Chapter 10: Management of Discomfort My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 10: Management of Discomfort

Test Bank 

MULTIPLE CHOICE

1. An 18-year-old pregnant woman, gravida 1, is admitted to the labor and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, My contractions are so strong that I dont know what to do. The nurse should:

a. Assess for fetal well-being.
b. Encourage the woman to lie on her side.
c. Disturb the woman as little as possible.
d. Recognize that pain is personalized for each individual.

ANS: D

Feedback
A This scenario includes no information that would indicate fetal distress or a logical reason to be overly concerned about the well-being of the fetus.
B The left lateral position is used to alleviate fetal distress, not maternal stress.
C The nurse has an obligation to provide physical, emotional, and psychosocial care and support to the laboring woman. This woman clearly needs support.
D Each womans pain during childbirth is unique and is influenced by a variety of physiologic, psychosocial, and environmental factors. A critical issue for the nurse is how support can make a difference in the pain of the woman during labor and birth.

DIF:Cognitive Level: ApplicationREF:285

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

2. Nursing care measures are commonly offered to women in labor. Which nursing measure reflects application of the gate-control theory?

a. Massaging the womans back
b. Changing the womans position
c. Giving the prescribed medication
d. Encouraging the woman to rest between contractions

ANS: A

Feedback
A According to the gate-control theory, pain sensations travel along sensory nerve pathways to the brain; however, only a limited number of sensations, or messages, can travel through these nerve pathways at one time. Distraction techniques such as massage or stroking, music, focal points, and imagery reduce or completely block the capacity of nerve pathways to transmit pain. These distractions are thought to work by closing down a hypothetic gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished.
B Changing the womans position does not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.
C Administering the prescribed medication will not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.
D Although rest should be encouraged between contractions, this does not reduce or block the capacity of nerve pathways to transmit pain using the gate-control theory.

DIF:Cognitive Level: ComprehensionREF:287

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

3. A woman in labor has just received an epidural block. The most important nursing intervention is to:

a. Limit parenteral fluids.
b. Monitor the fetus for possible tachycardia.
c. Monitor the maternal blood pressure for possible hypotension.
d. Monitor the maternal pulse for possible bradycardia.

ANS: C

Feedback
A Intravenous fluids are increased for a woman receiving an epidural to prevent hypotension.
B The nurse observes for signs of fetal bradycardia.
C The most important nursing intervention for a woman who has received an epidural block is to monitor the maternal blood pressure frequently for signs of hypotension.
D The nurse monitors for signs of maternal tachycardia secondary to hypotension.

DIF:Cognitive Level: ApplicationREF:304

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

4. A woman in the active phase of the first stage of labor is using a shallow pattern of breathing, which is about twice the normal adult breathing rate. She starts to complain about feeling lightheaded and dizzy and states that her fingers are tingling. The nurse should:

a. Notify the womans physician.
b. Tell the woman to slow the pace of her breathing.
c. Administer oxygen via a mask or nasal cannula.
d. Help her breathe into a paper bag.

ANS: D

Feedback
A This woman is experiencing the side effects of hyperventilation, which include the symptoms of light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.
B This woman is experiencing the side effects of hyperventilation, which include the symptoms of light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.
C This woman is experiencing the side effects of hyperventilation, which include the symptoms of light-headedness, dizziness, tingling of the fingers, or circumoral numbness. Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis. This enables her to rebreathe carbon dioxide and replace the bicarbonate ion.
D Having the woman breathe into a paper bag held tightly around her mouth and nose may eliminate respiratory alkalosis.

DIF:Cognitive Level: ApplicationREF:291

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

5. A woman has requested an epidural for her pain. She is 5 cm dilated and 100% effaced. The baby is in a vertex position and is engaged. The nurse increases the womans intravenous fluid for a preprocedural bolus. She reviews her laboratory values and notes that the womans hemoglobin is 12 g/dl, hematocrit is 38%, platelets are 67,000, and white blood cells (WBCs) are 12,000/mm3. Which factor would contraindicate an epidural for the woman?

a. She is too far dilated.
b. She is anemic.
c. She has thrombocytopenia.
d. She is septic.

