Chapter 07: Nursing Management of Pain During Labor and Birth

Chapter 07: Nursing Management of Pain During Labor and Birth MULTIPLE CHOICE 1. A nurse is teaching a childbirth preparation class. The group is discussing individual expression of labor pain. What statement is accurate about a patients expression of pain? a. It reduces the patients perception of pain. b. It is intensified by the vertex position of the fetus. c. It is influenced by culture. d. It can be completely controlled by nonpharmacological techniques. ANS: C Culture influences how women feel about birth and what is an acceptable response to pain. DIF: Cognitive Level: Comprehension REF: Page 168 TOP: Cultural Influences on Pain KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. What chemical substance(s) produced in the body acts as a natural pain reliever? a. Endorphins b. Morphine c. Codeine d. Atropine ANS: A Endorphins are natural body substances that are similar to morphine and may explain why laboring women need smaller doses of analgesia. DIF: Cognitive Level: Knowledge REF: Page 167 TOP: Endorphins KEY: Nursing Process StepN: NUR/ASINGTB.COM MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. A nurse instructs a womans labor coach to comfort her by firmly pressing on her lower back. What is this technique? a. Sacral pressure b. Distraction c. Effleurage d. Conscious relaxation ANS: A Sacral pressure refers to firm pressure against the lower back to relieve some of the pain of back labor. DIF: Cognitive Level: Knowledge REF: Page 167 OBJ: 6 TOP: Nonpharmacological Pain Management KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 4. A woman who is 6 cm dilated has the urge to push. What will the nurse instruct the woman to do during the contraction? a. Use slow-paced breathing. b. Hold her breath and push. c. Blow in short breaths. d. Use rapid-paced breathing. ANS: C If a laboring woman feels the urge to push before the cervix is fully dilated, then she is taught to blow in short breaths to avoid bearing down. DIF: Cognitive Level: Application REF: Page 170 TOP: Stair-Step Breathing Pattern KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Several hours into labor, a woman complains of dizziness, numbness, and tingling of her hands and mouth. What does the nurse recognize these symptoms signify? a. Hypertension b. Anxiety c. Anoxia d. Hyperventilation ANS: D Hyperventilation is sometimes a problem if a woman is breathing rapidly. DIF: Cognitive Level: Comprehension REF: Page 171 OBJ: 4 TOP: Hyperventilation KEY: Nursing Process Step: Data Collection MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. What is the most appropriate nursing action to take when a laboring woman hyperventilates? a. Help her breathe into her cupped hands. b. Place her flat on her back. c. Initiate oxygen at 2 liters via mask. d. Notify the doctor. ANS: A Measures to combat hyperventilation include breathing into cupped hands or a paper bag or holding breath for a few seconds. All of these techniques decrease PCO2. DIF: Cognitive Level: Application REF: Page 171 OBJ: 4 TOP: Nonpharmacological Pain ManaNgeUmReSnINt GTB.COM KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 7. A woman in the transition phase of labor requests a narcotic analgesic medication for pain relief. What should the nurse explain regarding giving a narcotic analgesic medication at this stage of labor? a. It can cause medication given at later stages to be ineffective. b. It will have no complications for the mother or infant. c. It may result in respiratory depression to the newborn. d. It will speed up labor and increase pain. ANS: C The risk of narcotic analgesics is that they cross the placenta and can cause fetal respiratory depression. DIF: Cognitive Level: Comprehension REF: Page 171 OBJ: 7 TOP: Opioids KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Reduction of Risk 8. What would the nurse guide a labor coach to do to comfort a woman tensing her muscles with contractions? a. Offer warm liquids to the patient. b. Encourage the patient to pant. c. Engage the patient in conversation. d. Assist the patient to the knee-chest position. ANS: B Panting relaxes the abdominal wall and distracts the patient. It would not be helpful to offer fluids or to attempt conversation during contractions. Walking intensifies contractions. DIF: Cognitive Level: Application REF: Page 170 TOP: Panting KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 9. A woman in labor will receive general anesthesia prior to cesarean section. The nurse reminds the patient that food and fluids need to be restricted for several hours prior to delivery. What will this prevent? a. Nausea and vomiting b. Vomiting and aspiration c. Abdominal cramping d. Intestinal obstruction ANS: B The major adverse effect of general anesthesia is aspiration of stomach contents. DIF: Cognitive Level: Comprehension REF: Page 173 OBJ: 7 TOP: General Anesthesia KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk 10. What assessment should be taken immediately after the anesthesiologist administers an epidural block to a laboring woman? a. Bladder for distention b. Blood pressure c. Sensation in the lower extremities d. Intravenous fluid flow rate ANS: B Blood pressure is checked every 