PN108 PrepU Chapter 9

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

What is a nursing intervention that helps prevent the most frequent side effect from epidural anesthesia in a pregnant client?

starting an IV and hanging IV fluids

When discussing the advantages and disadvantages of spinal anesthesia with a client in labor, which of the following would the nurse include as a disadvantage?

Lack of sensation of urge to push

A client asks why she should learn breathing patterns for labor. After instruction is given, the nurse determines teaching has been effective when the client states:

"Breathing patterns are distraction techniques taught to decrease pain in labor."

T/F: General anesthesia is a preferred method of pain management in childbirth.

False

A woman's husband expresses concern about risk of paralysis from an epidural block being given to his wife. Which would be the most appropriate response by the nurse?

"The injection is given in the space outside the spinal cord."

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?

Administration of 500 mL of IV Ringer's lactate

Which statement is true about systemic analgesia used during labor and birth?

Benzodiazepines are used to enhance pain relief attained with opioids and to cause sedation.

There are potentially fatal complications associated with both epidural and spinal anesthesia. What is one of these complications?

Total spinal blockade

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?

headache following anesthesia

Early signs of malignant hyperthermia include which of the following? Select all that apply.

Muscle rigidity Tachycardia and irregular heart rhythms Decreased oxygen saturation and cyanosis

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:

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

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."

Which nursing action is required before a client in labor receives an epidural?

Giving a fluid bolus of 500 ml

All pain management modalities can slow labor if given too early except:

acupuncture

A woman's perception of pain can differ according to all of the following except:

the presentation, lie, and attitude of the fetus.

A nurse is caring for a client in the labor surgery suite undergoing an emergency cesarean birth. Which complication with general anesthesia should the nurse watch for?

uterine atony

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 nurses'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."

Which is a benefit of spinal anesthesia versus epidural anesthesia?

Spinal anesthesia is a simpler technique that will provide pain relief more quickly than epidural anesthesia.

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 they felt they had a high degree of control over the pain experience.

A woman in early labor is using a variety of techniques to cope with her pain. When the nurse enters the room she notes that the woman is making light, circling movements with her fingertips across her abdomen. What technique is she using?

effleurage

A woman is lightly stroking her abdomen in rhythm with her breathing during contractions. The nurse identifies this technique as:

effleurage.

Opioids are the most frequently used medications to provide analgesia during labor. Which drug is an opioid that is used in obstetrics for relief of labor pain?

sublimaze

A woman states that she does not want any medication for pain relief during labor. Her primary care provider has approved this for her. What the nurse's best response to her concerning this choice?

"I respect your preference whether it is to have medication or not."

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 distracts your brain from the sensations of pain."

A woman who has just been admitted in labor indicates that her husband is parking the car and her doula is on her way. The nurse's best response would be:

"OK, let me ask you some personal questions before she arrives."

A woman refuses to have an epidural block because she does not want to have a spinal headache after birth. What would be the nurse's best response?

"Spinal headache is not a usual complication of epidural blocks."

A woman in labor has chosen to use hydrotherapy as a method of pain relief. Which statement by the woman would lead the nurse to suspect that the woman needs additional teaching?

"The temperature of the water should be at least 105 degrees F."

A primigravida, who is 1 cm dilated, is in early latent labor. She has expressed a desire to avoid epidural anesthesia and asks about nonpharmacologic options for pain relief as her labor progresses. How could the nurse appropriately respond? Select all that apply.

"The tub usually is not recommended when you are at such an early stage because it can cause your labor to slow down. Let's talk about using the tub as your labor progresses." "I can show you some simple breathing exercises that can help you relax." "You may want to go for a walk now. When you come back, I'll show you how to use the birthing ball."

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 have no trouble walking around and using the bathroom after you receive the epidural."

Why is general anesthesia not commonly used in labor and birth? Select all that apply.

A pregnant woman has a risk for vomiting and aspiration. General anesthesia readily crosses the placenta.

A woman is in labor with her second child. She knows that she will want epidural anesthesia, and she has already signed her consent form. What must the nurse do before the woman receives the epidural?

