Description
Maternity Nursing 10th Edition Leifer Test Bank
ISBN-13: 978-1416048701
ISBN-10: 1416048707
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Leifer: Maternity Nursing: An Introductory Text
Chapter 08: Management of Pain During Labor
Test Bank
MULTIPLE CHOICE
- Focusing strategies, cutaneous stimulation, and back massage are thought to reduce pain by:
| a. | Preventing pain sensations from being transmitted the spinal column |
| b. | Blocking the interpretation of painful stimuli in the brain |
| c. | Altering the perception of painful stimuli |
| d. | Decreasing the production of endorphins |
ANS: A
According to the gate control theory, distractions occupy the fibers that transmit painful stimuli to the brain via the spinal column. This prevents the pain sensation from being transmitted.
DIF: Cognitive Level: Comprehension REF: 148 OBJ: 5
TOP: Gate Control Theory KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Effleurage is an example of:
| a. | Thermal stimulation |
| b. | Cognitive stimulation |
| c. | Cutaneous stimulation |
| d. | Relaxation techniques |
ANS: C
Effleurage is a rhythmic stroking and massage of the abdomen—a form of cutaneous stimulation.
DIF: Cognitive Level: Comprehension REF: 148 OBJ: 5
TOP: Nonpharmacologic Pain Control Strategies KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- An analgesic drug is usually not given until the cervix is dilated to at least _____ cm.
| a. | 1 |
| b. | 2 |
| c. | 3 |
| d. | 4 |
ANS: D
By the time the cervix is dilated 4 cm, labor is usually well established and analgesics are less likely to slow its progress.
DIF: Cognitive Level: Knowledge REF: 152 OBJ: 7
TOP: Pharmacologic Pain Control Strategies KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- A complication of epidural block is:
| a. | Hyperglycemia in the newborn |
| b. | Maternal hypotension |
| c. | Fetal tachycardia |
| d. | Maternal and fetal respiratory distress |
ANS: B
Complications of epidural anesthesia include maternal hypotension, fetal bradycardia, and movement of the catheter into the spinal column.
DIF: Cognitive Level: Comprehension REF: 153-154 | Table 8-1
OBJ: 7 TOP: Regional Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- An opioid antagonist used to counteract respiratory depression in the newborn is:
| a. | Meperidine (Demerol) |
| b. | Naloxone (Narcan) |
| c. | Flumazenil (Romazicon) |
| d. | Pentazocine (Talwin) |
ANS: B
Naloxone is an opioid antagonist, meaning it can reverse the depressant effects of opioid analgesics such as morphine and meperidine. Flumazenil reverses the effects of benzodiazepine drugs. Pentazocine is a narcotic agonist-antagonist.
DIF: Cognitive Level: Knowledge REF: 157 OBJ: 6
TOP: Analgesia KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
- The Apgar score of a newborn is likely to be lowest when the mother has which type of anesthesia for childbirth?
| a. | Epidural block |
| b. | Spinal subarachnoid block |
| c. | Pudendal block |
| d. | General anesthesia |
ANS: D
General anesthesia sedates the baas well as the mother, so the bamay have more difficulty establishing normal respirations after birth.
DIF: Cognitive Level: Comprehension REF: 155 | 157 OBJ: 6
TOP: General Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
- During the active phase of labor, a patient reports severe back pain that becomes increasingly intense during contractions. The nurse should place the woman in which position?
| a. | Semi-Fowler’s |
| b. | Supine |
| c. | Knee-chest |
| d. | Side-lying on the side of the fetus’s back |
ANS: C
Severe back pain during the active phase of labor commonly is caused posterior fetal positioning, in which the fetal back and head press against the maternal spine. The knee-chest position facilitates rotation and descent of the fetus and lessens the degree of back pain during contractions. The supine and semi-Fowler’s positions would be inappropriate because they slow fetal rotation. The side-lying position uses gravity to facilitate fetal rotation when the mother is lying on the side opposite the fetus’s back.
DIF: Cognitive Level: Analysis REF: 148-149 | Box 8-1
OBJ: 5 | 8 TOP: Nonpharmacologic Pain Control Strategies
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiologic Integrity
- After receiving a pudendal block, which reaction is the patient likely to experience?
| a. | Complete relief from the pain of uterine contractions during labor |
| b. | Numbness of her legs after delivery |
| c. | Delayed voiding after delivery because the nerves supplying the bladder are numb |
| d. | Numbness of the birth canal and perineum to allow pushing during delivery |
ANS: D
A pudendal block is performed during the second stage of labor to block the pudendal nerve, numbing the birth canal and perineum to allow pushing during delivery, and to facilitate episiotomy repair. Although this type of anesthesia relieves discomfort from perineal distention, it does not affect pain from uterine contractions. The pudendal block does not affect the uterus, bladder, or legs.