ANS: C

Feedback
A Typically epidural analgesia/anesthesia is used in the laboring woman when a regular labor pattern has been achieved, as evidenced by progressive cervical change.
B The laboratory values show that the womans hemoglobin and hematocrit are in the normal range.
C The platelet count indicates thrombocytopenia (low platelets), which is a contraindication to epidural analgesia/anesthesia.
D The laboratory values show a slight increase in the WBC count; this is not uncommon in laboring women.

DIF:Cognitive Level: AnalysisREF:306

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

6. The role of the nurse with regard to informed consent is to:

a. Inform the patient about the procedure and have her sign the consent form.
b. Act as a patient advocate and help clarify the procedure and the options.
c. Call the physician to see the patient.
d. Witness the signing of the consent form.

ANS: B

Feedback
A  The physician is responsible for informing the woman of her options, explaining the procedure, and advising the patient about potential risk factors.
B Nurses play a part in the informed consent process by clarifying and describing procedures or by acting as the womans advocate and asking the primary health care provider for further explanations.
C The physician must be present to explain the procedure to the patient. However, the nurses responsibilities go further than simply asking the physician to see the patient.
D The nurse may witness the signing of the consent form. However, depending on the states guidelines, the womans husband or another hospital health care employee may sign as witness.

DIF:Cognitive Level: ComprehensionREF:309

OBJ:Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

7. A first-time mother is concerned about the type of medications she will receive during labor. She is in a fair amount of pain and is nauseous. In addition, she appears to be very anxious. You explain that opioid analgesics often are used with sedatives because:

a. The two together work the best for you and your baby.
b. Sedatives help the opioid work better, and they also will help relax you and relieve your nausea.
c. They work better together so you can sleep until you have the baby.
d. This is what the doctor has ordered for you.

ANS: B

Feedback
A A potentiator may cause the two drugs to work together more effectively, but it does not ensure no maternal or fetal complications.
B Sedatives can be used to reduce the nausea and vomiting that often accompany opioid use. In addition, some ataractics reduce anxiety and apprehension and potentiate the opioid analgesic affects.
C Sedation may be a related effect of some ataractics, but it is not the goal. Furthermore, a woman is unlikely to be able to sleep through transitional labor and birth.
D This statement may be true, but it is not an acceptable comment for the nurse to make.

DIF:Cognitive Level: ApplicationREF:295

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

8. To help patients manage discomfort and pain during labor, nurses should be aware that:

a. The predominant pain of the first stage of labor is the visceral pain located in the lower portion of the abdomen.
b. Referred pain is the extreme discomfort between contractions.
c. The somatic pain of the second stage of labor is more generalized and related to fatigue.
d. Pain during the third stage is a somewhat milder version of the second stage.

ANS: A

Feedback
A This pain comes from cervical changes, distention of the lower uterine segment, and uterine ischemia.
B Referred pain occurs when the pain that originates in the uterus radiates to the abdominal wall, lumbosacral area of the back, iliac crests, and gluteal area.
C Second-stage labor pain is intense, sharp, burning, and localized.
D Third-stage labor pain is similar to that of the first stage.

DIF:Cognitive Level: KnowledgeREF:285

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

9. Which statement correctly describes the effects of various pain factors?

a. Higher prostaglandin levels arising from dysmenorrhea can blunt the pain of childbirth.
b. Upright positions in labor increase the pain factor because they cause greater fatigue.
c. Women who move around trying different positions are experiencing more pain.
d. Levels of pain-mitigating -endorphins are higher during a spontaneous, natural childbirth.

ANS: D

Feedback
A Higher prostaglandin levels correspond to more severe labor pains.
B Upright positions in labor usually result in improved comfort and less pain.
C Moving freely to find more comfortable positions is important for reducing pain and muscle tension.
D Higher endorphin levels help women tolerate pain and reduce anxiety and irritability.

