Chapter 9: Pain Management during Labor and Birth

Prior to infusing medication into an epidural catheter inserted into a laboring mother, which vital sign is a priority? Temperature Pain level Respiratory rate Blood pressure

Blood pressure

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

Naloxone

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

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

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? "That's wonderful. Medication during labor is not good for the baby." "Your health care provider is a man and has never been in labor; he may be underestimating the pain you will have." "I respect your preference, whether it is to have medication or not." "Let me get you something for relaxation if you don't want anything for pain."

"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." "It causes the release of endorphins." "It blocks the transmission of nerve messages of pain at the receptors." "It disrupts the nerve signal of pain via mechanical irritation of the nerves."

"It distracts your brain from the sensations of pain."

A woman refuses to have an epidural block because she does not want to have a postdural puncture (spinal) headache after birth. What would be the nurse's best response? "The anesthesiologist will do her best to avoid this." "The pain relief offered will compensate for the discomfort afterward." "Spinal headache is not a usual complication of epidural blocks." "Your health care provider knows what is best for you."

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

When collecting data to devise a labor plan for a multiparous woman, which question best allows the nurse to develop individualized strategies? "Tell me how you handled labor pain in your past deliveries." "How do you want the health care team to plan your care?" "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."

The health care provider approves a labor plan which includes analgesia. The client questions how analgesia will help her pain during labor. Which answer is best? "The analgesia will limit your ability to be out of bed without assistance." "The analgesia will block pain sensation and limit your ability to push." "The analgesia will reduce the sensation of pain for a limited period of time." "The analgesia will allow for a pain-free birth experience."

"The analgesia will reduce the sensation of pain for a limited period of time."

An experienced nurse is mentoring a graduate nurse and critiquing the graduate's shift handoff. Which statement requires clarification? "The client is experiencing lower back pain and I gave a backrub." "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." "I instructed the client to ring if she felt the need to move her bowels."

"The client reports a pain level of 8. She has a low pain tolerance."

When a client is counseled about the advantages of epidural anesthesia, which statement made by the counselor would indicate the need for further teaching? "Epidural anesthesia is more effective than opioid analgesia in providing pain relief." "You can continuously receive epidural anesthesia until you have the baby, and even afterward if you need it." "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."

A client who is in the transition phase reports her pain medication last given 3 hours ago has worn off. She asks if she can have another dose of the meperidine. How should the nurse respond to the request? "Since it has been over 3 hours, you should be able to have more of the medication." "It is too early as the medication should be given only every 4 hours." "Your phase of labor makes giving another dose unsafe." "I will get permission from your health care provider."

"Your phase of labor makes giving another dose unsafe."

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? 37°C 35°C 39°C 41°C

37°C

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 acupuncture effleurage biofeedback

Acupressure

A pregnant client received an opioid analgesic 2 hours before birth. The newborn is lethargic and difficult to arouse. What should the nurse prepare to do to help this newborn? Administer intravenous fluids. Apply oxygen and place in a heated bassinet. Administer naloxone hydrochloride. Provide tactile stimulation to encourage crying.

Administer naloxone hydrochloride.

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. Explain to the client that opioids should only be administered an hour or less before birth. Refuse to administer opioids because they can develop dependency in the client and the fetus.

Advise the client to hold out a bit longer, if possible, before administration of the drug, to prevent slowing labor.

The labor nurse reports to the nurse on the oncoming 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 oncoming 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 Asking the visitors in the room if they think the woman is experiencing pain Taking the woman's vital signs and consulting with other staff members No additional assessments are indicated until the woman begins to report pain.

Asking the visitors in the room if they think the woman is experiencing pain

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 maternal blood pressure. Assess for constipation. Assess for dry mouth. Assess fetal heart rate.

Assess fetal heart rate

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

Assess vital signs.

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

Continue with the admission assessment

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

Effleurage.

The nurse is caring for a client with severe anxiety. The client states, "I have never had a baby before and am scared to death that I will not be able to do it." Which suggestion is most helpful? Encourage the use of a doula. Identify strategies to decrease anxiety. Document history on prenatal communication sheet. Consider requesting an anxiolytic during labor.

Encourage the use of a doula

How does a woman who feels in control of the situation during labor influence her pain? Feelings of control are inversely related to the client's report of pain. Decreased feeling of control helps during the third stage. There is no association between the two factors. Feeling in control shortens the overall length of labor.

Feelings of control are inversely related to the client's report of pain.

The nurse is caring for a client who is diagnosed with a postdural puncture (spinal) headache. When completing a nursing assessment, which position would exacerbate the symptoms? Supine On the left side Fowler position Recumbent lateral position

Fowler position

Which type of anesthesia is anticipated when the delivery of the fetus must be done quickly due to an emergency situation? General Regional Local Short acting

General

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

Identify how the client expresses labor pain.

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 Initiate comfort measures Limit interruptions in the room Encourage support person interaction

Initiate comfort measures

Which is identified as the primary outcome for initiating comfort measures during the labor process? Improve the psyche of the mother Increase client satisfaction Maintain the labor process Acknowledge pain during childbirth

Maintain the labor process

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 respirations decrease from 20 to 14 breaths/minute. Maternal blood pressure decreases from 130/70 to 98/50 mm Hg. Maternal pulse increases from 78 to 96 beats/minute. 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.

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

Maternal hypotension and fetal bradycardia

The nurse is caring for a client in the transition phase of the labor process. Which client statement requires nursing action? "My contractions are really intense now." "My lips and fingers are tingling." "My mouth and lips are so dry." "I feel burning in my perineum."