DIF: Cognitive Level: Comprehension REF: 153 | Table 8-1
OBJ: 7 TOP: Regional Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- After administration of epidural anesthesia, the nurse should immediately:
| a. | Assess pulse and respiration. |
| b. | Assess blood pressure and fetal heart tones. |
| c. | Administer oxygen via nasal cannula. |
| d. | Place patient in semi-Fowler’s position. |
ANS: B
Epidural anesthesia commonly causes maternal hypotension, which can cause decreased placental circulation and inadequate fetal oxygenation. Therefore, it is important to check blood pressure and fetal heart tones immediately after administration of the anesthetic. Oxygen would not be necessary unless signs of hypotension and fetal distress are present. Placing the patient in a lateral position would ensure placental circulation and fetal oxygenation and would be the preferred position.
DIF: Cognitive Level: Application REF: 153-155 | Table 8-1
OBJ: 8 TOP: Regional Anesthesia
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity
- A plan to achieve adequate pain relief without maternal or fetal risk is most effective if:
| a. | The mother has the bawithout any analgesic or anesthetic. |
| b. | The primary health care provider decides the best pain relief for the mother and baby. |
| c. | Mother and family priorities and preferences are incorporated into the plan. |
| d. | The nurse informs the family of all alternative methods of pain relief available. |
ANS: C
By working with the woman and her family, taking into account pain characteristics in labor, interventions for pain relief, comfort methods, and cultural responses to pain, the nurse is able to design a care plan to safely meet the specific needs of the woman in labor.
DIF: Cognitive Level: Application REF: 147 | Box 8-3 | NCP 8-1
OBJ: 8 TOP: Pain Management
KEY: Nursing Process Step: Assessment, Planning
MSC: NCLEX: Health Promotion and Maintenance
- A woman in active first stage of labor is using a shallow pattern of breathing that is about twice the normal adult breathing rate. She begins to complain of feeling lightheaded and dizzy and states her fingers are tingling. The nurse should:
| a. | Tell the woman to slow the pace of her breathing. |
| b. | Administer oxygen via mask or nasal cannula. |
| c. | Notify the health care provider. |
| d. | Help her breathe into a paper bag or her cupped hands. |
ANS: D
Hyperventilation (decreased carbon dioxide [CO2]) can occur as a result of rapid breathing. CO2 depletion can cause dizziness, numbness or tingling of hands and mouth, blurring of vision, and muscle spasms of the hands. The woman should be encouraged to rebreathe CO2 from a paper bag or cupped hands because continued hyperventilation can deprive the fetus of oxygen. Generally, this will help the woman slow her breathing pattern. Oxygen administration will not solve the problem.
DIF: Cognitive Level: Analysis REF: 150-151 | Box 8-2
OBJ: 5 | 8 TOP: Breathing Techniques
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiologic Integrity
- A woman is complaining of intense lower back pain during contractions. An effective pain relief measure would be to use:
| a. | Counterpressure against the sacrum |
| b. | Pant-blow breathing techniques |
| c. | Conscious relaxation or guided imagery |
| d. | Effleurage |
ANS: A
Cutaneous stimulation, such as counterpressure applied to the sacral area, helps provide pain relief closing the “gate” to transmission of pain impulses to the brain. The other pain relief measures are not usually as effective for back pain during labor.
DIF: Cognitive Level: Application REF: 150 | Box 8-1
OBJ: 5 TOP: Cutaneous Stimulation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiologic Integrity
- If a narcotic antagonist is administered to a laboring woman, she should be told:
| a. | She will feel less anxious. |
| b. | Her pain will decrease. |
| c. | Her pain will return. |
| d. | She will no longer feel the urge to push. |
ANS: C
Narcotic antagonists administered to the laboring woman reverse the analgesic effects of her pain medication, and the pain will return.
DIF: Cognitive Level: Application REF: 157 OBJ: 8
TOP: Analgesia KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiologic Integrity
- Which nursing action will be most effective in helping a woman who is apprehensive cope with her labor?
| a. | Promote relaxation through reassurance and comfort measures. |
| b. | Explain the physiologic basis of labor so the woman understands what is happening. |
| c. | Allow the woman to remain agitated if that is her method of coping. |
| d. | Distract the woman with other activities. |
ANS: A
An important principle of nursing care during labor is comfort. General comfort can reduce stress and thus reduce pain. Comfort measures can also encourage rest and relaxation.
