Maternity CH 22
1) A patient is labor is prescribed to receive nalbuphine 10 m g/70 k g intravenously now. The patient weighs 198 l b s. How many m g of medication should the nurse provide this patient? (Round to the nearest tenth decimal point.)
Answer: 12.9 m g Explanation: First calculate the patient's weight in k g by dividing the weight in lb by 2.2 or 198/2.2 = 90 k g. Then set up the equation 10 m g/70 k g = x/90 k g. When cross-multiplying, the equation will be 10/70 = x/90; 70x = 900. Then solve for x by dividing 900/70 = 12.85 m g. When rounding to the nearing tenth decimal point the dose should be 12.9 m g.
1) A cesarean section is ordered for a pregnant client. Because the client is to receive general anesthesia, what is the primary danger with which the nurse is concerned? A) Fetal depression B) Vomiting C) Maternal depression D) Uterine relaxation
Answer: A Explanation: A) A primary danger of general anesthesia is fetal depression. The depression in the fetus is directly proportional to the depth and duration of the anesthesia. B) Vomiting is not a primary concern. C) Maternal depression is not a primary danger of general anesthesia. D) Uterine relaxation has nothing to do with general anesthesia.
1) The nurse is caring for a client in labor who has a history of physical dependence on narcotics. Which consideration should the nurse take with regard to the administration of naloxone (Narcan)? A) Inducing withdrawal symptoms B) Prolonging respiratory depression C) Exacerbating pruritis D) Increasing the risk for fetal depression
Answer: A Explanation: A) Administering naloxone (Narcan) to a client who is physically dependent on narcotics may induce withdrawal symptoms, which will adversely affect her and her baby. B) Naloxone (Narcan) is used to correct respiratory depression, and does not prolong it. C) Naloxone is an opiate antagonist, and is not expected to exacerbate the side effects of opioids such as pruritis. D) Fetal depression is not expected to occur with the use of naloxone (Narcan).
1) A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of anesthesia? A) Spinal B) Pudendal C) General D) Epidural
Answer: A Explanation: A) Following the birth, the woman may be kept flat. Although the effectiveness of the supine position to avoid headache following a spinal is controversial, the physician's orders may include lying flat for 6-12 hours. B) It is not necessary to keep the postpartum client in bed for 6-12 hours after receiving a pudendal. C) The decision to keep the postpartum client in bed after receiving a general anesthesia depends on the client. D) It is not usually necessary to keep the postpartum client in bed for 6-12 hours after receiving an epidural.
1) The nurse is caring for a laboring client with thrombocytopenia. During labor, it is determined that the client requires a cesarean delivery. The nurse is preparing the client for surgery, and should instruct the client that the recommended method of anesthesia is which of the following? A) General anesthesia B) Epidural anesthesia C) Spinal anesthesia D) Regional anesthesia
Answer: A Explanation: A) General anesthesia will be recommended. Women with thrombocytopenia should avoid regional blocks. B) Women with thrombocytopenia should avoid regional blocks. C) Women with thrombocytopenia should avoid regional blocks. D) Women with thrombocytopenia should avoid regional blocks.
An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was effective? A) The client dozes between contractions. B) The client is moaning during contractions. C) The contractions decrease in intensity. D) The contractions decrease in frequency.
Answer: A Explanation: A) If the client dozes between contractions, the analgesic is effective. Analgesics decrease discomfort and increase relaxation. B) Analgesics decrease the discomfort of contractions. C) Contractions will not decrease in intensity. D) Contractions will not decrease in frequency.
1) The nurse is inducing the labor of a client with severe preeclampsia. As labor progresses, fetal intolerance of labor develops. The induction medication is turned off, and the client is prepared for cesarean birth. Which statement should the nurse include in her preoperative teaching? A) "Because of your preeclampsia, you are at higher risk for hypotension after an epidural anesthesia." B) "Because of your preeclampsia, you might develop hypertension after a spinal anesthesia." C) "Because of your preeclampsia, your baby might have decreased blood pressure after birth." D) "Because of your preeclampsia, your husband will not be allowed into the operating room."
