OB Chapter 16

An experienced nurse is mentoring a graduate nurse and critiquing the graduate's shift handoff. Which statement requires clarification? "I instructed the client to ring if she felt the need to move her bowels." "I changed the client position from her back to her side." "The client reports a pain level of 8. She has a low pain tolerance." "The client is experiencing lower back pain and I gave a backrub."

"The client reports a pain level of 8. She has a low pain tolerance." Shift handoff includes a report of the client's pain assessment. Pain is a perceptive experience as individual pain tolerances vary. The nurse must do a complete pain assessment and not assume that the client has a low pain tolerance. Pain is an indication that a complication of labor is occurring. All of the other options are appropriate.

General anesthesia is not used frequently in obstetrics because of the risks involved. There are physiologic changes that occur during pregnancy that make the risks of general anesthesia higher than it is in the general population. What is one of those risks? The client is less sensitive to inhalation anesthetics. The client is more sensitive to preanesthetic medications. Fetal hypersensitivity to anesthetic is possible. Neonatal depression is possible.

Neonatal depression is possible. General anesthesia is not used frequently in obstetrics because of the risks involved. The pregnant woman is at higher risk for aspiration. It requires more skill to intubate a pregnant woman because of physiologic changes in the trachea and thorax. In addition, general anesthetic agents cross the placenta and can result in the birth of a severely depressed neonate who requires full resuscitation.

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? Trendelenburg left lateral lithotomy prone

lithotomy 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.

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

Massage the woman's back. 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.

Which neonatal assessment is the highest priority if the mother received meperidine during labor? Temperature regulation Lung sounds Time of first meconium Respiratory rate

Respiratory rate 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.

Fentanyl has been administered to a client in labor. What assessment should the nurse prioritize? Blood pressure Respiratory status Level of consciousness Maternal heart rate

Respiratory status Opioids like fentanyl have significant effects on the client's respiratory status. This is the priority assessment because the other parameters are affected to a lesser degree.

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: "I may end up with a severe headache from the spinal anesthesia." "I will need to lie on my right side to reduce vena cava compression." "I can continue sitting up after the spinal is given." "The anesthesia will numb both of my legs to a level above my breasts."

"I may end up with a severe headache from the spinal anesthesia." 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.

A nurse recommends to a client in labor to try concentrating intently on a photo of her family as a means of managing pain. The woman looks skeptical and asks, "How would that stop my pain?" Which explanation should the nurse give? "It disrupts the nerve signal of pain via mechanical irritation of the nerves." "It causes the release of endorphins." "It blocks the transmission of nerve messages of pain at the receptors." "It distracts your brain from the sensations of pain."

"It distracts your brain from the sensations of pain." Concentrating intently on an object is another method of distraction, or another method of keeping sensory input from reaching the cortex of the brain. The other answers refer to other means of pain management.

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

"Tell me how you handled labor pain in your past deliveries." 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.

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? 35°C 41°C 39°C 37°C

37°C 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.

A client in labor has requested the administration of opioids to reduce pain. At 2 cm cervical dilation (dilatation), she says that she is managing the pain well at this point but does not want it to get ahead of her. What should the nurse do? Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. Agree with the client, and administer the drug immediately to keep the pain manageable. Refuse to administer opioids because they can develop dependency in the client and the fetus. Explain to the client that opioids should only be administered an hour or less before birth

Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor. The timing of administration of opioids in labor is especially important as, if given too early (before 3 cm cervical dilatation), they tend to slow labor. If given close to birth, because the fetal liver takes 2 to 3 hours to activate a drug, the effect will not be registered in the fetus for 2 to 3 hours after maternal administration. For this reason, opioids are preferably given when the mother is more than 3 hours away from birth. This allows the peak action of the drug in the fetus to have passed by the time of birth.

Which statement is true regarding analgesia versus anesthesia? Hypertension is the most common side effect when systemic analgesia is used. Increased FHR variability is a common side effect when regional anesthesia is used. Analgesia and anesthesia perform the same function when it comes to blocking pain. Regional anesthesia should be given with caution close to the time of birth because it crosses the placenta and can cause respiratory depression in the newborn.

Analgesia and anesthesia perform the same function when it comes to blocking pain. Systemic analgesia should be used with caution near the time of birth because it can cause respiratory depression, in addition to decreased FHR variability. Hypotension is a common side effect of regional anesthesia.

