Sem 3 - Unit 5 - Pain (Labor Pain) - NCO

7. A woman is admitted to triage at 32 wks gestation and in premature labor, which of the following medications should the nurse anticipate be order to treat her patient SELECT ALL THAT APPLY? a. Dexamethasone b. Brethane c. Magnesium Sulfate d. Petocin e. Cytotec

a. Dexamethasone b. Brethane c. Magnesium Sulfate

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 Blowing forcefully through the mouth controls the strong urge to push and allows for a controlled birth of the head. A shallow breathing pattern does not help control expulsion of the fetus. Slow chest breathing is used during the latent phase of the first stage of labor; it is not helpful in overcoming the urge to push. Modified paced breathing is used during active labor when the cervix is dilated 3 to 7 cm; it is not helpful in overcoming the urge to push.

9. Which of the following medications used during the management of a client in PTL can cause maternal and/or fetal tachycardia? a. Antibiotics b. Dexamethasone c. Magnesium sulfate d. Tabeuteline [Brethane]

d. Tabeuteline [Brethane]

A 30-week-pregnant woman reports low backache and abdominal cramps. Which drug may be prescribed if the client is suspected of having preterm labor? 1 Methylergonovine 2 Mifepristone 3 Calcium gluconate 4 Magnesium sulfate

4 Magnesium sulfate Low backache and abdominal cramps in a pregnant woman may indicate labor; however, labor pains may not be safe if the gestation is not at full term. Magnesium sulfate may be prescribed to prevent preterm labor. Methylergonovine is prescribed to reduce postpartum uterine hemorrhage. Mifepristone may cause an elective termination of pregnancy. Calcium gluconate may be prescribed to reverse magnesium toxicity.

A nurse is teaching a childbirth preparation class. Which information regarding discomfort during labor should the nurse be certain to include in her teaching? 1 Labor should be mostly pain free and uneventful. 2 Breathing techniques will be taught to prevent the need for medication. 3 Medication is given to women who experience painful labor contractions. 4 Comfort measures are available when the discomfort of contractions becomes excessive.

4 Comfort measures are available when the discomfort of contractions becomes excessive. Classes in preparation for parenthood should help couples develop realistic expectations of the labor process, including associated discomfort and ways of dealing with it. Stating that labor should be mostly pain free and uneventful is false reassurance; contractions are uncomfortable, and there is no guarantee that the birthing process will be uneventful. Breathing techniques may not be enough for some women to limit the discomfort of contractions. The focus should not be on pain; comfort measures should be attempted first before medication is used.

An expectant couple asks the nurse about the cause of low back pain during labor. The nurse replies that this pain occurs most often when the fetus is positioned how? 1 Breech 2 Transverse 3 Occiput anterior 4 Occiput posterior

4 Occiput posterior Persistent occiput posterior positioning causes intense back pain, the result of fetal compression of the sacral nerves. The breech position is not associated with back pain. The transverse position is not associated with back pain. Occiput anterior, the most common fetal position, generally does not cause back pain.

8. The nurse is evaluating the client for PTL she knows of the following, the most concerning factor for this progressing to a PTL/deliver is: a. Smoking 2 packs of cigarettes per day b. Cervical dilation and effacement with contraction c. Low birth weight d. Frequent fetal movement

b. Cervical dilation and effacement with contraction

2. Prima Gravida client is 28 wks pregnant she tells the nurse she hears terrible things about labor from her friends and family, what method of preparation is best for the nurse to advise.

ANY TYPE OF FORMAL CHILD BIRTH EDUCATION PREPARATION IS MOST HELPFUL TO TEACH ABOUT EDUCATION, BREATHING AND RELAXATION

3. The stage of labor where the patient might be asked to assume the squatting position is _______?

STAGE 2 {PUSHING}

A pregnant woman reports upper back pain and frequent and painful urination. Upon diagnosis, the client has a urinary tract infection and is treated with nitrofurantoin. Which teratogenic effect is likely to occur in the infant? 1 Cleft palate 2 Tooth anomalies 3 Neural tube defects 4 Ebstein anomaly

1 Cleft palate Nitrofurantoin may cause cleft palate in fetuses. The use of drug tetracyclines may cause tooth anomalies in fetuses. Ebstein anomaly may be caused by the use of the drug lithium. Neural tube defects may be caused by valproic acid.

A client in active labor is considering combined spinal-epidural analgesia. She states that she is concerned about her ability to walk after receiving this type of analgesia. What is the most accurate response by the nurse? 1 "This analgesia gives you pain relief without compromising your ability to ambulate." 2 "The analgesia will require you to remain in bed, but you'll be able to move from side to side." 3 "You may experience slight weakness, but someone will be at your side when you're ambulating." 4 "Someone will help you ambulate every couple of hours before you're given another dose of the analgesia."

1 "This analgesia gives you pain relief without compromising your ability to ambulate." Because the spinal nerve receptors are sensitive to opioids, small quantities are needed to produce analgesia; therefore the client's ability to ambulate without assistance is not jeopardized. Bed rest is not required. The analgesia does not cause weakness. The client's ability to ambulate without assistance is not jeopardized. The analgesia lasts for more than 2 hours; there is no need to ambulate before a dose is given.