Answer: A Explanation: A) Pregnancies complicated by preeclampsia are high-risk situations. The woman with mild preeclampsia usually may have the analgesia or anesthesia of choice, although the incidence of hypotension with epidural anesthesia is increased. If hypotension occurs with the epidural block, it provides further stress on an already compromised cardiovascular system. B) Hypertension is not associated with spinal anesthesia. C) Preeclampsia does not affect the baby's blood pressure. D) The presence of preeclampsia does not mean the husband cannot be present at the birth.
1) Upon the client's admission to the birthing unit, the nurse performs a careful assessment to determine whether the client has a history of physical dependence on narcotics. For which complication related to analgesic administration is the nurse preparing? A) Respiratory depression B) Urinary retention C) Fetal depression D) Pruritis
Answer: A Explanation: A) Respiratory depression may require the use of naloxone (Narcan) to reverse the effects of narcotic agents. If the client has a history of physical dependence on narcotics, naloxone (Narcan) may induce withdrawal symptoms, which will adversely affect the client and her baby. B) Naloxone (Narcan) is given to correct respiratory depression, sedation, and hypotension, but not for urinary retention. C) Naloxone (Narcan) is given to correct respiratory depression, sedation, and hypotension, but not for fetal depression. D) Naloxone (Narcan) is given to correct respiratory depression, sedation, and hypotension, but not for pruritis.
1) What is the major adverse side effect of epidural anesthesia? A) Maternal hypotension B) Decrease in variability of the F H R C) Vertigo D) Decreased or absent respiratory movements
Answer: A Explanation: A) The major adverse effect of epidural anesthesia is maternal hypotension caused by a spinal blockade, which lowers peripheral resistance, decreases venous return to the heart, and subsequently lessens cardiac output and lowers blood pressure. B) A decrease in variability of the F H R is a fetal side effect of benzodiazepines. C) Vertigo is a side effect of the drug Nubain. D) Meperidine has multiple fetal side effects, including decreased or absent respiratory movements.
1) A cesarean section is ordered for the laboring client with whom the nurse has worked all shift. The client will receive general anesthesia. The nurse knows that potential complications of general anesthesia include which of the following? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Fetal depression that is directly proportional to the depth and duration of the anesthesia B) Poor fetal metabolism of anesthesia, which inhibits use with preterm infants C) Uterine relaxation D) Increased gastric motility E) Itching of the face and neck
Answer: A, B, C Explanation: A) A primary danger of general anesthesia is fetal depression, because the medication reaches the fetus in about 2 minutes. The depression is directly proportional to the depth and duration of anesthesia. B) The poor fetal metabolism of general anesthetic agents is similar to that of analgesic agents administered during labor. General anesthesia is not advocated when the fetus is considered to be at high risk, particularly in preterm birth. C) Most general anesthetic agents cause some degree of uterine relaxation. D) Pregnancy results in decreased gastric motility, and the onset of labor halts the process almost entirely. Food eaten hours earlier may remain undigested in the stomach. E) Itching of the face and neck is not associated with general anesthesia.
1) The nurse is performing an assessment on a client admitted to the birthing unit. Which assessment finding(s) contraindicate(s) an epidural block? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Maternal refusal B) Local infection of the skin on the lower back C) Coagulation disorder D) Long-term N S A I D use E) Previous back surgery
Answer: A, B, C Explanation: A) Maternal refusal is an absolute contraindication to an epidural block. B) Local infection is an absolute contraindication to an epidural block. C) Coagulation disorders are an absolute contraindication to an epidural block. D) Long-term N S A I D use may be cause for concern that needs to be evaluated on an individual basis. It is not considered a contraindication for an epidural block. E) Previous back surgery may be cause for concern that needs to be evaluated on an individual basis. It is not considered a contraindication for an epidural block.
