Ch 16: The Nursing Role in Providing Comfort During Labor and Birth

d) Identify how the client expresses labor pain Pg. 392 Pain is a part of the labor process and management of the pain impacts the labor process itself. The nurse must effectively be able to assess the client's pain level to be able to provide care. Individuals from different cultures express pain in different ways. All of the other options are important to understand but they do not directly relate to the client and birth process.

1. In providing culturally competent care to a laboring woman, which is a priority? a) Identify the decision maker within the family b) Identify who is the support person during the labor c) Identify any cultural foods used prior to labor d) Identify how the client expresses labor pain

a) Acupressure Pg. 380 Acupressure is the application of pressure or massage at designated susceptible body points. A common point used for a woman in labor is Co4, which is located between the first finger and thumb on the back of the hand. Women may report their contractions feel lighter when a support person holds and squeezes their hand because the support person is accidentally triggering this point. Acupuncture involves insertion of needles into the same body points. Effleurage, the technique of gentle abdominal massage often taught with Lamaze in preparation for birth classes, is a classic example of therapeutic touch. Biofeedback is based on the belief that people have control and can regulate internal events such as heart rate and pain responses.

10. The coach of a client in labor is holding the client's hand and appears to be intentionally applying pressure to the space between the first finger and thumb on the back of the hand. The nurse recognizes this as which form of therapy? a) Acupressure b) Biofeedback c) Acupuncture d) Effleurage

c) Inability to push Pg. 383-385 If the client is not able to push, her epidural dose may need to be adjusted to decrease the impact on the sensory system. Dry lips indicate that she may need fluids, so the nurse should give her some ice chips or a drink of water. Urinary retention and rapidly progressing labor should be directly reported to the obstetrician, not the anesthesiologist.

11. The nurse is assisting a client through labor, monitoring her closely now that she has received an epidural. Which finding should the nurse prioritize to the anesthesiologist? a) Urinary retention b) Dry, cracked lips c) Inability to push d) Rapid progress of labor

d) Pain originates from the cervix and lower uterine segment Pg. 375 Pain sensations associated with labor originate from different places depending on the stage of labor. During the first stage of labor, the stretching required to efface and dilate the cervix stimulates pain receptors in the cervix and lower uterine segment.

12. The nurse is preparing an educational event for pregnant women on the topic of labor pain and birth. The nurse understands the need to include the origin of labor pain for each stage of labor. What information will the nurse present for the first stage of labor? a) Pain is focal in nature b) It is reported as the worst pain a woman will ever feel c) Diffuse abdominal pain signals a complication with progression of labor d) Pain originates from the cervix and lower uterine segment

a) These methods are a technique to prevent the painful stimuli from entering the brain Pg. 376 Gate-control diverts the pain stimuli from the pain site by replacing with a comfort stimuli in a new location. Gate control does not need to be applied directly to the site of the pain. Anxiety heightens the painful feelings. Gating blocks the flow of painful stimuli to the sensory centers in the brain.

13. The nurse instructs the client about skin massage and the gate control theory of pain. Which statement would be appropriate for the nurse to include for client understanding of the nonpharmacologic pain relief methods? a) These methods are a technique to prevent the painful stimuli from entering the brain b) The gating mechanism opens so all the stimuli pass through to the brain c) Pain perception is decreased if anxiety is present d) The gating mechanism is located at the pain site

c) Naloxone Pg. 382 Naloxone is an opioid antagonist. Butorphanol, nalbuphine, and meperidine are opioids.

14. Which medication is administered to reverse the depressant effects of opioids? a) Nalbuphine b) Butorphanol c) Naloxone d) Meperidine

b) Slowing of labor Pg. 383 Fentanyl when given IV can lead to hypotension, respiratory depression, and a slowing of labor. Since it is an opioid, the woman may also report a feeling of euphoria.

15. A pregnant client is to receive fentanyl IV for pain control during labor. The nurse would assess the client for which possible effect? a) Depression b) Slowing of labor c) Hypertension d) Tachypnea

b) Difficulty breathing Pg. 383 Total spinal blockade occurs when an inadvertent injection of a local anesthetic is placed into the intrathecal or epidural space. The resulting effect is that the anesthetic travels too high in the body causing paralysis of the respiratory muscles. Difficulty breathing is a sign. A decreased level of consciousness will occur later. A staggering gait or intense pain is not a primary symptom.

