Chapter 18: Pain Management for Childbirth My Nursing Test Banks

Chapter 18: Pain Management for Childbirth

Test Bank

MULTIPLE CHOICE

1. Childbirth preparation can be considered successful if the outcome is described as

a.

Labor was pain-free.

b.

Birth experiences of friends and families were discredited.

c.

The woman rehearsed labor and practiced skills to master pain.

d.

Only nonpharmacologic methods for pain control were used.

ANS: C

Feedback

A

Childbirth preparation does not guarantee a pain-free labor. A woman should be prepared for pain and anesthesia/analgesia realistically.

B

Friends and families can be an important source of support if they convey realistic information about labor pain.

C

Preparation allows the woman to rehearse for labor and to learn new skills to cope with the pain of labor and the expected behavioral changes.

D

Women will not always achieve their desired level of pain control by using nonpharmacologic methods alone.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 388

OBJ: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

2. In order 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.

Somatic 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

Somatic pain is a faster, sharp pain. Somatic pain is most prominent during late first-stage labor and during second-stage labor as the descending fetus puts direct pressure on maternal tissues.

C

Second-stage labor pain is intense, sharp, burning, and localized.

D

Third-stage labor pain is similar to that of the first stage.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 389

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

3. The nurse caring for women in labor understands that childbirth pain is different from other types of pain in that it is

a.

More responsive to pharmacologic management

b.

Associated with a physiologic process

c.

Designed to make one withdraw from the stimulus

d.

Less intense

ANS: B

Feedback

A

Pain management during labor may affect the course and length of labor.

B

Childbirth pain is part of a normal process, whereas other types of pain usually signify an injury or illness.

C

The pain with childbirth is a normal process; it is not caused by the type of injury when withdrawal from the stimuli is seen.

D

Childbirth pain is not less intense than other types of pain.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 388

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

4. Excessive anxiety in labor heightens the womans sensitivity to pain by increasing

a.

Muscle tension

b.

Blood flow to the uterus

c.

The pain threshold

d.

Rest time between contractions

ANS: A

Feedback

A

Anxiety and fear increase muscle tension, diverting oxygenated blood to the womans brain and skeletal muscles. Prolonged tension results in general fatigue, increased pain perception, and reduced ability to use coping skills.

B

Anxiety can decrease blood flow to the uterus.

C

Anxiety will decrease the pain threshold.

D

Anxiety will decrease the amount of rest the mother gets between contractions.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 390

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

5. When providing labor support, the nurse knows that which fetal position might cause the laboring woman more back discomfort?

a.

Right occiput anterior

b.

Left occiput anterior

c.

Right occiput transverse

d.

Left occiput posterior

ANS: D

Feedback

A

Back labor is seen mostly when the fetus is in the posterior position.

B

Back labor is seen mostly when the fetus is in the posterior position.

C

Back labor is seen mostly when the fetus is in the posterior position.

D

In the left occiput posterior position, each contraction pushes the fetal head against the mothers sacrum, which results in intense back discomfort.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 390

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

6. It is important for the nurse to develop a realistic birth plan with the pregnant woman. The nurse can explain that a major advantage of nonpharmacologic pain management is that

a.

More complete pain relief is possible.

b.

No side effects or risks to the fetus are involved.

c.

The woman remains fully alert at all times.

d.

A more rapid labor is likely.

ANS: B

Feedback

A

There is less pain relief with nonpharmacologic pain management during childbirth.

B

Because nonpharmacologic pain management does not include analgesics, adjunct drugs, or anesthesia, it is harmless to the mother and the fetus.

C

The womans alertness is not altered by medication, but the increase in pain will decrease alertness.

D

Pain management may or may not alter the length of labor. At times when pain is decreased, the mother relaxes and labor progresses at a quicker pace.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 391

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

7. The best time to teach nonpharmacologic pain control methods to an unprepared laboring woman is during which phase?

a.

Latent phase

b.

Active phase

c.

Transition phase

d.

Second stage

ANS: A

Feedback

A

The latent phase of labor is the best time for intrapartum teaching, because the woman is usually anxious enough to be attentive, yet comfortable enough to understand the teaching.

B

During the active phase, the woman is focused internally and unable to concentrate on teaching.

C

During transition, the woman is focused on keeping control; she is unable to focus on anyone else or learn at this time.

D

During the second stage, the woman is focused on pushing. She normally handles the pain better at this point because she is active in doing something to hasten the delivery.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 391

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

8. The nurse providing newborn stabilization must be aware that the primary side effect of maternal narcotic analgesia in the newborn is

a.

Respiratory depression

b.

Bradycardia

c.

Acrocyanosis

d.

Tachypnea

ANS: A

Feedback

A

An infant delivered within 1 to 4 hours of maternal analgesic administration is at risk for respiratory depression from the sedative effects of the narcotic.

B

Bradycardia is not the anticipated side effect of maternal analgesics.

C

Acrocyanosis is an expected finding in a newborn and is not related to maternal analgesics.

D

The infant who is having a side effect to maternal analgesics normally would have a decrease in respirations, not an increase.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 399 | Table 18-1

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

9. A woman received 50 mcg of Fentanyl intravenously 1 hour before delivery. What drug should the nurse have readily available?

a.

Promethazine (Phenergan)

b.

Nalbuphine (Nubain)

c.

Butorphanol (Stadol)

d.