1) During a labor and delivery class, a client asks the nurse, "Why would I be placed under general anesthesia during delivery?" What should the nurse include in the response? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Perceived lack of time for regional anesthesia B) Contraindications for regional anesthesia C) Failure of regional anesthesia D) Refusal of regional anesthesia E) Provider preference over regional anesthesia
Answer: A, B, C, D Explanation: A) Perceived lack of time is a common indication for general anesthesia. B) When regional anesthesia is contraindicated, general anesthesia is commonly used. C) Failure of regional anesthesia is a common indication for general anesthesia. D) Patient refusal of regional anesthesia is a common indication for general anesthesia. E) Provider preference is not a common indication of general anesthesia.
1) For what common side effects of epidural anesthesia should the nurse watch? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Elevated maternal temperature B) Urinary retention C) Nausea D) Long-term back pain E) Local itching
Answer: A, B, C, E Explanation: A) Elevated maternal temperature is a potential side effect of epidural anesthesia. B) Urinary retention is a potential side effect of epidural anesthesia. C) Nausea is a potential side effect of epidural anesthesia. D) Long-term back pain should not result from an epidural. E) Pruritus may occur at any time during the epidural infusion. It usually appears first on the face, neck, or torso and is generally the result of the agent used in the epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus.
1) When general anesthesia is necessary for a cesarean delivery, what should the nurse be prepared to do? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) Administer an antacid to the client. B) Place a wedge under the client's thigh. C) Apply cricoid pressure to the client during anesthesia intubation. D) Preoxygenate the client for 3-5 minutes before anesthesia. E) Place a Foley catheter in the client's bladder.
Answer: A, C, D, E Explanation: A) Prophylactic antacid therapy is given to reduce the acidic content of the stomach before general anesthesia. B) Before the induction to anesthesia, the woman should have a wedge placed under her hip to displace the uterus and avoid vena caval compression in the supine position. C) During the process of rapid induction of anesthesia, the nurse applies cricoid pressure. D) The woman should be preoxygenated with 3 to 5 minutes of 100% oxygen. E) Urinary retention can be treated with the placement of an indwelling Foley catheter.
1) The client at 39 weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate intervention? A) The baby's hands and feet are blue at 1 minute after birth. B) The fetal heart rate is 70 prior to making the skin incision. C) Clear fluid is obtained from the baby's oropharynx. D) The neonate cries prior to delivery of the body.
Answer: B Explanation: A) Acrocyanosis is an expected finding at 1 minute of age. B) Fetal bradycardia occurs when the fetal heart rate falls below 110 beats/minute during a 10-minute period of continuous monitoring. When fetal bradycardia is accompanied by decreased variability, it is considered ominous and could be a sign of fetal compromise. C) Clear fluid from the baby's oropharynx is an expected finding. D) A primary danger of general anesthesia is fetal depression. Crying after delivery of just the head indicates that no neonatal depression has occurred.
1) Narcotic analgesia is administered to a laboring client at 10:00 a.m. The infant is delivered at 12:30 p.m. What would the nurse anticipate that the narcotic analgesia could do? A) Be used in place of preoperative sedation B) Result in neonatal respiratory depression C) Prevent the need for anesthesia with an episiotomy D) Enhance uterine contractions
Answer: B Explanation: A) Analgesics do not take the place of preoperative sedation. B) Analgesia given too late is of no value to the woman and may cause neonatal respiratory depression. C) Local anesthetic is needed for an episiotomy. D) Analgesics do not enhance uterine contractions.
1) The laboring client brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 c m and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" What is the nurse's best response? A) "The narcotic in the epidural will make both you and the baby sleepy." B) "It is unlikely that an epidural will decrease your baby's heart rate." C) "Epidurals tend to cause low blood pressure in babies after birth." D) "I can't get you an epidural, because of your birth plan."
Answer: B Explanation: A) It is rare for sedation to occur from absorption of the medications of a continuous epidural. B) Maternal hypotension results in uteroplacental insufficiency in the fetus, which is manifested as late decelerations on the fetal monitoring strip. The risk of hypotension can be minimized by hydrating the vascular system with 500 to 1000 m L of I V solution before the procedure and changing the woman's position and/or increasing the I V rate afterward. C) Mothers can experience hypotension after the epidural is administered, but babies do not develop hypotension after birth as a result of a labor epidural. D) A birth plan is what the client hopes for prior to the onset of labor, but it can be modified at any time.