5 minutes when the epidural block is first begun. Bladder assessment is also important but not an initial assessment. DIF: Cognitive Level: Application REF: Page 173 OBJ: 6 TOP: Epidural Block KEY: Nursing Process Step: Implementation NURSINGTB.COM MSC: NCLEX: Physiological Integrity: Reduction of Risk 11. A woman in labor has had an epidural block for pain relief. The nurse will be assessing carefully for what associated side effect of this type of regional anesthesia? a. Reduced fetal heart rate b. Long, intense contractions c. Sudden leg cramps d. Bladder distention ANS: D A side effect of an epidural block is urine retention because the anesthesia interferes with the womans ability to have an urge to void. The patient may have to be catheterized. DIF: Cognitive Level: Knowledge REF: Page 173 OBJ: 7 TOP: Epidural Block KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Reduction of Risk 12. Which narcotic antagonist is used to reverse narcotic-induced respiratory depression? a. Hydroxyzine (Vistaril) b. Phenobarbital c. Naloxone (Narcan) d. Nitrous oxide ANS: C Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics. DIF: Cognitive Level: Knowledge REF: Page 172 TOP: Narcotic Antagonist KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Reduction of Risk 13. The nurse is preparing a teaching plan for a woman receiving a subarachnoid block before delivery. What nursing action will be included in this plan to prevent the associated side effect of this type of anesthesia? a. Restrict oral fluids. b. Keep legs flexed. c. Walk with assistance as soon as possible. d. Lie flat for several hours. ANS: D The woman would be advised to remain flat for several hours after the block to decrease the chance of postspinal headache. DIF: Cognitive Level: Application REF: Page 173 OBJ: 7 TOP: Subarachnoid Block KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Reduction of Risk 14. A woman requests a pudendal block to manage her labor pain. What statement by the woman indicates a need for further explanation about the pudendal block? a. Im having a contraction. Can I get the pudendal block now? b. Ill get the pudendal block right before I deliver. c. The nurse midwife will insert the needles into my vagina. d. It takes a few minutes after the medicine is administered to make me feel numb. ANS: A The pudendal block does not block pain from contractions and is given just before birth. DIF: Cognitive Level: Comprehension REF: PNaUgeRS1I7N3GTB.COM OBJ: 7 TOP: Pudendal Block KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 15. An 18-year-old primigravida is 4 cm dilated and her contractions are 5 minutes apart. She received little prenatal care and had no childbirth preparation. She is crying loudly and shouting, Please give me something for the pain. I cant take the pain! What is the priority nursing diagnosis? a. Pain related to uterine contractions b. Knowledge deficit related to the birth experience c. Ineffective coping related to inadequate preparation for labor d. Risk for injury related to lack of prenatal care ANS: A The most important issue for this woman, at this time, is effective pain management. DIF: Cognitive Level: Analysis REF: Page 177 OBJ: 3 TOP: Pain as a Priority KEY: Nursing Process Step: Nursing Diagnosis MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 16. The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management? a. Slow abdominal breathing b. Guided relaxation c. Listening to music d. Massage ANS: D According to the gate control theory, stimulating large-diameter nerve fibers temporarily interferes with conduction of impulses through small-diameter fibers. Massage is a technique that stimulates large-diameter fibers and closes the gate. DIF: Cognitive Level: Analysis REF: Page 166 TOP: Gate Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 17. When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an epidural for delivery. What is a contraindication to an epidural block? a. Abnormal clotting b. Previous cesarean delivery c. History of migraine headaches d. History of diabetes mellitus ANS: A An epidural block is not used if a woman has abnormal blood clotting. DIF: Cognitive Level: Comprehension REF: Page 173 OBJ: 7 TOP: Epidural Block KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Reduction of Risk 18. The nurse coaches the primigravida not to bear down until the cervix is completely dilated. What may premature bearing down cause? a. Increased use of oxygen b. Cervical laceration c. Uterine rupture d. Compression of the cord ANS: B NURSINGTB.COM Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix. DIF: Cognitive Level: Comprehension REF: Page 170 TOP: Cervical Laceration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 19. What is the Dick-Read method of childbirth preparation based on? a. Mild sedation throughout labor b. Relaxation techniques c. Skin stimulation d. Deep massage ANS: B The Dick-Read method depends on the use of relaxation techniques to reduce the discomforts of labor. DIF: Cognitive Level: Knowledge REF: Page 168 TOP: Dick-Read Method KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 20. The nurse is instructing a Lamaze class on abdominal breathing and tells a patient that her baseline respiratory rate is 22 