16. Which primary symptom does the nurse identify as a potentially fatal complication of epidural or intrathecal anesthesia? a) Decreased level of consciousness b) Difficulty breathing c) Intense pain d) Staggering gait

d) Instruct the client or her partner to perform light fingertip repetitive abdominal massage Pg. 379 Effleurage is light fingertip repetitive abdominal massage. The relaxation technique of visualization is used in hypnobirthing or focused meditation. Controlled chest breathing is a technique used in Lamaze breathing. Pressing on trigger points is an acupressure technique.

17. A client who requested "no drugs" in labor asks the nurse what other options are available for pain relief. The nurse reviews several options for nonpharmacologic pain relief, and the client thinks effleurage may help her manage the pain. This indicates that the nurse will: a) Press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist b) Instruct the client to perform controlled chest breathing with a slow inhale and a quick exhale c) Lead the client through a series of visualizations to aid in relaxation d) Instruct the client or her partner to perform light fingertip repetitive abdominal massage

b) Give an intravenous bolus of fluid Pg. 384 On detecting maternal hypotension as a result of epidural anesthesia, the nurse should administer a bolus of IV fluid to the client. This generally raises the BP to normal. If this is ineffective, the nurse should consider injecting ephedrine to raise the BP only after notifying the anesthesiologist and receiving an order for the drug. There is no need to call the anesthesiologist immediately. Injection of propranolol will decrease the BP further and is not recommended.

18. A client in labor receiving epidural anesthesia develops hypotension. What would the nurse do first? a) Inject ephedrine immediately b) Give an intravenous bolus of fluid c) Inject propranolol immediately d) Call the anesthesiologist immediately

c) My doula will help me with contractions so I will not need any pain relief in labor Pg. A doula is a professional support person who can provide continuous support in the prenatal, labor, and postpartum periods for both the client and partner. The doula will provide support for nonpharmacologic pain relief, such as massage. Doula care is associated with less intervention and pharmacologic pain relief in labor but is not a guarantee that pharmacologic pain relief will not be needed; this misconception should be addressed with the client.

19. The pregnant client is planning to hire a doula for support during labor. What statement by the client requires follow-up by the nurse? a) My doula will be able to support both me and my partner during the labor and birth b) My doula will come to my home in early labor and stay with me once I am admitted to the hospital c) My doula will help me with contractions so I will not need any pain relief in labor d) My doula will provide me with massage and encouragement in labor

a) Lithotomy Pg. 387 Pudendal anesthesia is typically administered to anesthetize the lower vagina, vulva, and perineum. The obstetrician or certified nurse midwife injects the anesthetic agent, such as lidocaine, through the lateral vaginal walls into the area near both the right and left pudendal nerve behind the sacrospinous ligament at the level of the ischial spines. The injection is made through the vagina with the client in lithotomy or dorsal recumbent position. The left lateral, prone or Trendelenburg positions would be inappropriate.

2. The nurse is preparing a client in labor to receive a pudendal block with lidocaine. The nurse would place the client in which position for administration? a) Lithotomy b) Left lateral c) Prone d) Trendelenburg

d) Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience Pg. 375 Women identify being involved in their pain management and adequate control of their pain as important factors in their overall labor experience. Women often report that it is not the amount of pain they have during labor that contributes to a satisfactory birth experience but rather how their pain is managed.

20. There has been much research done on pain and the perception of pain. What is the result of research done on levels of satisfaction with the control of labor pain? a) Women report higher levels of satisfaction when regional anesthetics are used to control pain b) Women report higher levels of satisfaction when the primary care provider makes the decision on what type of pain control to use c) Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain d) Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience

a) Respiratory rate Pg. 382 The fetal respiratory rate immediately after delivery assessed as respiratory depression is a side effect of the maternal dose of meperidine. Meperidine crosses the placenta and can remain in the fetal system. The other options are assessed and monitored but for reasons not related to the opioid medication administration.

21. Which neonatal assessment is the highest priority if the mother received meperidine during labor? a) Respiratory rate b) Lung sounds c) Temperature regulation d) Time of first meconium

c) Starting an IV and hanging IV fluids Pg. 384 Prehydration with IV fluids helps to prevent the most common side effect of epidural anesthesia, which is hypotension (20%). If the client develops hypotension or respiratory depression, then IV ephedrine or IV naloxone, respectively, can be administered, but neither is preventive. Maintaining the client in a supine position is recommended for a spinal headache, which can be a side effect of epidural anesthesia but is not the most common side effect and is not preventive.