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

1 Deep-breathe slowly. Slow, deep breathing expands the spaces between the ribs and raises the abdominal muscles, giving the uterus room to expand and preventing painful pressure of the uterus against the abdominal wall. Pelvic rocking is used to relieve pressure from back labor. Panting is used to halt or delay the expulsion of the infant's head before complete dilation has occurred. Patterned, paced breathing is used during the transition phase of the first stage; the client has not yet reached this phase.

The nurse is providing care to a multiparous client in active labor. The client is requesting something for the pain. What is the nurse's priority intervention? 1 Examining the client's cervix for dilation and effacement 2 Determining the client's options by assessing the prescriptions in the chart 3 Asking her whether she prefers an epidural or something in her intravenous line 4 Evaluating the fetal monitoring strip to determine the frequency and duration of contractions

1 Examining the client's cervix for dilation and effacement Evaluating the client's cervical dilation and effacement determines her progress in labor and reveals whether it is safe to administer analgesia or anesthesia. Assessment is the initial step of the nursing process. Options for pain management would be determined after dilation has been assessed. The client may be asked about her preferred method of analgesia, but that should be done after her degree of dilation has been determined. The stem of the question indicated that the client is in active labor; information on the fetal monitoring strip regarding contractions will not add to the assessment data.

The nurse is caring for a client in the first stage of labor. Which position is the least desirable for the client if she is experiencing lower back pain? 1 Sitting 2 Supine 3 Knee-chest 4 Left side-lying

2 Supine Low back pain is aggravated when the client is in the supine position because of increased pressure from the fetus as the head rotates. A sitting position relieves back pain. The knee-chest position is an alternate position that a client may choose to use when laboring. The left side-lying position relieves back pain.

The partner of a primigravida who has been in active labor for about 6 hours asks the nurse, "How much longer will this take? She's having a lot of back pain, and she's so uncomfortable." How should the nurse respond? 1 "It shouldn't be much longer now." 2 "Take a short break while I take over." 3 "Let me show you how to apply back pressure." 4 "Everything is progressing nicely, just as expected.

3 "Let me show you how to apply back pressure." Counterpressure against the sacrum during contractions affords some relief from the discomfort of back pain. It is difficult to predict the duration of labor for any client. Telling the coach to leave is not a response to the situation; the coach should be included in providing comfort to the client. Telling the client that everything is progressing nicely is false reassurance; the data do not indicate that labor is progressing as expected.

A client who underwent treatment for infertility gave birth to triplets. She often complained of breast pain during the infertility treatment. Which drug may have been administered to the client for infertility treatment? 1 Estradiol 2 Haloperidol 3 Clomiphene 4 Promethazine

3 Clomiphene Clomiphene is an ovarian stimulant that may cause multiple pregnancies. Breast pain is an adverse effect of clomiphene. Estradiol helps to reduce postmenopausal hot flashes. Haloperidol and promethazine are contraindicated while using clomiphene.

A laboring client has asked the nurse to help her use a nonpharmacologic strategy for pain management. Name the sensory simulation strategy. 1 Gentle massage of the abdomen 2 Biofeedback-assisted relaxation techniques 3 Application of a heat pack to the lower back 4 Selecting a focal point and beginning breathing techniques

4 Selecting a focal point and beginning breathing techniques Selecting a focal point and beginning breathing techniques Use of a focal point and breathing techniques are sensory simulation strategies. Heat and massage are cutaneous stimulation strategies; biofeedback-assisted relaxation is a cognitive strategy.

A primigravida at 34 weeks' gestation tells the nurse that she is beginning to experience some lower back pain. What should the nurse recommend that the client do? Select all that apply. 1 Wear low-heeled shoes. 2 Wear a maternity girdle during waking hours. 3 Sleep flat on her back with her feet elevated. 4 Perform pelvic tilt exercises several times a day. 5 Take an ibuprofen (Motrin) tablet at the onset of back pain.

1 Wear low-heeled shoes. 4 Perform pelvic tilt exercises several times a day. Low-heeled shoes help maintain her center of gravity to counterbalance the gravid uterus. Pelvic tilt exercises help relieve lower backaches, are easily learned, and can be done without any equipment. A maternity girdle is not routinely recommended. Sleeping flat during this stage of pregnancy decreases venous return, impedes respiration, and puts pressure on the vena cava, which can cause uteroplacental insufficiency. Nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin) should be avoided during pregnancy, and the prescription of medications is beyond the scope of nursing practice.

A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. Which nursing action will help relieve this discomfort? 1 Positioning her on the left side 2 Using effleurage on her abdomen 3 Applying pressure against her sacrum 4 Placing her in the semi-Fowler position

3 Applying pressure against her sacrum Counterpressure over the sacral area helps relieve the pain caused by the pressure of the fetal head in the posterior position. Although helpful for placental perfusion, positioning the client on her left side is not the best action for reducing pain caused by the pressure of the fetal head in the posterior position. Massaging the abdomen with the fingertips (effleurage) does not relieve the painful pressure in the lower back. The semi-Fowler position causes additional discomfort because the sacrum is inaccessible and counterpressure cannot be applied to the sacral area.