DIF:Cognitive Level: ComprehensionREF:286

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

10. Nurses with an understanding of cultural differences regarding likely reactions to pain may be better able to help patients. Nurses should know that _____ women may be stoic until late in labor, when they may become vocal and request pain relief.

a. Chinese
b. Arab or Middle Eastern
c. Hispanic
d. African-American

ANS: C

Feedback
A Chinese women may not show reactions to pain. Medical interventions must be offered more than once.
B Arab or Middle Eastern women may be vocal in response to labor pain from the start. They may prefer pain medications.
C Hispanic women may be stoic early, more vocal and ready for medications later.
D African-American women may express pain openly; use of medications for pain is more likely to vary with the individual.

DIF:Cognitive Level: KnowledgeREF:287

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

11. With regard to a pregnant womans anxiety and pain experience, nurses should be aware that:

a. Even mild anxiety must be treated.
b. Severe anxiety increases tension, which increases pain, which in turn increases fear and anxiety, and so on.
c. Anxiety may increase the perception of pain, but it does not affect the mechanism of labor.
d. Women who have had a painful labor will have learned from the experience and have less anxiety the second time because of increased familiarity.

ANS: B

Feedback
A Mild anxiety is normal for a woman in labor and likely needs no special treatment other than the standard reassurances.
B Anxiety and pain reinforce each other in a bad cycle.
C Anxiety increases muscle tension and ultimately can build sufficiently to slow the progress of labor.
D Unfortunately an anxious, painful first labor is likely to carry over, through expectations and memories, into an anxious and painful experience in the second pregnancy.

DIF:Cognitive Level: ComprehensionREF:287

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

12. In the current practice of childbirth preparation, emphasis is placed on:

a. The Dick-Read (natural) childbirth method.
b. The Lamaze (psychoprophylactic) method.
c. The Bradley (husband-coached) method.
d. Getting expectant parents to attend childbirth preparation classes for any (no specific) method.

ANS: D

Feedback
A The Dick-Read method focuses on childbirth without fear through breathing and relaxation. It is one of several acceptable methods of preparation for labor.
B The Lamaze method of childbirth preparation has been prevalent since the 1960s. It is one of the more popular methods of labor preparation; however, there are numerous others available to new parents.
C The Bradley method utilizes the husband or coach to assist the mother to work in harmony with her body. This popular method of childbirth preparation is one of many available.
D Getting expectant parents to attend any childbirth preparation class is important, because preparation increases a womans confidence and thus her ability to cope with labor and birth. There are a number of methods available today.

DIF:Cognitive Level: ComprehensionREF:288, 289

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

13. Maternity nurses often have to answer questions about the many, sometimes unusual, ways people have tried to make the birthing experience more comfortable. For instance, nurses should be aware that:

a. Music supplied by the support person has to be discouraged because it could disturb others or upset the hospital routine.
b. Women in labor can benefit from sitting in a bathtub, but they must limit immersion to no longer than 15 minutes at a time.
c. Effleurage is permissible, but counterpressure is almost always counterproductive.
d. Electrodes attached to either side of the spine to provide high-intensity electrical impulses facilitate the release of endorphins.

ANS: D

Feedback
A Music may be very helpful for reducing tension and certainly can be accommodated by the hospital.
B Women can stay in a bath as long as they want, although repeated baths with breaks might be more effective than a long soak.
C Counterpressure can help the woman cope with lower back pain.
D Transcutaneous electrical nerve stimulation does help.

DIF:Cognitive Level: ApplicationREF:293

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

14. With regard to nerve block analgesia and anesthesia, nurses should be aware that:

a. Most local agents are related chemically to cocaine and end in the suffix -caine.
b. Local perineal infiltration anesthesia is effective when epinephrine is added, but it can be injected only once.
c. A pudendal nerve block is designed to relieve the pain from uterine contractions.
d. A pudendal nerve block, if done correctly, does not significantly lessen the bearing-down reflex.