22. What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client? a) Maintaining the client in a supine position b) Administrating IV ephedrine c) Starting an IV and hanging IV fluids d) Administrating IV naloxone

a) Practicing effleurage on the abdomen Pg. 379 In early labor, the less medication use the better; allow use of nonpharmacologic management and control the pain with effleurage. Sitting in a warm pool of water is relaxing and may lessen the pain, but it does not control the pain. Sedatives are not indicated as they may slow the birthing process. Opioids should be limited as they too may slow the progression of labor.

23. A client has presented in the early phase of labor, experiencing abdominal pain and signs of growing anxiety about the pain. Which pain management technique should the nurse prioritize at this stage? a) Practicing effleurage on the abdomen b) Administering a sedative such as secobarbital or pentobarbital c) Administering an opioid such as meperidine or fentanyl d) Immersing the client in warm water in a pool or hot tub

d) Fear of pain during labor Pg. 376 Fear of pain during labor is a psychosocial factor. The stretching of the cervix, descent of the fetus into the birth canal, and pressure on the perineum are physical factors.

24. The nursing instructor is teaching a group of nursing students about the uniqueness of pain involved with the birthing process. The instructor determines the session is successful when the students correctly choose which pain factor to be related to psychosocial influences? a) Descent of fetus into birth canal b) Stretching of cervix c) Pressure in the perineum d) Fear of pain during labor

d) Maternal blood pressure decreases from 130/70 to 98/50 mm Hg Pg. 384 As the epidural anesthetic agent spreads through the spinal canal, it may produce hypotensive crisis, which is characterized by maternal hypotension, decreased beat-to-beat variability, and fetal bradycardia. The respiratory rate, pulse rate, and temperature are within normal limits for a laboring client.

25. A client in labor has been given an epidural anesthetic. Which nursing assessment finding is most important immediately following the administration of epidural anesthesia? a) Maternal respirations decrease from 20 to 14 breaths/minute b) Maternal temperature increases from 99° F (37.2° C) to 100° F (37.8° C) c) Maternal pulse increases from 78 to 96 beats/minute d) Maternal blood pressure decreases from 130/70 to 98/50 mm Hg

b) Assess maternal blood pressure Pg. A pudendal nerve block is the injection of a local anesthetic such as bupivacaine (Marcaine) through the vagina to anesthetize the pudendal nerve. It is used for a client who has not had an epidural to provide a pain-free birth and, if the client should have an episiotomy, painless surgical suturing and repair. Although a pudendal nerve block is local, the nurse should assess the fetal heart rate and the mother's blood pressure immediately after the injection to be certain maternal hypotension does not occur. IV fluid bolus would be appropriate for an epidural block. Turning the client on her side would enhance perfusion but is not specific to the care of a client receiving a pudendal nerve block. Oxygen administration would be appropriate if the client exhibited signs of distress.

26. A pregnant client in labor receives a pudendal block for pain relief. Which action by the nurse would be appropriate after the block is given? a) Turn the client on her left side b) Assess maternal blood pressure c) Administer supplemental oxygen d) Give a bolus of IV fluid

d) Support the client's decision and call the provider Pg. 384 Pain is subjective and its level is only what the client experiences. The nurse should support the desire of the client. Sedatives would be counterproductive as they may slow the labor process. It would be inappropriate to negate her feelings and remind her of earlier goals; that is the job of the support person and should be left up him or her to decide what to say and when to say it.

27. A client and her husband have prepared for a natural birth; however, as the client progresses to 8 cm dilation, she can no longer endure the pain and begs the nurse for an epidural. What is the nurse's best response? a) Ask the husband to gently remind her of their goal of natural birth and to encourage and help her b) Suggest a less extreme alternative such as a sedative c) Gently remind the client of her goal of a natural birth and encourage and help her d) Support the client's decision and call the provider

d) Massage the woman's back Pg. 379 Gate-control is based on the idea of distraction or redirection of the conduction of impulses up the neural pathways. Massage redirects the paths of sensation away from the pain to the other area. Encouragement is a form of psychological support. Position change will only distract the client. Medication should be withheld until all nonpharmacologic treatments have been exhausted.