1) A client received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This client is at increased risk for which problem during the fourth stage of labor? A) Nausea B) Bladder distention C) Uterine atony D) Hypertension
Answer: B Explanation: A) The epidural is discontinued after delivery, decreasing the likelihood of nausea. B) Nursing care following an epidural block includes frequent assessment of the bladder to avoid bladder distention. C) Uterine atony is not a result of epidurals. D) Hypotension, not hypertension, is an early side effect of epidurals.
1) The nurse knows that which of the following are advantages of spinal block? Note: Credit will be given only if all correct answers and no incorrect answers are selected. Select all that apply. A) Intense blockade of sympathetic fibers B) Relative ease of administration C) Maternal compartmentalization of the drug D) Immediate onset of anesthesia E) Larger drug volume
Answer: B, C, D Explanation: A) The primary disadvantage of spinal block is intense blockade of sympathetic fibers, resulting in a high incidence of hypotension. B) One of the advantages of spinal block is the relative ease of administration. C) One of the advantages of spinal block is the maternal compartmentalization of the drug. D) One of the advantages of spinal block is the immediate onset of anesthesia. E) One of the advantages of spinal block is a smaller drug volume, not a larger one.
1) A client dilated to 5 c m has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her B P? A) Epinephrine B) Terbutaline C) Ephedrine D) Epifoam
Answer: C Explanation: A) Epinephrine is used to relieve bronchospasm, or during anaphylactic reactions. B) Terbutaline is used as a tocolytic. C) Ephedrine is the medication of choice to increase maternal blood pressure. D) Epifoam is a topical anesthetic.
1) After nalbuphine hydrochloride (Nubain) is administered, labor progresses rapidly, and the baby is born less than 1 hour later. The baby shows signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn? A) Fentanyl (Sublimaze) B) Butorphanol tartrate (Stadol) C) Naloxone (Narcan) D) Pentobarbital (Nembutal)
Answer: C Explanation: A) Fentanyl would not reverse the effects of the Nubain. B) Stadol would not reverse the effects of the Nubain. C) Narcan is useful for respiratory depression caused by nalbuphine (Nubain). Respiratory depression in the mother or fetus/newborn can be improved by the administration of naloxone (Narcan), which is a specific antagonist for this agent. D) Nembutal would not reverse the effects of the Nubain.
1) The nurse is providing preoperative teaching to a client for whom a cesarean birth under general anesthesia is scheduled for the next day. Which statement by the client indicates that she requires additional information? A) "General anesthesia can be accomplished with inhaled gases." B) "General anesthesia usually involves administering medication into my I V." C) "General anesthesia will provide good pain relief after the birth." D) "General anesthesia takes effect faster than an epidural."
Answer: C Explanation: A) General anesthesia can be accomplished via inhalation, intravenous injection, or a combination of the two. B) General anesthesia can be accomplished via inhalation, intravenous injection, or a combination of the two. C) General anesthesia provides no pain relief after birth, as regional anesthesia does. D) General anesthesia takes effect very quickly.
1) The client with a normal pregnancy had an emergency cesarean birth under general anesthesia 2 hours ago. The client now has a respiratory rate of 30, pale blue nail beds, a pulse rate of 110, and a temperature of 102.6°F, and is complaining of chest pain. The nurse understands that the client most likely is experiencing which of the following? A) Pulmonary embolus B) Pneumococcal pneumonia C) Pneumonitis D) Gastroesophageal reflux disease
Answer: C Explanation: A) Pulmonary embolus does not cause fever. B) General anesthesia does not cause pneumococcal pneumonia. C) Even when food and fluids have been withheld, the gastric juice produced during fasting is highly acidic and can produce chemical pneumonitis if aspirated. This pneumonitis is known as Mendelson syndrome. The signs and symptoms are chest pain, respiratory distress, cyanosis, fever, and tachycardia. Women undergoing emergency cesarean births appear to be at considerable risk for adverse events. D) Gastroesophageal reflux disease does not cause a fever or cyanosis.
1) Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do? A) Remove the epidural catheter and apply a Band-Aid to the injection site. B) Offer the client a cool cloth and let her know the itching is temporary. C) Recognize that this is a common side effect, and follow protocol for administration of Benadryl. D) Call the anesthesia care provider to re-dose the epidural catheter.
Answer: C Explanation: A) Removing the epidural catheter does not address the side effects of the medication. B) Using a cool cloth does not address the side effects of the medication. C) Itching is a side effect of the medication used for an epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus. D) The anesthesia care provider would not re-dose, as that would continue or worsen the side effects of the medication.
1) The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed? A) "An epidural can be continuous or can be given in one dose." B) "A spinal is usually used for a cesarean birth." C) "Pudendal blocks are effective when a vacuum is needed." D) "Local anesthetics provide good labor pain relief."
Answer: D Explanation: A) Epidurals can be given either as a bolus or as a continuous infusion. B) Spinals are anesthesia, and are commonly used for cesarean birth. C) The advantages of pudendal block are ease of administration and absence of maternal hypotension. It also allows the use of low forceps or vacuum extraction for birth. Local anesthetics are not used for labor pain relief. They are used prior to episiotomy and for laceration repair
1) A client has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands which of the following? A) In order to respect her wishes, no medication will be given. B) Pain relief will allow a more enjoyable birth experience. C) The use of medications allows the client to rest and be less fatigued. D) Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.
Answer: D Explanation: A) It is important to respect the client's wishes when possible. Once the effects are explained, it is still the client's choice whether to receive medication. B) That pain relief can lead to a more enjoyable experience might be the view of the nurse, but not of the mother. C) While pain relief can allow the mother to be less fatigued, that might not be the mother's first priority. D) The nurse can explain to the client that, although pharmacologic agents do affect the fetus, so does the pain and stress experienced by the laboring mother. If the woman's pain and anxiety are more than she can cope with, the adverse physiologic effects on the fetus may be as great as would occur with the administration of a small amount of an analgesic agent. Once the effects are explained, however, it is still the client's choice whether to receive medication.
1) A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse suggest? A) That a mild analgesic be administered B) An epidural C) A local anesthetic block D) Nonpharmacologic methods of pain relief
Answer: D Explanation: A) The client does not have an established labor pattern, and analgesics given for pain relief could prolong labor or stop the process. B) The client does not have an established labor pattern, and an epidural given for pain relief could prolong labor or stop the process. C) The pudendal block technique provides perineal anesthesia for the second stage of labor, birth, and episiotomy repair. For this pattern of labor, nonpharmacologic methods of pain relief should be suggested. These can include back rubs, providing encouragement, and clean linens
1) Toward the end of the first stage of labor, a pudendal block is administered transvaginally. What will the nurse anticipate the client's care will include? A) Monitoring for hypotension every 15 minutes B) Monitoring F H R every 15 minutes C) Monitoring for bladder distention D) No additional assessments
Answer: D Explanation: A) There is no need for any additional monitoring of the mother. B) There is no need for any additional monitoring of the fetus. C) There is no need to monitor for bladder distension. D) Because a pudendal block is done using a local anesthetic, there is no need for additional monitoring of the mother or the fetus.
1) Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which position? A) On her right side in the center of the bed with her back curved B) Lying prone with a pillow under her chest C) On her left side with the bottom leg straight and the top leg slightly flexed D) Sitting on the edge of the bed
Answer: D Explanation: A) This position is not consistent with access to the epidural spaces. B) This position is not consistent with access to the epidural spaces. C) This position is not consistent with access to the epidural spaces. D) The woman is positioned on her left or right side, at the edge of the bed with the assistance of the nurse, with her legs slightly flexed, or she is asked to sit on the edge of the bed.