A primigravida client has just arrived in early labor and is showing signs of extreme anxiety over the birthing process. Why should the nurse prioritize helping the client relax? Anxiety can slow down labor and decrease oxygen to the fetus. Anxiety will increase blood pressure, increasing risk with an epidural. Increased anxiety will increase the risk for needing anesthesia. Decreased anxiety will increase trust in the nurse.

Anxiety can slow down labor and decrease oxygen to the fetus. Out-of-control anxiety can decrease the oxygen of the mother by increasing her respiratory rate and increasing the demand on her body, and can have a negative impact on the fetus by decreasing the amount of oxygen reaching the fetus. Encourage control of the anxiety. Anxiety will not negatively affect the action of the epidural or the need for anesthesia. Trust in the nurse is not determined by the amount of anxiety the client experiences.

The nurse is reviewing the medication administration record (MAR) of a client at 39 weeks' gestation and notes that she is ordered an opioid for pain relief. Which is an assessment priority after administering? Assess for constipation. Assess fetal heart rate. Assess for dry mouth. Assess maternal blood pressure.

Assess fetal heart rate. After administering an opioid to a laboring mother, the priority is to assess the impact on the fetus. Opioid administration can cross the placental barrier and affect fetal heart rate and variability. After birth, there may be a decrease in alertness of the neonate. Maternal factors of decreased blood pressure, constipation, and dry mouth are of a lower priority.

The nurse has just applied a sterile pressure dressing to an epidural site after removing the epidural catheter in a client who is now recovering from a standard delivery. Which action should the nurse now prioritize? Help the client get up and walk around immediately. Let the client rest and recover while keeping her legs slightly elevated. Make sure the client receives plenty of fluids. Assess return of sensory and motor functions to the lower extremities.

Assess return of sensory and motor functions to the lower extremities. After removal of the epidural catheter and medication is terminated, the nurse needs to assess for return of motor function to ambulate the mother. The mother will not be able to walk for some time (at least until the medication wears off). Do not elevate the legs; the goal is to maintain normal circulation. Fluids are important, but they are not related to the epidural or to the metabolism of the medication.

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

Assess vital signs. 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.

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?

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 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.

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

Difficulty breathing 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.

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

Identify how the client expresses labor pain. 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.

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? Dry, cracked lips Rapid progress of labor Urinary retention Inability to push

Inability to push 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.

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

Maternal blood pressure decreases from 130/70 to 98/50 mm Hg. 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.

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? Diffuse abdominal pain signals a complication with progression of labor. Pain originates from the cervix and lower uterine segment. Pain is focal in nature. It is reported as the worst pain a woman will ever feel.

Pain originates from the cervix and lower uterine segment. 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.

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? Administering an opioid such as meperidine or fentanyl Practicing effleurage on the abdomen Administering a sedative such as secobarbital or pentobarbital Immersing the client in warm water in a pool or hot tub

Practicing effleurage on the abdomen 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.

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? Remind the client that medication will assist in relieving pain from contractions. Restrict the client's fluid to further prevent constipation from the medication. Remind the client to call for assistance before getting out of bed. Assure the fetal heart tones are assessed every 2 to 3 hours via monitoring.

Remind the client to call for assistance before getting out of bed. 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.

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

The characteristics of labor pain follow a pattern. 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.

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? The client should be encouraged to drink plenty of fluids. Sitting upright will relieve the headache. The headache usually resolves on its own within 24 hours. The headache is usually mild in severity.

The client should be encouraged to drink plenty of fluids. 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.

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

The client will direct her pain management techniques. 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.

The nurse in an obstetric clinic is conducting client education with a group of expectant mothers. One young woman asks the nurse to tell the group what labor pain is like. What would be the nurse's best response? The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in." "It is best evaluated by talking with visitors in the labor room because they know you best." "It comes in waves." "It has been described as the worst pain you will ever feel."

The pain of labor is unique and multidimensional. It originates from different places depending on what stage of labor you are in." Pain sensations associated with labor originate from different places, depending on the stage of labor.

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

The woman is prepared for labor and birth. 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.

The client is progressing into the second stage of labor and coping well with the natural birth method. Which instructions should the nurse prioritize at this point in the process? Use the Valsalva maneuver for effective pushing. Use a birthing ball and find a position of comfort. Ask for privacy, and have just the partner present. Stay low on her back to ease the back pain.