28. Which nursing intervention offered in labor would probably be the most effective in applying the gate control theory for relief of labor pain? a) Give the prescribed medication b) Encourage the woman to rest between contractions c) Change the woman's position d) Massage the woman's back

b) "The baby is coming. I'll explain what's happening and guide you" Pg. 377 Continuous labor support with a trained nurse or doula has been shown to be effective in increasing coping ability of laboring woman. To keep her calm, the nurse needs to explain all procedures and discuss all events to the mother. The nurse cannot know the final outcome and should be careful of making general statements indicating everything will be OK. It is the nurse's responsibility to calm the client down and not wait for the health care provider. While calling the family may help, there is no guarantee and the nurse needs to work to calm the client down.

29. The nurse is admitting a primigravida client who has just presented to the unit in early labor. Which response should the nurse prioritize to assist the client in remaining calm and cooperative during birth? a) "Even though the baby is coming, the health care provider will be here soon" b) "The baby is coming. I'll explain what's happening and guide you" c) "Do you want me to call in your family?" d) "The baby is coming. Relax and everything will turn out fine"

a) The characteristics of labor pain follow a pattern Pg 377 While pain is individualized, labor pain is defined and follows a pattern. Since it follows a typical path, education and planning are completed. All pain is not the same. A primigravid needs education and guidance to best navigate the process. A cesarean birth is not an option as a method of pain management.

3. When planning a labor experience for a primigravid, understanding which characteristic of labor pain is most helpful? a) The characteristics of labor pain follow a pattern b) All pain is the same c) If the woman is in too much pain, a cesarean birth is an option d) Women innately know how to deal with labor pain

c) Remind the client to call for assistance before getting out of bed Pg. The nurse will remind the client to call for help before getting out of bed to prevent falling from the sedation effects. The nurse would not expect sedatives to cause constipation if given for a limited time during labor. Fetal heart tones are assessed continuously to monitor for side effects of decreased fetal heart rate variability secondary to maternal sedatives. Sedatives do not relieve pain but may provide an opportunity to sleep and decreases anxiety during labor.

30. The nurse is caring for a client who received a dose of IV sedation, given by the charge nurse, 30 minutes prior. What action is appropriate? a) Remind the client that medication will assist in relieving pain from contractions b) Restrict the client's fluid to further prevent constipation from the medication c) Remind the client to call for assistance before getting out of bed d) Assure the fetal heart tones are assessed every 2 to 3 hours via monitoring

a) Assist the client to semi-Fowler position, assess the fetal heart rate, start an IV bolus of 500 ml, and administer oxygen via face mask Pg. 384-385 In a pregnant woman, hypotension is best managed in the left lateral or semi-Fowler position owing to the risk of supine hypotension in the supine position and in Trendelenburg position. The sitting position could exacerbate hypotension. Naloxone is administered for respiratory depression. When the mother experiences a change in vital signs, this may affect the fetal heart rate.

31. A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform? a) Assist the client to semi-Fowler position, assess the fetal heart rate, start an IV bolus of 500 ml, and administer oxygen via face mask b) Assist the client to the supine position, recheck the blood pressure, and administer an IV bolus of 1000 ml c) Assist the client to a sitting position, assess the fetal heart rate, give naloxone, and administer oxygen via face mask d) Assist the client to Trendelenburg position, assess the fetal heart rate, and administer oxygen via face mask

b) 37°C Pg. 378 Standing under a warm shower or soaking in a tub of warm water, jet hydrotherapy tub, or whirlpool is another way to apply heat to help reduce the pain of labor. The temperature of water used should be 37°C to prevent hyperthermia of the woman and also the newborn at birth.

32. A nurse is serving as a doula to a client who is now in labor at an alternative birthing center. The client has opted for a water birth, and the nurse is now drawing the water into a large tub. What temperature should the nurse keep the water at? a) 39°C b) 37°C c) 35°C d) 41°C

c) "I may end up with a severe headache from the spinal anesthesia" Pg. 386 Cerebrospinal fluid (CSF) leakage from the needle insertion site and irritation caused by a small amount of air that enters at the injection site and shifts the pressure of the CSF causes strain on the cerebral meninges, initiating pain from a postdural puncture (spinal) headache.