ANS: A

Feedback
A Common agents include lidocaine and chloroprocaine.
B Injections can be repeated to prolong the anesthesia.
C A pudendal nerve block relieves pain in the vagina, vulva, and perineum but not the pain from uterine contractions.
D A pudendal nerve block lessens or shuts down the bearing-down reflex.

DIF:Cognitive Level: ComprehensionREF:299

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

15. A woman in labor is breathing into a mouthpiece just before the start of her regular contractions. As she inhales, a valve opens, and gas is released. She continues to inhale the gas slowly and deeply until the contraction starts to subside. When the inhalation stops, the valve closes. This procedure is:

a. Not used much anymore.
b. Likely to be used in the second stage of labor but not in the first stage.
c. An application of nitrous oxide.
d. A prelude to cesarean birth.

ANS: C

Feedback
A This is an acceptable method of pain control more commonly used in Canada or the United Kingdom.
B Nitrous oxide can be used safely in both the first and second stages of labor.
C This is an application of nitrous oxide mixed with oxygen that can be inhaled at a low concentration. This reduces, however, does not eliminate pain and is commonly used in either the first or second stage of labor (or both) as part of the preparation for a vaginal birth. Nitrous oxide can be used in combination with other measures for pain relief.
D Nitrous oxide would not provide adequate pain relief for a woman about to undergo a cesarean birth.

DIF:Cognitive Level: ComprehensionREF:306

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

16. After change-of-shift report, the nurse assumes care of a multiparous patient in labor. The woman is complaining of pain that radiates to her abdominal wall, lower back, and buttocks and down her thighs. Before implementing a plan of care, the nurse should understand that this type of pain is:

a. Visceral.
b. Referred.
c. Somatic.
d. Afterpain.

ANS: B

Feedback
A Visceral pain is that which predominates in the first stage of labor. This pain originates from cervical changes, distention of the lower uterine segment, and uterine ischemia. Visceral pain is located over the lower portion of the abdomen.
B As labor progresses, the woman often experiences referred pain. This occurs when pain that originates in the uterus radiates to the abdominal wall, the lumbosacral area of the back, the gluteal area, and thighs. The woman usually has pain only during a contraction and is free from pain between contractions.
C Somatic pain is described as intense, sharp, burning, and well localized. This results from stretching of the perineal tissues and the pelvic floor. This occurs during the second stage of labor.
D Pain experienced during the third stage of labor or afterward during the early postpartum period is uterine. This pain is very similar to that experienced in the first stage of labor.

DIF:Cognitive Level: ComprehensionREF:285

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

COMPLETION

1. Today the pregnant woman has a number of nonpharmacologic measures available to her to assist with pain relief in labor. One such measure involves the application of heat, cold, or pressure to specific areas of the body and is known as ________________.

ANS:

Acupressure

The effectiveness of acupressure has been attributed to the gate-control theory of pain and an increase in endorphin levels. Pressure is applied to acupuncture points called tsubos. These points have an increased density of neuroreceptors and increased electrical conductivity. Pressure is initially applied with contractions and then continually as labor progresses.

DIF:Cognitive Level: ApplicationREF:293

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

TRUE/FALSE

1. Benzodiazepines (Valium, Ativan), when given in conjunction with opioid analgesia, appear to enhance pain relief and reduce nausea and vomiting. Because of the positive effects of this combination, benzodiazepines are frequently used during labor.

ANS: F

Because all benzodiazepines cause significant maternal amnesia, their use should be avoided during labor. Another major disadvantage is the subsequent disruption of thermoregulation in the newborn.

DIF:Cognitive Level: ApplicationREF:295

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

2. Opioids such as hydromorphone, fentanyl, and meperidine can cause excessive CNS depression in both the mother and newborn. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects, especially respiratory depression. The RN should use caution in administering naloxone to opioid dependent women in labor.

ANS: T

An opioid antagonist is contraindicated for any opioid-dependent woman because it may precipitate abstinence syndrome (withdrawal symptoms).

DIF:Cognitive Level: ComprehensionREF:299

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

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