician.
B) Tell the woman to slow her pace of her breathing.
C) Administer oxygen via a mask or nasal cannula.
D) Help her breathe into a paper bag.

Question 23

The class of drugs known as opioid analgesics (butorphanol,nalbuphine)is not suitable for administration to women with known opioid dependence.The antagonistic activity could precipitate withdrawal symptoms (abstinence syndrome)in both mothers and newborns.Which signs would indicate opioid or narcotic withdrawal in the mother?

A) Yawning, runny nose
B) Increase in appetite
C) Chills or hot flashes
D) Constipation
E) Irritability, restlessness

Question 24

Which alternative approaches to relaxation have proven successful when working with the client in labor?

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

Question 25

Maternal hypotension is a potential side effect of regional anesthesia and analgesia.What nursing interventions could the nurse use to increase the client's blood pressure?

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 26

A client is experiencing back labor and complains of intense pain in her lower back.Which measure would best support this woman in labor?

A) Counterpressure against the sacrum
B) Pant-blow (breaths and puffs) breathing techniques
C) Effleurage
D) Conscious relaxation or guided imagery

Question 27

The obstetric nurse is preparing the client for an emergency cesarean birth,with no time to administer spinal anesthesia.The nurse is aware of and prepared for the greatest risk of administering general anesthesia to the client.What is this risk?

A) Respiratory depression
B) Uterine relaxation
C) Inadequate muscle relaxation
D) Aspiration of stomach contents

Question 28

A woman has requested an epidural block 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.Before the initiation of the epidural,the woman should be informed regarding the disadvantages of an epidural block.Which concerns should the nurse share with this client?

A) Ability to move freely is limited.
B) Orthostatic hypotension and dizziness may occur.
C) Gastric emptying is not delayed.
D) Higher body temperature may occur.
E) Blood loss is not excessive.

Question 29

While developing an intrapartum care plan for the client in early labor,which psychosocial factors would the nurse recognize upon the client's pain experience?

A) Culture
B) Anxiety and fear
C) Previous experiences with pain
D) Intervention of caregivers
E) Support systems

Question 30

Which alterations in the perception of pain by a laboring client should the nurse understand?

A) Sensory pain for nulliparous women is often greater than for multiparous women during early labor.
B) Affective pain for nulliparous women is usually less than for multiparous women throughout the first stage of labor.
C) Women with a history of substance abuse experience more pain during labor.
D) Multiparous women have more fatigue from labor and therefore experience more pain.

Question 31

What is the correct terminology for the nerve block that provides anesthesia to the lower vagina and perineum?

A) Epidural
B) Pudendal
C) Local
D) Spinal block

Question 32

Developing a realistic birth plan with the pregnant woman regarding her care is important for the nurse.How would the nurse explain the major advantage of nonpharmacologic pain management?

A) Greater and more complete pain relief is possible.
B) No side effects or risks to the fetus are involved.
C) The woman will remain fully alert at all times.
D) Labor will likely be more rapid.

Question 33

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.The nurse 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 this woman?

A) She is too far dilated.
B) She is anemic.
C) She has thrombocytopenia.
D) She is septic.

Question 34

The nurse should be aware of what important information regarding systemic analgesics administered during labor?

A) Systemic analgesics cross the maternal blood-brain barrier as easily as they do the fetal blood-brain barrier.
B) Effects on the fetus and newborn can include decreased alertness and delayed sucking.
C) Intramuscular (IM) administration is preferred over IV administration.
D) IV patient-controlled analgesia (PCA) results in increased use of an analgesic.