33. A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states: a) "I can continue sitting up after the spinal is given" b) "The anesthesia will numb both of my legs to a level above my breasts" c) "I may end up with a severe headache from the spinal anesthesia" d) "I will need to lie on my right side to reduce vena cava compression"

b) The woman is prepared for labor and birth Pg. 376 The woman who enters labor with realistic expectations usually copes well and reports a more satisfying labor experience than does a woman who is not as well prepared.

34. The pain of labor is influenced by many factors. What is one of these factors? a) The woman has a high tolerance for pain b) The woman is prepared for labor and birth c) The woman has a high threshold for pain d) The woman has lots of visitors during labor

d) Continue with the admission assessment Pg. 377 The nurse should continue with the assessment to establish a baseline for the client and determine her status. This could include asking any personal questions that might be inappropriate to ask in front of the doula. Doulas are birth coaches who provide one-on-one support in labor and throughout birth. A doula does not take the place of a nurse or client's partner but is there to assist in the process. There would be no need to print off any instructions for the doula to sign.

35. The nurse is admitting a client who is in labor who reports her husband and doula will be arriving shortly. Which action should the nurse prioritize in response? a) Ask the client who she would like to see first b) Print a copy of the instructions for the doula to sign c) Determine what activities the doula is qualified to handle d) Continue with the admission assessment

c) The client should be encouraged to drink plenty of fluids Pg. 386 A client with a postdural puncture (spinal) headache should be encouraged to drink plenty of fluids. Treatment of postdural spinal headache usually includes proper hydration. Sitting upright increases the severity of the headache. The headache is usually very severe. Without a treatment, it may last for days to weeks.

36. A client received epidural anesthesia and developed a postdural puncture (spinal) headache. Which of the following should the nurse know about a postdural spinal headache? a) Sitting upright will relieve the headache b) The headache is usually mild in severity c) The client should be encouraged to drink plenty of fluids d) The headache usually resolves on its own within 24 hours

d) Ambulate only with assistance from the nurse or caregiver Pg. 390 The client may have decreased sensory ability from the medication. She needs assistance to ambulate for safety. She will be largely unable to move, so she should remain in bed unless absolutely necessary.

37. The nurse is monitoring a client who just received IV sedation. Which instruction should the nurse prioritize with the client and her partner? a) Remain in bed for at least 30 minutes b) Ambulate within 15 minutes to prevent spinal headache c) Sit on the edge of the bed with her feet dangling before ambulating d) Ambulate only with assistance from the nurse or caregiver

a) Assess vital signs Pg. 386 The most common side effect of spinal and epidural anesthesia is hypotension, which can lead to fetal bradycardia, decelerations, or fetal distress. Although each is important, assessment of vital signs should be performed first.

38. A client has just received combined spinal epidural. Which nursing assessment should be performed first? a) Assess vital signs b) Assess for fetal tachycardia c) Assess pain level using a pain scale d) Assess for spontaneous rupture of membranes e) Assess for progress in labor

c) Lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels Pg. 375 During contractions, blood vessels constrict, reducing the blood supply to uterine and cervical cells, resulting in anoxia to muscle fibers. This anoxia can cause pain in the same way blockage of the cardiac arteries causes the pain of a heart attack. Endorphins are naturally occurring opiate-like substances that reduce pain, not cause it. Distraction and mechanical irritation of nerve fibers are also methods of reducing pain, not causes of pain.

39. Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide? a) Release of endorphins in response to the uterine contractions b) Blocking of nerve transmission via mechanical irritation of nerve fibers c) Lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels d) Distraction of the brain cortex by other stimuli occuring in the body

a) Administration of 500 mL of IV Ringer's lactate Pg. 384 The chief concern with epidural anesthesia is its tendency to cause hypotension because of its blocking effect on the sympathetic nerve fibers in the epidural space. This risk can be reduced by being certain a woman is well hydrated with 500 to 1000 mL of IV fluid, such as Ringer's lactate, before the anesthetic is administered. Ringer's lactate is preferable to a glucose solution because too much maternal glucose can cause hyperglycemia with rebound hypoglycemia in the newborn. Be certain a woman does not lie supine but remains on her side after an epidural block, to help prevent supine hypotension syndrome. Be sure to caution women not to take acetylsalicylic acid (aspirin) for pain in labor as aspirin interferes with blood coagulation, increasing the risk for bleeding in the newborn or herself.