A pregnant client has labor pains. However, the nurse finds that the client's cervix is not dilated. Which drug should be administered to the client to promote labor? 1 Oxytocin 2 Nifedipine 3 Dinoprostone 4 Methylergonovine

3 Dinoprostone Dinoprostone induces cervical ripening. This action helps in the induction of labor at term. Oxytocin enhances labor when uterine contractions are weak and ineffective. Nifedipine is a calcium channel blocker used to maintain pregnancy during preterm labor. Methylergonovine reduces postpartum hemorrhage.

A client at 22 weeks' gestation asks the nurse how to prevent back pain as her pregnancy progresses. What does the nurse suggest that she wear? 1 Maternity girdle 2 Support stockings 3 Low-heeled shoes 4 Loose-fitting clothing

3 Low-heeled shoes Low-heeled supportive shoes help maintain the body's center of gravity over the hips, limiting arching of the back that compensates for the increased weight in the abdominal area. Maternity girdles are no longer recommended. Support stockings may be helpful for a woman with varicose veins or ankle edema; however, wearing them does not prevent back pain. Loose-fitting clothing is more comfortable, but has no effect on back pain.

A client undergoes a cesarean birth because of cephalopelvic disproportion. What care is needed for this client in addition to the routine nursing care given to all postpartum clients during the first 24 hours? 1 Encouraging early ambulation 2 Assessing the fundus gently but firmly 3 Checking vital signs for evidence of shock 4 Administering the prescribed pain medication

4 Administering the prescribed pain medication Because of increased pain and increased flatus, clients who have had cesarean births require more pain medication than do women who have vaginal births. Early ambulation is encouraged for all postpartum clients. Although this may be difficult because of the incision, palpating the fundus is a necessary part of postpartum care. Vital signs are checked routinely in all postpartum clients.

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

4 By acting on opioid receptors to reduce pain Nalbuphine is classified as an opioid analgesic and is effective in relieving pain; it induces little or no newborn respiratory depression. Nalbuphine does not induce amnesia, act as an anesthetic, or induce sleep.

Ten minutes after administering nalbuphine via intravenous piggyback to a primigravida in active labor, the nurse notes a fetal heart rate of 132 with minimal variability. The client states that the pain is more tolerable and she is able to use her breathing techniques more effectively. Contractions continue every 2 to 3 minutes and are of 60 seconds' duration. What is the nurse's next action? 1 Reposition the client on the left side to increase placental perfusion. 2 Administer oxygen via mask to minimize apparent fetal compromise. 3 Have an opioid antagonist available to be administered to the infant at the time of birth. 4 Document the findings, including the stable fetal heart rate variability after administering the opioid infusion.

4 Document the findings, including the stable fetal heart rate variability after administering the opioid infusion. A common side effect of an opioid analgesic is decreased fetal heart rate variability. Because the fetal heart rate and the length and duration of the contractions remain stable and the analgesic appears to be effective, the only nursing action is to document the findings. Repositioning the client is not necessary because the data do not indicate decreased placental perfusion. It is not necessary to administer oxygen because the data do not indicate fetal compromise. Naloxone, an opioid antagonist, may need to be administered to the newborn, but the present data do not indicate that this is necessary.

A pregnant woman reports severe headaches, chest pain, and fatigue. Upon diagnosis, the woman has hypertension. Which drug can be prescribed to reduce hypertension? 1 Lithium 2 Miglitol 3 Calcium gluconate 4 Magnesium sulfate

4 Magnesium sulfate Magnesium sulfate can be prescribed for pregnancy-induced hypertension. Lithium is used to treat body water retention. Miglitol is used to decrease blood sugar levels. Calcium gluconate is used to relieve magnesium toxicity associated with magnesium sulfate.

1. The stage of phase of labor where the cervix is Dilated 5 cm and contractions are every 4 - 5 min lasting is _______________?

ACTIVE

6. When planning comfort measures for a woman in active labor tolerate her pain the nurse must consider which of the following? a. Early labor contractions are usually regular, coordinated and very painful b. If women have been well prepared and educated about childbirth they are more likely to require less medication to manage their pain c. Tranquilizers given during any phase of labor are not likely to impair the contraction pattern d. The transition phase is a phase of minimal pain and discomfort.

b. If women have been well prepared and educated about childbirth they are more likely to require less medication to manage their pain

5. When caring for a client who will receive epidural anesthesia in the active phase of labor the nurse will implement all of the following nursing measures, EXCEPT: a. Frequent monitoring of BP b. O2 and a face mask are required c. IV Bolus of 1000-2000 of LR d. Close surveillance of FHR

b. O2 and a face mask are required [O2 should be available but is not required]

4. When administering narcotic analgesics to a woman in active labor all of the following EXCEPT _________ must be assessed? a. Cervical Exam b. Vital Signs (including FHR) c. Heart Rate d. Gestational age

d. Gestational age