Chapter 9

A nurse is caring for an obese client in early labor. The anesthesiologist discussed several types of analgesia/anesthesia with the client and recommended one.The client requests clarification before signing the consent form. Which type did the anesthesiologist recommend? 1) Epidural anesthesia 2)Oral opioid analgesia 3)Pudendal nerve anesthesia 4)IV infusion of opioid analgesia

1) Epidural anesthesia

A nurse applies an ice pack to a client's back for 20 minutes . What clinical indicator helps the nurse determine the effectiveness of the treatment. 1)Local anesthesia 2) Peripheral vasodilation 3)Depression if vital signs 4) Decreased viscosity of blood

1)Local anesthesia

A nurse is caring for a primigravida during labor. At 7 cm dilation a prescribed pain medication is administered. Which medication requires monitoring of the new born for the side effect of respiratory depression? 1) Meperidine hydrochloride 2) Hydroxyzine 3)Promethazine 4)Diphenhydramine

1) Meperidine hydrochloride

How should a nurse direct care for a client in the transition phase of the first stage of labor? 1) Decrease IV fluid intake. 2) Help the client to maintain control. 3) Reduce the client's discomfort with medications. 4) Institute simple breathing patterns during contractions.

2. The transition phase is the mosr difficult part of labor, and the client needs encouragement and support to cope.

What position should a nurse teach a client to AVOID when the client is experiencing back pain during labor. 1) Sims 2) Sitting 3) Supine 4)Side-lying

3) Supine

A nurse has just finished reviewing how anesthesia will be used during a vaginal birth for a client with class 1 heart disease. What type of anesthesia does the client discuss that indicates to the nurse that the teaching was effective ? 1) Spinal 2) Inhalation 3)Epidural regional 4)Local perineal filtration

3)Epidural regional

A pregnant client is now in the third trimester. The client tells the nurse, "I want to be knocked out for the birth ." How should the nurse respond ? 1) " You are worried about too much pain." 2) " You don't want to be awake during the birth." 3)" I can understand that because labor is uncomfortable ." 4) "I will tell your health care provider about this request."

2 ) You don't want to be awake during the birth

A client and her partner are working together during the woman's labor. The client's cervix is now dilated 7 cm, and the presenting part is low in the midpelvis. What should the nurse instruct the partner to do that would alleviate the client's discomfort during contractions? 1) Deep- breathe slowly. 2) Perform pelvic rocking. 3) Use the panting technique. 4) Begin pattern-paced breathing

2) Pelvic rocking

A laboring client reports low back pain, What should a nurse recommend to the client's coach that will promote comfort? 1) Instruct her to flex her knees 2) Place her in the supine position 3)Apply pressure to her back during contractions. 4)Perform neuromuscular control exercises with her.

1 ) Instruct her to flex her knees

Which breathing technique should the nurse instruct the client to use as the head of the fetus is crowning? 1) Shallow 2) Blowing 3) Slow chest 4) Modified paced

2. Blowing

Why should a nurse teach pregnant women the importance of conserving the"spurt of energy" before labor? 1. Energy helps to increase the progesterone level . 2. Fatigue may influence the need for pain medication . 3. Energy is needed to push during the first stage of labor. 4.Fatigue will increase the intensity of the uterine contractions.

2. Fatigue may influence the need for pain medication .

A nurse is caring for a client who is having a prolonged labor. The client is annoyed and nurse has acknowledged the client's feeling , what is the next BEST intervention? 1) "I'll leave so you can talk to your partner." 2) "I'll rub your back , and you tell me if it helps." 3) "Let's talk some more about what's really bothering you." 4) "Women usually become weary and frustrated during labor."

2. This statement, "I'll rub your back, and you tell me if it helps."

A client with an inflamed sciatic nerve is to have conventional transcutaneous electrical nerve stimulation (TENS) device applied to the painful nerve pathway. When operating the TENS unit, which nursing action is appropriate? 1) Maintain the settings programmed by the health care provider 2) Turn the machine on several times a day for 10 to 20 minutes 3) Adjust the dial on the unit until the client states the pain relieved. 4) Apply the color-coded electrodes on the client where they are most comfortable.

3)Adjust the dial on the unit until the client states the pain relieved.

A primigravida who is at 40 weeks gestation arrives at the birthing center with abdominal cramping and a bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal examination reveals 1 cm dilation and the presenting part at -1 station. After obtaining the fetal heart rate and maternal vital signs, what should the nurse do next? 1) Teach the client how to push with each contraction 2) Encourage the client to perform pattern-paced breathing. 3) Provide the client with comfort measures used for women labor. 4) Prepare to have the client's blood typed and crossmatched for a possible transfusion.

3. The client is experiencing the expected discomforts of labor; the nurse should initiate measures that will promote relaxation

A nurse is caring for an adolescent in labor an hour after she was admitted to the birthing unit. The adolescent is anxious and tense. She cries during contractions and asks the nurse for epidural anesthesia. The nurse obtains the adolescent's current vital signs and reviews her history and admission information. What nursing interventions are essential before epidural anesthesia is administered? Select all that apply 1) Perform a baseline vaginal examination 2) Tell the adolescent what to expect with each procedure 3) Identify risk factors that contraindicate epidural anesthesia. 4)Have the parents sign a consent form for the epidural anesthesia. 5) Explain the need to stay in one position while the epidural catheter is in place.

1 , 2 ,3

In childbirth classes, the nurse is teaching paced- breathing techniques to use during labor. In which order should the breathing techniques be used as labor progress? 1) Cleansing breaths 2) Slow , deep breaths 3) Pant-blow breathing 4) Slow, exhalation pusing 5) Modified-paced breathing

1 , 2, 5,3,4

During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and dummy.What is the nurse's immediate reaction? 1)Turn the client on her side 2)Notify the health care provider 3) Check the vaginal area for bleeding 4)Monitor the fetal heart rate every 3 minutes

1)Turn the client on her side

A client in active labor becomes very uncomfortable and asks nurse for pain medication. Nalbuphine is prescribed. How does the medication relieve pain? 1)Produces amnesia 2)Acts as a preliminary anesthetic 3)Induces sleep until the time of birth 4) Acts on opioid receptors to reduce pain

4) Acts on opioid receptors to reduce pain

A client arrives in the birthing room with the fetal caput emerging . What should the nurse tell the client to do during a contraction? 1) "Push head" 2) "Hold your breath" 3) "Take slow , deep breaths" 4) "Use the panting - breathing pattern"

4) Use the panting - breathing pattern

What does a nurse consider the MOST significant influence on many clients' perception of pain when interpreting finding a pain assessment. 1.Age and sex 2. Physical and physiologic status 3. Intelligence and economic status 4.Previous experience findings from a pain assessment.

4.Previous experience findings from a pain assessment.