4. A client has opted to receive epidural anesthesia during labor. Which intervention should the nurse implement to reduce the risk of a significant complication associated with this type of pain management? a) Administration of 500 mL of IV Ringer's lactate b) Administration of aspirin c) Move the woman into a supine position d) Administration of 1000 mL of IV glucose solution

d) Black cohosh Pg. 378 Several herbal preparations have traditionally been used to reduce pain with dysmenorrhea or labor, although there is little evidence-based support for their effectiveness. Examples include chamomile tea for its relaxing properties; raspberry leaf tea (women freeze it into ice cubes to suck on), which is thought to strengthen uterine contractions; skullcap and catnip, which are thought to help with pain. Jasmine and lavender may both be mixed into oils and rubbed on the perineum before and during labor to soften the muscle and help prevent perineal tears. Black cohosh (squaw root), an herb that induces uterine contractions, is not recommended because of the risk of acute toxic effects such as a cerebrovascular accident to the mother or fetus.

40. A pregnant client mentions to the nurse that a friend has given her a variety of herbs to use during her upcoming labor to help manage pain. Specifically, she gave her chamomile tea, raspberry leaf tea, skullcap, catnip, jasmine, lavender, and black cohosh. Which of these should the nurse encourage the client not to take because of the risk of acute toxic effects such as cerebrovascular accident? a) Jasmine b) Catnip c) Skullcap d) Black cohosh

d) Transitioning breaths from "slow, deep breaths to quicker short breaths" at the contraction peak Pg. 316-317 A client who is in active labor varies her breathing technique to modified-paced breathing, which alters between slow, deep breaths to shorter and quicker breaths at the contraction peak. Slow-paced breathing is for early labor and focuses on relaxation. Short, quick breaths are used with more intense and frequent contractions. The client should not hold her breath until pushing begins.383

5. The nurse is correct to instruct the client in active labor on which type of patterned breathing? a) Hold the breath throughout the contraction and take deep breaths in between b) Slow paced breaths "in through the nose and out through the mouth" c) Begin rhythmic "short, quick breaths then blow out through pursed lips" d) Transitioning breaths from "slow, deep breaths to quicker short breaths" at the contraction peak

d) Respiratory depression Pg. 383 Respiratory depression is a complication of epidural anesthesia and should be closely monitored in laboring clients. A failed block, accidental intrathecal block, and a postdural puncture (spinal) headache are all side effects of a spinal epidural block.

6. A nurse is monitoring a female client with an epidural block. Which complication would be the most important for the nurse to monitor in the client? a) Postdural puncture (spinal) headache b) A failed block c) Accidental intrathecal block d) Respiratory depression

d) The client will direct her pain management techniques Pg. 381 Clients who have their pain managed report higher satisfaction with the birth experience. By working with the nurse in determining the labor plan, the health care provider, nurse, and client can work together to obtain a plan to manage labor pain. This puts the client in control of her care. Neither the client nor the nurse is able to determine if a vaginal birth is feasible. It is rarely realistic to have pain-free labor. Some discomfort is felt at some time within the labor process. It is strongly encouraged to have attended prenatal classes but not the priority.

7. When developing a labor plan with the client, which outcome is the priority? a) The client will deliver the fetus vaginally b) The client will be pain-free during the labor process c) The client will attend all prenatal classes prior to delivery d) The client will direct her pain management techniques

b) Naloxone Pg. 382 Naloxone is the drug used for reversal of opioids' adverse effects. If an opioid is given too close to birth, the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered (respiratory depression, sleepiness) in the fetus for 2 to 3 hours after birth. Indomethacin is an analgesic and NSAID; ampicillin is an antibiotic; and epinephrine is a vasopressor.

8. A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication? a) Epinephrine b) Naloxone c) Ampicillin d) Indomethacin

a) "Tell me how you handled labor pain in your past deliveries" Pg. 374 When the nurse is collecting data, it is best to discuss previous experiences with labor pain. Other questions may include, "What was helpful?" or "What did you not like?" While it is true that every labor is different, understanding the client's perspective from past experiences is valuable in developing individualized strategies. Developing a plan is best as a collaborative effort, not by picking pre-prepared options. It is important to include a support person if desired.

9. When collecting data to devise a labor plan for a multiparous woman, which question best allows the nurse to develop individualized strategies? a) "Tell me how you handled labor pain in your past deliveries" b) "Picking from these options, what options do you feel is best?" c) "How do you want the health care team to plan your care?" d) "Who do you want to be with you when you are in labor?"