DIF: Cognitive Level: Application REF: 149 OBJ: 5
TOP: General Comfort Measures KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
- A woman who is a gravida 2, para 1 comes to the labor and delivery suite with a spontaneous rupture of membranes, uterine contractions every 2 minutes, and strong cervical dilation 10 cm with 100% effacement, +2 station. She states she feels a lot of pressure and is asking for something for pain. The nurse recognizes that:
| a. | Analgesics given at this point will likely stop her labor. |
| b. | Analgesics given at this time could cause respiratory depression in the newborn. |
| c. | A sedative would be the drug of choice this late in labor. |
| d. | There are no pain relief measures that can be given at this time. |
ANS: B
Analgesic drugs should not be given if less than 1 hour remains before delivery because after birth the newborn may have difficulty metabolizing the drugs and may have respiratory depression. Analgesic drugs, if given at this point in labor, will not likely stop its progress. Sedatives do not produce pain relief and may actually inhibit a mother’s ability to cope with the pain. This late in labor, a type of anesthesia, such as a pudendal block, may be more appropriate.
DIF: Cognitive Level: Analysis REF: 151-152 OBJ: 6-7
TOP: Limitations of Pharmacologic Methods | Sedatives
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiologic Integrity
- The natural opiate-like chemicals produced a woman during labor and delivery are known as:
| a. | Endorphins |
| b. | Testosterone |
| c. | Progesterone |
| d. | Androgens |
ANS: A
Endorphins, or endogenous opiates, are produced in the anterior pituitary gland and hypothalamus as a result of stress. These morphine-like substances appear to raise the pain threshold, helping women better tolerate the pain of labor and birth.
DIF: Cognitive Level: Comprehension REF: 148 OBJ: 4
TOP: Chemical Factors KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The nurse recognizes the most common treatment for a postspinal headache to be which of the following?
| a. | Morphine |
| b. | Blood patch |
| c. | Blood transfusion |
| d. | Local anesthesia |
ANS: B
A blood patch often provides immediate relief for a postspinal headache. An injection of the patient’s blood into the site of the spinal block puncture seals the hole, preventing further cerebrospinal fluid leakage.
DIF: Cognitive Level: Analysis REF: 155 | Figure 8-6 | Table 8-1
OBJ: 7 TOP: Side Effects of Regional Anesthesia and the Nursing Role
KEY: Nursing Process Step: N/A MSC: NCLEX: Physiologic Integrity
- When anesthesia is introduced into the cerebrospinal fluid, it is referred to as _____ anesthesia.
| a. | Paracervical |
| b. | Epidural |
| c. | General |
| d. | Spinal |
ANS: D
Spinal anesthesia is delivered in the cerebrospinal fluid.
DIF: Cognitive Level: Comprehension REF: 153 | Table 8-1
OBJ: 7 TOP: Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The patient states, “My epidural isn’t working! I can still feel my contractions.” Which of the following statements the nurse is most appropriate?
| a. | “Don’t worry, the pain won’t be too bad.” |
| b. | “I will ask the doctor to order you a narcotic.” |
| c. | “The doctor must have done it wrong.” |
| d. | “An epidural will allow you to sense your contractions, but you won’t feel the pain.” |
ANS: D
An epidural will allow the woman to feel the contractions and bear down during labor without feeling pain.
DIF: Cognitive Level: Application REF: 153 | Table 8-1
OBJ: 7 TOP: Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- If the patient asks the nurse where the medication is placed during an epidural block, the most appropriate response is that the anesthetic is introduced:
| a. | Near the dural sac in the lumbar region of the spine |
| b. | Into the intravenous line in the arm |
| c. | Near the dural sac in the cervical area of the spine |
| d. | To the perineal area |
ANS: A
With an epidural block, the anesthetic is injected into the epidural space, located inside the vertebral column surrounding the dural sac in the lumbar region of the spine.
DIF: Cognitive Level: Application REF: 153 | Table 8-1
OBJ: 7 TOP: Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- The patient who delivered without anesthesia requires an episiotomy repair. The nurse will most likely prepare for which type of anesthesia?
| a. | Pudendal block |
| b. | Epidural block |
| c. | General anesthesia |
| d. | Spinal block |
ANS: A
The purpose of the pudendal block is to anesthetize the perineum, vulva, and rectal area.