Administer a fluid bolus through the IV line to reduce the risk of hypotension.

A nurse is monitoring a female labor client with a spinal epidural block. On assessment, the nurse finds maternal hypotension and changes in the fetal heart rate (FHR). Which nursing intervention would be the most appropriate to perform?

Administer supplemental oxygen.

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. 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.

Which statement is true regarding analgesia versus anesthesia?

Analgesia only reduces pain, but anesthesia partially or totally blocks all pain in a particular area.

A client has just received combined spinal epidural. Which nursing assessment should be performed first?

Assess vital signs.

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 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?

Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.

A client in labor receiving epidural anesthesia develops hypotension. Which of the following would the nurse do first?

Give an intravenous bolus of fluid

A 21-year-old G1P0000 was admitted four hours ago. She is now requesting an epidural. Which of the following interventions would you expect the nurse to provide in preparation for the procedure?

Insert an IV line and administer a 500 mL bolus of fluid.

A 34-year-old gravida 3 para 2 is experiencing severe back pain with each contraction. She is extremely uncomfortable and upset because she never had this type of pain with her other labors. What intervention is most likely to help in this situation?

Intradermal water injections

There are advantages and disadvantages to any kind of method used to control pain during labor and birth. What is an advantage of opioid administration?

It has the ability to be administered by the nurse.

How should the nurse counsel a client who is about to receive meperidine 25 mg IV?

It's possible you may feel a bit sleepy or nauseous after I administer this medication."

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?

Neonatal depression is possible.

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?

Pain originates from the cervix and lower uterine segment.

A laboring client is restless and moving frequently in the bed. She appears to be more uncomfortable with the contractions but refuses pain medication when offered. The client's partner has left the room to stretch his legs. Which of the following responses by the nurse is most helpful?

Stand next to the client at the side of the bed.

A nurse is caring for a female client in labor who has chosen hydrotherapy as her pain management for labor. As the nurse prepares the client for this treatment, which procedure is recommended as the most appropriate consideration?

The client should be in active labor.

Which possible outcome would be a major disadvantage of any pain-relief method that also affects awareness of the mother?

The mother may have difficulty working effectively with contractions.

The pain of labor is influenced by many factors. What is one of these factors?

The woman is prepared for labor and birth.

T/F: The pressure of the fetal head pressing against the stretched perineum during labor is a natural form of anesthesia.

True

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?

acupressure

The labor nurse reports to the nurse on the on-coming shift, "The woman in labor room 2 is handling her pain very well. She smiles whenever I go in to talk to her, and she doesn't complain at all!" What assessment by the on-coming labor nurse would best reveal if the off-going labor nurse's observations were correct?

asking the woman to describe her pain and rate it on a scale of 0 to 10

A pregnant client has received general anesthesia for the birth of her neonate. The client manifests tachycardia, decreased oxygen saturation, cyanosis, and muscle rigidity. The nurse anticipates the primary care provider will prescribe what medication?

dantrolene sodium

Which is least likely to be a side effect of epidural anesthesia?

decreased FHR variability

The nurse has just administered butorphanol 2 mg IV to a laboring client. Which change in the fetal heart rate pattern would the nurse consider to be a result of this medication?

decreased variability

A woman in labor who is receiving an opioid for pain relief is to receive promethazine. The nurse determines that this drug is effective when the woman demonstrates which finding?

less anxiety

A nurse is caring for a client who has just received an epidural. Which side effect is the most common in epidural anesthesia?

maternal hypotension, which can lead to fetal bradycardia

A client received IV meperidine for pain. An hour later a full-term neonate is born with respiratory depression. The nurse anticipates the neonate will require administration of which medication?

naloxone

A woman in labor who received an opioid for pain relief develops respiratory depression. The nurse would expect which agent to be administered?

naloxone

The injection of a local anesthetic to block specific nerve pathways is referred to as:

regional block.

Which medication is not an opioid that is commonly used during labor and birth?

secobarbital