chapter 9 maternity

A client in active labor is given spinal anesthesia. Which of the following would the nurse include when discussing with the client and family about the disadvantages of spinal anesthesia? a) Headache following anesthesia b) Increased frequency of micturition c) Passage of the drug to the fetus d) Excessive contractions of the uterus

a

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? a) Neonatal depression b) Fetal hypersensitivity to anesthetic c) Woman is more sensitive to pre-anesthetic medications d) Woman is less sensitive to inhalation anesthetics

a

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 of the following explanations should the nurse give? a) "It distracts your brain from the sensations of pain." b) "It causes the release of endorphins." c) "It disrupts the nerve signal of pain via mechanical irritation of the nerves." d) "It blocks the transmission of nerve messages of pain at the receptors."

a

The pain of labor is influenced by many factors. What is one of these factors? a) Woman's preparation for labor and delivery b) Woman has a high threshold for pain c) Woman has lots of visitors during labor d) Woman has a high tolerance for pain

a

Which of the following is true regarding analgesia versus anesthesia? a) Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area. b) Hypotension is the most common side effect when systemic analgesia is used. c) Decreased FHR variability is a common side effect when regional anesthesia is used. d) Regional anesthesia should be given with caution close to the time of delivery because it crosses the placenta and can cause respiratory depression in the newborn.

a

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

b

A woman's perception of pain can differ according to all of the following EXCEPT a) Her expectations and preparation for labor b) The presentation, lie, and attitude of the fetus c) Psychosocial, physiologic, and cultural influences d) The length of her labor e) Fear, anxiety, and self-efficacy

b

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 the physician makes the decision on what type of pain control to use b) Women report higher levels of satisfaction when they felt they had a high degree of control over the pain experience c) Women report higher levels of satisfaction when regional anesthetics are used to control pain d) Women report higher levels of satisfaction when different types of relaxation techniques are used to control pain

b

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 blood pressure decreases from 130/70 to 98/50 mm Hg. c) Maternal pulse increases from 78 to 96 beats/minute. d) Maternal temperature increases from 99° F (37.2° C) to 100° F (37.8° C).

c

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

c

A nurse is caring for a client who has just received an epidural. Which of the following is the MOST common side effect of epidural anesthesia? a) Maternal hypertension, which can lead to fetal tachycardia b) Maternal hypertension, which can lead to fetal bradycardia c) Maternal hypotension, which can lead to fetal bradycardia d) Maternal hypotension, which can lead to fetal tachycardia

c

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) 35°C b) 41°C c) 37°C d) 39°C

c

A woman refuses to have an epidural block because she does not want to have a spinal headache after delivery. Which of the following would be your best response? a) "The pain relief offered will compensate for the discomfort afterward." b) "Your doctor knows what is best for you." c) "Spinal headache is not a usual complication of epidural blocks." d) "The anesthesiologist will do her best to avoid this."

c

Which of the following would be a major disadvantage of any pain-relief method that also affects awareness of the mother? a) The father's coaching role may be disrupted at times. b) The mother may have continued memory loss postpartum. c) The mother may have difficulty working effectively with contractions. d) The infant may show increased drowsiness.

c

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

c

A 33-year-old G4P2012 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 patient says she feels light-headed 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 patient to the supine position, recheck the blood pressure, and administer an IV bolus of 1000 mL. b) Assist the patient to Trendelenburg's, assess the fetal heart rate, and administer oxygen via face mask. c) Assist the patient to a sitting position, assess the fetal heart rate, give naloxone (Narcan), and administer oxygen via face mask. d) Assist the patient to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.

d

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

d

A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered? a) Promethazine b) Butorphanol c) Fentanyl d) Naloxone

d

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

e