breaths per minute. What should be the patients rate while performing slow breathing? a. 9 b. 11 c. 15 d. 20 ANS: B The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate. DIF: Cognitive Level: Comprehension REF: Page 167 OBJ: 5 TOP: Lamaze Method KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 21. What is the least amount of sensation that one perceives as pain? a. Tolerance b. Threshold c. Level d. Abatement ANS: B Pain threshold is the least amount of sensation that one perceives as pain. Thresholds are different for each individual. DIF: Cognitive Level: Knowledge REF: Page 166 TOP: Pain Threshold KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 22. The nurse is caring for a laboring patient who is not reporting pain. What sign would alert the nurse of the need for pain relief? a. Frequently asking for ice chips b. Facial grimacing c. Changing positions in bed d. Covering her face with her hands ANS: B Facial grimacing may be an indicator of unexpressed pain. DIF: Cognitive Level: Comprehension REF: PNaUgeRS1I7N1GTB.COM TOP: Nonverbal Pain Expressing KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 23. A patient who received an epidural block asks why her blood pressure is taken so often. What is the nurses best response to explain the frequent blood pressure assessments? a. They ensure that unsafe levels of hypertension do not occur. b. They help assess for the need for further pain relief. c. They monitor the progress of labor. d. They ensure adequate placental perfusion. ANS: D The hypotension that accompanies an epidural block may cause inadequate perfusion of the placenta, leading to fetal hypoxia. DIF: Cognitive Level: Comprehension REF: Page 173 OBJ: 7 TOP: Disadvantage of Epidural Block KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 24. A laboring patient requests hot and cold applications be applied to her abdomen for pain control. How will this intervention act to control pain? a. By increasing endorphin production b. By facilitating effacement and dilation c. By producing increasing pain tolerance d. By stimulation of large nerve fibers ANS: D The gate control theory explains how pain impulses reach the brain for interpretation. It supports several nonpharmacological methods of pain control. According to this theory, pain is transmitted through small- diameter nerve fibers. However, the stimulation of large-diameter nerve fibers temporarily interferes with the conduction of impulses through small-diameter fibers. Techniques to stimulate large-diameter fibers and close the gate to painful impulses include massage, palm and fingertip pressure, and heat and cold applications. DIF: Cognitive Level: Comprehension REF: Page 166 OBJ: 3 TOP: Nonpharmacological Pain Relief KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 25. When caring for the laboring patient, the nurse determines that the fetus is located in the right occiput posterior (ROA). What will the nurse anticipate? a. Urinary retention b. Severe lower back pain c. A shorter labor process d. Nausea ANS: B If the fetal occiput is in a posterior pelvic quadrant, each contraction pushes it against the mothers sacrum, resulting in persistent and poorly relieved back pain (back labor). Labor is often longer with this fetal position. DIF: Cognitive Level: Application REF: Page 168 TOP: Maternal Condition KEY: Nursing Process Step: Data Collection MSC: NCLEX: Physiological Integrity: Basic Care and Comfort MULTIPLE RESPONSE 26. What typical types of classes are available to help expectant parents prepare for parenthood? (Select all that apply.) a. Infant care b. Breastfeeding c. Gestational diabetes d. Sources of financial aid e. Yoga NURSINGTB.COM ANS: A, B, C Prenatal classes include such topics as infant care, breastfeeding, gestational diabetes, exercising, and sibling and grandparent preparation. Yoga and financial information are not traditional content for prenatal instruction DIF: Cognitive Level: Knowledge REF: Page 164 OBJ: 2 TOP: Prenatal Classes KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 27. What breathing techniques would the nurse teach the prenatal patient to help her focus during labor in order to reduce pain? (Select all that apply.) a. First stage breathing b. Abdominal breathing c. Fourth stage breathing d. Modified pace breathing e. Patterned paced breathing ANS: A, B, D, E First stage breathing includes the techniques of modified pace breathing and patterned paced breathing, which are types of abdominal breathing techniques. These patterns of breathing will help a woman in labor to focus and reduce pain perception. The fourth stage of labor is the womans recovery stage and does not require a breathing technique. DIF: Cognitive Level: Comprehension REF: Page 170 TOP: Breathing Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 28. How does the pain of childbirth differ from other types of pain? (Select all that apply.) a. Childbirth pain is part of a normal process. b. Childbirth pain seldom needs narcotic relief. c. Position changes relieve pain and facilitate delivery. d. Childbirth pain declines following birth. e. Childbirth pain is self-limited. ANS: A, C, D, E Childbirth pain differs from other types of pain because it is part of a normal, natural, and