Use a birthing ball and find a position of comfort. The position is very important during labor. Allowing the woman to assume the most comfortable position will facilitate natural birth. The birthing ball allows the woman to move and adjust her position so that she can remain comfortable. The Valsalva maneuver may result in dangerous increases in blood pressure, so the nurse should be sure to instruct the mother to breathe as she pushes. The nurse should not intervene with who comes in or what family members are present unless she is asked, or unless the visitation is upsetting the mother.

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? Women report higher levels of satisfaction when the primary care provider makes the decision on what type of pain control to use. Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience. Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain. Women report higher levels of satisfaction when regional anesthetics are used to control pain.

Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience. 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.

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching? "You can continuously receive epidural anesthesia until you have the baby, and even afterward if you need it." "Epidural anesthesia is more effective than opioid analgesia in providing pain relief." "If you end up having a cesarean, the epidural can be used for anesthesia during surgery." "You have no trouble walking around and using the bathroom after you receive the epidural."

You have no trouble walking around and using the bathroom after you receive the epidural." Epidural anesthesia impairs mobility; most clients are placed on bed rest after epidural anesthesia is given. Urinary catheterization is frequently required.

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? biofeedback acupressure effleurage acupuncture

acupressure 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.

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? administration of 500 mL of IV Ringer's lactate move the woman into a supine position administration of aspirin administration of 1000 mL of IV glucose solution

administration of 500 mL of IV Ringer's lactate 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.

The nursing instructor is preparing a presentation which will explore the various sources of pain during the labor process. Which source should the instructor emphasize as the main source of pain during the first stage? perineum cervix birth canal back

cervix The first stage of labor is when the cervix is dilating. The woman in labor will have pain from the stretching and dilation (dilatation) of the cervix. Stretching of the perineum and birth canal is associated with the second stage of labor. Not all women have back pain, and typically when they do it is referred pain from the lower abdomen and can happen in both the first and second stage of labor.

A gravida 3 para 2 client has been in labor for 4 hours and is experiencing severe back pain with each contraction. She is extremely uncomfortable and distressed because she never had this type of pain with her other labors. Which intervention can the nurse point out is best for this client to try to address her pain? imagery oral pain medication effleurage lying still

effleurage Effleurage or massage would be an appropriate technique to use at this point. It is used as a distraction and relaxation technique. It increases the production of endorphins which reduce the transmission of signals between nerve cells and thus lowers the perception of pain. Imagery is another technique but may not be as effective for relieving the pain if it is intense. A change of position may help with the pain as the woman finds a position of comfort; lying still may not be effective. The use of oral pain medication presents a danger to the fetus depending on what is used, as it can pass through the placenta and adversely affect the heart and lungs of the fetus.

A client in active labor is given spinal anesthesia. Which information would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? excessive contractions of the uterus headache following anesthesia increased frequency of micturition passage of the drug to the fetus

headache following anesthesia The nurse should inform the client and her family about the possibility of headache after spinal anesthesia. The drug is retained in the mother's body and not passed to the fetus. There may be uterine atony, and not excessive uterine contractions, following spinal anesthesia. Spinal anesthesia may lead to bladder atony, and not an increased frequency of micturition.

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: press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist. instruct the client to perform controlled chest breathing with a slow inhale and a quick exhale. lead the client through a series of visualizations to aid in relaxation. instruct the client or her partner to perform light fingertip repetitive abdominal massage.

instruct the client or her partner to perform light fingertip repetitive abdominal massage. 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.

The nurse is preparing to assist with a pudendal block. The nurse predicts the client is at which point in the labor process? just after birth early-stage labor before dilation (dilatation) only just before birth

just before birth Pudendal block is a local block in the perineal area and is used to numb for birth. Giving a pudendal block before labor begins or while labor is in its early stages would be counterproductive, as the client would not have proper feeling and would have a harder time pushing. After birth it is pointless; the most painful part is over.

Early in labor, a pregnant client asks why contractions hurt so much. Which answer should the nurse provide? blocking of nerve transmission via mechanical irritation of nerve fibers release of endorphins in response to the uterine contractions distraction of the brain cortex by other stimuli occuring in the body lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels

lack of oxygen to the muscle fibers of the uterus due to compression of blood vessels 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.

