S3: U5: Pain: Practice Questions
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? A) Estradiol B) Haloperidol C) Clomiphene 4) Promethazine
C) 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 pregnant woman reports severe headaches, chest pain, and fatigue. Upon diagnosis, the woman has hypertension. Which drug can be prescribed to reduce hypertension? A) Lithium B) Miglitol C) Calcium gluconate D) Magnesium sulfate
D) 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.
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? A) Methylergonovine B) Mifepristone C) Calcium gluconate D) Magnesium sulfate
D) 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.Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.
A client in labor is experiencing discomfort because her fetus is in the occiput posterior position. Which nursing action will help relieve this discomfort? A) Positioning her on the left side B) Using effleurage on her abdomen C) Applying pressure against her sacrum D) Placing her in the semi-Fowler position
C) 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.Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten.
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. A) Wear low-heeled shoes. B) Wear a maternity girdle during waking hours. C) Sleep flat on her back with her feet elevated. D) Perform pelvic tilt exercises several times a day. E) Take an ibuprofen (Motrin) tablet at the onset of back pain.
A) Wear low-heeled shoes. D) 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.
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? A) "It shouldn't be much longer now." B) "Take a short break while I take over." C) "Let me show you how to apply back pressure." D) "Everything is progressing nicely, just as expected."
C) "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.Test-Taking Tip: Notice how the subjects of the questions are related and, through that relationship, the answers to some of the questions may be provided within other questions of the test.
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? A) Maternity girdle B) Support stockings C) Low-heeled shoes D) Loose-fitting clothing
C) 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. View Topics
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? A) Breech B) Transverse C) Occiput anterior D) Occiput posterior
D) 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.
A laboring client has asked the nurse to help her use a nonpharmacologic strategy for pain management. Name the sensory simulation strategy. A) Gentle massage of the abdomen B) Biofeedback-assisted relaxation techniques C) Application of a heat pack to the lower back D) Selecting a focal point and beginning breathing techniques
D) 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 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? A) Cleft palate B) Tooth anomalies C) Neural tube defects D) Ebstein anomaly
A) 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.
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? A) Examining the client's cervix for dilation and effacement B) Determining the client's options by assessing the prescriptions in the chart C) Asking her whether she prefers an epidural or something in her intravenous line D) Evaluating the fetal monitoring strip to determine the frequency and duration of contractions
A) 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? A) Sitting B) Supine C) Knee-chest D) Left side-lying
B) 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.
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? A) Encouraging early ambulation B) Assessing the fundus gently but firmly C) Checking vital signs for evidence of shock D) Administering the prescribed pain medication
D) 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.Test-Taking Tip: Because few things in life are absolute without exceptions, avoid selecting answers that include words such as always, never, all, every, and none. Answers containing these key words are rarely correct.
A client in active labor becomes very uncomfortable and asks a nurse for pain medication. Nalbuphine is prescribed. How does this medication relieve pain? A) By producing amnesia B) By acting as a preliminary anesthetic C) By inducing sleep until the time of birth D) By acting on opioid receptors to reduce pain
D) 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.
A nurse is teaching a childbirth preparation class. Which information regarding discomfort during labor should the nurse be certain to include in her teaching? A) Labor should be mostly pain free and uneventful. B) Breathing techniques will be taught to prevent the need for medication. C) Medication is given to women who experience painful labor contractions. D) Comfort measures are available when the discomfort of contractions becomes excessive.
D) 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.