expected process, can be relieved by change of position, declines immediately following birth, and is self-limiting. Childbirth pain requires pharmacological management with narcotics in many cases. DIF: Cognitive Level: Comprehension REF: Page 166 TOP: Childbirth Pain KEY: Nursing Process Step: Planning MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 29. Which are nonpharmacological forms of pain relief? (Select all that apply.) a. Skin stimulation b. Diversion and distraction c. Breathing techniques d. Exercise e. Yoga ANS: A, B, C Skin stimulation, diversion and distraction, and breathing techniques are the bases of nonpharmacological pain control. Although exercise and practices such as yoga and Pilates are beneficial, they are not means of pain control. NURSINGTB.COM DIF: Cognitive Level: Knowledge REF: Page 167 OBJ: 5 TOP: Nonpharmacological Pain Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 30. Which position(s) and exercise(s) will the nurse teach as beneficial in combating discomfort in the later stages of pregnancy? (Select all that apply.) a. Leg lifts b. Pelvic rock c. Tailor sitting d. Sit-ups e. Shoulder curling ANS: B, C, E Pelvic rock, tailor sitting, and shoulder curling are beneficial to the muscles that will have to adapt to the extra weight and changed posture of later pregnancy. Leg lifts and sit-ups are not beneficial because they both increase intraabdominal pressure. DIF: Cognitive Level: Comprehension REF: Page 165 OBJ: 6 TOP: Helpful Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. The nurse is providing a conference on nonpharmacological pain control methods. What major advantages of nonpharmacological pain control methods will the nurse include in the presentation? (Select all that apply.) a. They sedate the mother. b. They do not slow labor. c. They do not dull the excitement of the birth experience. d. They do not have the potential to cause allergic reactions. e. They do not have to be delayed until labor is well established. ANS: B, C, D, E All the options mentioned are benefits of nonpharmacological pain control methods with the exception of sedating the mother. DIF: Cognitive Level: Knowledge REF: Page 168 TOP: Advantages of Nonpharmacological Pain Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 32. The nurse is caring for a woman with epidural anesthesia for pain control during a vaginal delivery. A risk for injury related to epidural anesthesia has been identified by the nursing staff. What interventions are appropriate for the nurse to implement related to this diagnosis? (Select all that apply.) a. Assess leg movement and sensation before ambulating. b. Administer antibiotic as ordered. c. Observe for signs of impending birth. d. Provide sacral pressure as needed. e. Assess fetal position frequently. ANS: A, C To prevent the risk for injury related to epidural anesthesia the nurse should asses for movement, sensation, and leg strength before ambulating, ambulate cautiously with an assistant, assist the woman to change positions regularly, and observe for signs that birth may be near: increase in bloody show, perineal bulging, and/or crowning. DIF: Cognitive Level: Application REF: Page 179 TOP: Epidural Anesthesia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk NURSINGTB.COM 33. The physician has ordered Fentanyl (Sublimaze) for a woman in labor and has asked the nurse to provide patient education. What will the nurse include in the educational plan? (Select all that apply.) a. Onset is slow. b. Duration is short. c. Administration is by mouth. d. No known side effects. e. It is not the same drug as sufentanil. ANS: B, E Fentanyl has a rapid onset and short duration of action. Fentanyl, sufentanil, and alfentanil are not the same drugs. Fentanyl can cause respiratory depression but less than meperidine. It is not administered by mouth. DIF: Cognitive Level: Comprehension REF: Page 172 OBJ: 8 TOP: Narcotic Analgesia KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk COMPLETION 34. The amount of pain a person is willing to endure is referred to as . ANS: pain tolerance Pain tolerance is the amount of pain a person is willing to endure. Pain threshold is the point at which pain is perceived. Pain threshold is relatively consistent from person to person, but pain tolerance differs greatly. DIF: Cognitive Level: Knowledge REF: Page 166 TOP: Pain Tolerance KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 35. The massage technique that stimulates the large-diameter fibers in order to block impulses from the small- diameter fibers is . ANS: effleurage Effleurage stimulates the large-diameter fibers and blocks the pain impulses from the small-diameter fibers. DIF: Cognitive Level: Comprehension REF: Page 166 OBJ: 6 TOP: Effleurage KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 36. The , also called the psychoprophylactic method, is the basis of most childbirth preparation classes in the United States. ANS: Lamaze method The Lamaze method, also called the psychoprophylactic method, is the basis of most childbirth preparation classes in the United States. DIF: Cognitive Level: Knowledge REF: Page 168 TOP: Childbirth Preparation KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Basic Care and Comfort NURSINGTB.COM