My lips and fingers are tingling."

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 more sensitive to preanesthetic medications. The client is less sensitive to inhalation anesthetics. Neonatal depression is possible. Fetal hypersensitivity to anesthetic is possible.

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. It is reported as the worst pain a woman will ever feel. Pain is focal in nature. Diffuse abdominal pain signals a complication with progression of labor.

Pain originates from the cervix and lower uterine segment.

The nurse is preparing to administer an intradermal water injection to a client who is in labor. Which action should the nurse prioritize? Repeat the injection every 15 to 20 minutes as necessary Prepare four 1 mL syringes of 0.05 to 0.1 mL sterile water using a 25 gauge needle. These injections are very effective in relieving abdominal pain caused by contractions. Prepare two injections of 1 mL to 5 mL normal saline using a 10 mL syringe with a 25 gauge needle.

Prepare four 1 mL syringes of 0.05 to 0.1 mL sterile water using a 25 gauge needle.

Which statement is true regarding analgesia versus anesthesia? Analgesia and anesthesia perform the same function when it comes to blocking pain. Increased FHR variability is a common side effect when regional anesthesia is used. 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. Hypertension is the most common side effect when systemic analgesia is used.

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.

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 response by the nurse is most helpful? Stand silently at the back of the room. Stand next to the client at the side of the bed. Turn up the volume of music playing in the room. Turn on the television as a focal point.

Stand next to the client at the side of the bed

During labor, a pregnant client's doula uses therapeutic touch and massage. Which outcome indicates that these approaches have been effective? The client is not complaining of leg cramps. The client is not requesting pain medication. The client is focusing on a painting during contractions. The client asks for a cold compress at the end of a contraction.

The client is not requesting pain medication.

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

The client will direct her pain management techniques

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

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. The woman has a high tolerance for pain. The woman has a high threshold for pain. The woman has lots of visitors during labor.

The woman is prepared for labor and birth.

The laboring client who is at 3 cm dilation (dilatation) and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice? This would cause fetal depression in utero. This may prolong labor and increase complications. The effects would wear off before birth. This can lead to maternal hypertension.

This may prolong labor and increase complications.

Immediately following an epidural block, a pregnant client's blood pressure suddenly falls to 90/50 mmHg. What action should the nurse take first? Place the client in a supine position. Raise the head of the bed. Ask the client to take deep breaths. Turn the client onto the left side or raise the legs.

Turn the client onto the left side or raise the legs.

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 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 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 different types of relaxation techniques 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.

When entering the second phase of labor, a client tells the nurse that the pain is severe and is unsure if pain medication should be used. Which nursing diagnosis should the nurse use to guide the care of the client at this time? pain related to labor contractions powerlessness related to the duration and intensity of labor decision conflict related to the use of analgesia during labor anxiety related to lack of knowledge about normal labor processes

decision conflict related to the use of analgesia during labor

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? passage of the drug to the fetus headache following anesthesia excessive contractions of the uterus increased frequency of micturition

headache following 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 thiopental hydroxyzine hydrochloride secobarbital

meperidine

A full-term neonate delivered an hour after the mother received IV meperidine is showing signs of respiratory depression. The nurse should be prepared to administer which medication? indomethacin ampicillin naloxone epinephrine

naloxone

The nurse is preparing materials to instruct a pregnant client about the use of a local anesthetic to block specific nerve pathways. About which type of pain reduction technique will the nurse instruct the client? general anesthesia pressure anesthesia regional anesthesia pudendal nerve block

regional anesthesia

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 respiratory depression postdural puncture (spinal) headache a failed block

respiratory depression

Which order by the health care provider would the nurse question if given in the active stage of labor? ice chips as requested secobarbital for relaxation positioning with pillows out of bed with assistance

secobarbital for relaxation

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

starting an IV and hanging IV fluids

A woman's perception of pain can differ according to all of the following except: her expectations and preparation for labor. the length of her labor. psychosocial, physiologic, and cultural influences. fear, anxiety, and self-efficacy. the presentation, lie, and attitude of the fetus.

the presentation, lie, and attitude of the fetus.

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? "An injury is unlikely because of expert professional care given." "I have never read or heard of this happening." "The injection is given in the space outside the spinal cord." "The injection is given at the third or fourth thoracic vertebrae so paralysis is not a problem."

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

A pregnant client planning for labor is asking questions about pain control options. What should the nurse explain about pain control during labor? The physician will decide how much pain relief is needed during labor. Pain medication should be started immediately when contractions are thought to begin. Any medication should have maximum effect for the client and minimal effect on the fetus. Any medication will interfere with the ability of the uterus to contract during labor and delivery.

Any medication should have maximum effect for the client and minimal effect on the fetus.

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

Give an intravenous bolus of fluid.

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. Assist the client to a sitting position, assess the fetal heart rate, give naloxone, and administer oxygen via face mask. Assist the client to the supine position, recheck the blood pressure, and administer an IV bolus of 1000 ml. Assist the client to Trendelenburg position, assess the fetal heart rate, and administer oxygen via face mask.

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.

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: 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 to perform controlled chest breathing with a slow inhale and a quick exhale. press down firmly with her index finger and forefinger on key trigger points on the client's ankle or wrist.

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

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 more sensitive to preanesthetic medications. The client is less sensitive to inhalation anesthetics. Neonatal depression is possible. Fetal hypersensitivity to anesthetic is possible

Neonatal depression is possible.