A client in labor has administered an epidural anesthesia. Which assessment findings should the nurse prioritize? maternal hypertension and fetal bradycardia maternal hypotension and fetal bradycardia maternal hypotension and fetal tachycardia maternal hypertension and fetal tachycardia

maternal hypotension and fetal bradycardia Epidural anesthesia conveys the risk of hypotension, especially if the client has not received an adequate amount of fluid before the procedure is performed. A sudden drop in maternal blood pressure can cause uterine hypoperfusion, which may result in fetal bradycardia. The other choices are not an adverse effect of epidural anesthesia.

The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control? meperidine secobarbital hydroxyzine hydrochloride thiopental

meperidine Meperidine is an opioid that is commonly used during labor and birth. Secobarbital and thiopental are barbiturates. Hydroxyzine hydrochloride is a tranquilizer which can be used to supplement the opioid or reduce anxiety.

The nurse is caring for a client who appears tense and apprehensive as labor progresses. Which nursing intervention is most helpful? Instruct on the labor process. Encourage support person interaction. Initiate comfort measures. Limit interruptions in the room.

nitiate comfort measures. Limit interruptions in the ro Initiating comfort measures allows the tense client to relax, which may decrease anxiety and apprehension. Comfort measures can include a variety of interventions such as ice chips; lip balm; or touch, massage, and acupressure. This interaction between the nurse and client also conveys a caring, supportive attitude. This establishes a trusting relationship which again decreases anxiety. All other options are appropriate but not as helpful personally to the client in labor

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? accidental intrathecal block a failed block postdural puncture (spinal) headache respiratory depression

respiratory depression 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.

What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client? maintaining the client in a supine position administrating IV naloxone starting an IV and hanging IV fluids administrating IV ephedrine

starting an IV and hanging IV fluids 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.

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

Ambulate only with assistance from the nurse or caregiver. 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.

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? Ask the client who she would like to see first Determine what activities the doula is qualified to handle Print a copy of the instructions for the doula to sign Continue with the admission assessment

Continue with the admission assessment 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.

The nurse is monitoring a client who is in the second stage of labor, at +2 station, and anticipating birth within the hour. The client is now reporting the epidural has stopped working and is begging for something for pain. Which action should the nurse prioritize? Call the anesthetist from the nurse's station to retry the epidural. Encourage her through the contractions, explaining why she cannot receive any pain medication. Give the meperidine because she needs pain relief now. Call the primary care provider, and obtain a reduced dose of meperidine.

Encourage her through the contractions, explaining why she cannot receive any pain medication. At this point, any medication would be contraindicated as it would pass to the fetus and may cause respiratory depression. The nurse will have to work with the mother through the contractions and pushing. The client has progressed too far to retry the epidural medication. No meperidine should be given due to the risk to the fetus.

The nurse is monitoring a woman in labor, who reports severe pain. What action will the nurse take? Assess the woman for cultural pain expectations during labor. Reassure the woman that the pain is short-term and a sign of progressing labor. Explain the risk of the pain control measures already implemented. Further assess the woman for complications or a medical emergency.

Further assess the woman for complications or a medical emergency. The woman with severe pain in the presence of typical pain relief measures will be further assessed for complications of labor. Reassurance of the reason for the pain would be a secondary approach and only if the pain is being accurately managed. The woman is supported in her decisions of pain management, and the risks should be understood before the measures are implemented, not afterward, and not in place of an assessment. Cultural assessment is vital in caring for the woman but does not prioritize above a further assessment to assure there are no complications.

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

Give an intravenous bolus of fluid. 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.

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? Support the client's decision and call the provider. Gently remind the client of her goal of a natural birth and encourage and help her. Ask the husband to gently remind her of their goal of natural birth and to encourage and help her. Suggest a less extreme alternative such as a sedative.

Support the client's decision and call the provider. 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.

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? The gating mechanism is located at the pain site. Pain perception is decreased if anxiety is present. These methods are a technique to prevent the painful stimuli from entering the brain. The gating mechanism opens so all the stimuli pass through to the brain.

These methods are a technique to prevent the painful stimuli from entering the brain. 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.

Which of the following is not a physiologic basis for painful contractions during labor? The presenting part of the fetus puts additional pressure on adjacent organs. The cervix is stretched. Uterine and cervical blood vessels dilate, increasing blood flow and causing hypoxia in the muscle fibers. The descent of the fetus increases perineal pressure and stretching.

Uterine and cervical blood vessels dilate, increasing blood flow and causing hypoxia in the muscle fibers. Uterine and cervical blood vessels constrict, reducing blood flow and causing anoxia in the muscle fibers.