DIF: Cognitive Level: Application REF: 153 | Table 8-1
OBJ: 7 TOP: Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
- Maternal hypotension is a major adverse reaction to which method of pain relief?
| a. | Epidural block |
| b. | Pudendal block |
| c. | Cutaneous stimulation |
| d. | Cognitive stimulation |
ANS: A
Hypotension is a common side effect of regional anesthesia, so frequent monitoring of blood pressure is required.
DIF: Cognitive Level: Comprehension REF: 153-154 | Table 8-1
OBJ: 8 TOP: Pain Management KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
- Before administration of epidural anesthesia, a woman should be adequately hydrated with which intravenous solution?
| a. | 5% dextrose in water |
| b. | Normal saline with added potassium |
| c. | Ringer’s lactate solution |
| d. | 10% dextrose in water |
ANS: C
Ringer’s lactate solution or normal saline is most often used for hydration because a glucose-containing solution causes the fetus to increase insulin production, possibly resulting in hypoglycemia after birth. Potassium would not commonly be added to the solution.
DIF: Cognitive Level: Application REF: 155 OBJ: 8
TOP: Pain Management KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
- Which position would be inappropriate during labor?
| a. | Hands-and-knees |
| b. | Side-lying |
| c. | Supine |
| d. | Squatting |
ANS: C
Any position except the supine position is acceptable during labor.
DIF: Cognitive Level: Comprehension REF: 149 | Box 8-1
OBJ: 2 TOP: Pain Management KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
- Which class of medication would the nurse expect to administer to a patient undergoing general anesthesia?
| a. | Antihistamine |
| b. | Beta blocker |
| c. | Antacid |
| d. | Antidiarrheal |
ANS: C
Administration of drugs to raise the gastric pH and make secretions less acidic reduces the risk of lung injury if aspiration occurs. General anesthesia puts the woman at risk for regurgitation and aspiration of gastric contents. Gastric contents are highly acidic and can produce chemical pneumonitis if aspirated.
DIF: Cognitive Level: Comprehension REF: 155 OBJ: 8
TOP: General Anesthesia KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
MULTIPLE RESPONSE
- The nurse is caring for a patient who delivered under general anesthesia. The nurse understands the risks of general anesthesia and will assess for which complication(s)? (Select all that apply.)
| a. | Postpartum hemorrhage in the mother |
| b. | Decreased respiratory status of infant |
| c. | Aspiration of gastric contents in the mother |
| d. | Diarrhea in the mother |
| e. | Hypertension in the mother |
ANS: A, B, C
General anesthesia puts the woman at risk for regurgitation and aspiration of gastric contents. It crosses the placental barrier and the fetus will be under its effects at birth, making establishment of initial respiration difficult. General anesthesia may cause the uterus to relax in the postpartum period, which can contribute to postpartum hemorrhage.
DIF: Cognitive Level: Application REF: 155 OBJ: 7
TOP: Anesthesia KEY: Nursing Process Step: N/A MSC: NCLEX: N/A
- The nurse understands that childbirth pain differs from pain experienced in other conditions in what way(s)? (Select all that apply.)
| a. | Labor pain is part of a normal process. |
| b. | The sources of labor pain are unknown. |
| c. | There is time for preparation to manage labor pain. |
| d. | The pain of labor is self-limiting. |
| e. | The purpose of labor pain helps in the birthing process. |
ANS: A, C, D, E
Childbirth pain differs from pain experienced in other conditions. Labor pain is part of a normal process, the pain of labor is self-limiting, the pain aids in the birthing process, and there is time to prepare for the pain.
DIF: Cognitive Level: Comprehension REF: 147 OBJ: 2
TOP: Pain Management KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
- Pain during labor occurs as a result of which stressor(s)? (Select all that apply.)
| a. | Contraction of the cervix |
| b. | Pressure and pulling of the pelvic structures |
| c. | Distention and stretching of the vagina and perineum |
| d. | Size and position of the fetus |
| e. | Fear and anxiety |
ANS: B, C, D, E
Sources of pain during labor include pressure and pulling of the pelvic structures, distention and stretching of the vagina and perineum, the size and position of the fetus, and fear and anxiety (which exaggerates the pain sensation of the labor contraction). Dilation (not contraction) and stretching of the cervix also contribute to labor pain.
DIF: Cognitive Level: Comprehension REF: 148 OBJ: 3
TOP: Pain Management KEY: Nursing Process Step: N/A
MSC: NCLEX: Physiologic Integrity