Naloxone (Narcan)

ANS: D

Feedback

A

Phenergan is normally given for nausea.

B

Nubain is an analgesic given to women in labor.

C

Stadol is an analgesic given to women in labor.

D

Naloxone (Narcan) reverses narcotic-induced respiratory depression, which may occur with administration of narcotic analgesia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 408 | Table 18-2

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

10. The nerve block used in labor that provides anesthesia to the lower vagina and perineum is called a(n)

a.

Epidural

b.

Pudendal

c.

Local

d.

Spinal block

ANS: B

Feedback

A

An epidural provides anesthesia for the uterus, perineum, and legs.

B

A pudendal block anesthetizes the lower vagina and perineum to provide anesthesia for an episiotomy and use of low forceps if needed.

C

A local provides anesthesia for the perineum at the site of the episiotomy.

D

A spinal block provides anesthesia for the uterus, perineum, and down the legs.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 408 | Table 18-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

11. The most important nursing intervention after the injection of epidural anesthesia is monitoring

a.

Urinary output

b.

Contractions

c.

Maternal blood pressure

d.

Intravenous infusion rate

ANS: C

Feedback

A

The mother is prone to bladder distention and this needs to be monitored. However, this does not become a problem until 1 to 3 hours later.

B

Continuing monitoring of the contractions is important, because they may be altered by the epidural. However, this is not the most important nursing intervention after the epidural is administered.

C

Epidural anesthesia may produce maternal hypotension due to vasodilation.

D

The intravenous infusion needs to be maintained before, during, and after the epidural. However, it is not the most important nursing intervention at this point.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 409 | Table 18-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

12. Which statement is true about the physiologic effects of pain in labor?

a.

It usually results in a more rapid labor.

b.

It is considered to be a normal occurrence.

c.

It may result in decreased placental perfusion.

d.

It has no effect on the outcome of labor.

ANS: C

Feedback

A

Excessive pain may prolong the labor due to increase anxiety in the woman.

B

Pain is considered normal for labor. However, excessive pain may be an indication of other problems and must be assessed.

C

When experiencing excessive pain, the woman may react with a stress response that diverts blood flow from the uterus and the fetus.

D

It may affect the outcome of the labor depending on the cause and the effect on the woman.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 389

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

13. Which woman will most likely have increased anxiety and tension during her labor?

a.

Gravida 1 who did not attend prepared childbirth classes

b.

Gravida 2 who refused any medication

c.

Gravida 2 who delivered a stillborn baby last year

d.

Gravida 3 who has two children younger than 3 years

ANS: C

Feedback

A

The woman is not prepared for labor and will have increased anxiety during labor. However, the woman with a poor previous outcome is more likely to experience more anxiety.

B

A gravida 2 has previous experience and can anticipate what to expect. By refusing any medication, she is taking control over her situation and will have less anxiety.

C

If a previous pregnancy had a poor outcome, the woman will probably be more anxious during labor and delivery.

D

This gravida 3 has previous experience and is aware of what to expect.

PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 390-391

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

14. Which method of pain management is safest for a gravida 3 para 2 admitted at 8 cm cervical dilation?

a.

Epidural anesthesia

b.

Narcotics

c.

Spinal block

d.

Breathing and relaxation techniques

ANS: D

Feedback

A

Probably not enough time remains to administer epidural anesthesia.

B

A narcotic given at this time may reach its peak about the time of birth and result in respiratory depression in the newborn.

C

Probably not enough time remains to administer spinal anesthesia.

D

Nonpharmacologic methods of pain management may be the best option for a woman in advanced labor.

PTS: 1 DIF: Cognitive Level: Application REF: p. 392

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

15. The laboring woman who imagines her body opening to let the baby out is using a mental technique called

a.

Dissociation

b.

Effleurage

c.

Imagery

d.

Distraction

ANS: C

Feedback

A

Dissociation helps the woman learn to relax all muscles except those that are working.

B

Effleurage is self-massage.

C

Imagery is a technique of visualizing images that will assist the woman in coping with labor.

D

Distraction can be used in the early latent phase by having the woman involved in another activity.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 393

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

16. When giving a narcotic to a laboring woman, the nurse should inject the medication at the beginning of a contraction so that

a.

Full benefit of the medication is received during that contraction.

b.

Less medication will be transferred to the fetus.

c.

The medication will be rapidly circulated.

d.

The maternal vital signs will not be adversely affected.

ANS: B

Feedback

A

The full benefit will be received by the woman; however, it will decrease the amount reaching the fetus.

B

Injecting at the beginning of a contraction, when blood flow to the placenta is normally reduced, limits transfer to the fetus.

C

It will not increase the circulation of the medication.

D

It will not alter the vital signs any more than giving it at another time.

PTS: 1 DIF: Cognitive Level: Application REF: p. 401

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

17. The method of anesthesia in labor considered the safest for the fetus is the

a.

Pudendal block

b.

Epidural block

c.

Spinal (subarachnoid) block

d.

Local infiltration

ANS: D

Feedback

A

The fetus can be affected by maternal side effects.

B

The fetus can be affected by maternal hypotension.

C

The fetus can be affected by maternal side effects.

D

Local infiltration of the perineum rarely has any adverse effects on either the mother or the fetus.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 402

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

18. To improve placental blood flow immediately after the injection of an epidural anesthetic, the nurse should

a.

Turn the woman to the right side.

b.

Place a wedge under the womans right hip.

c.

Give the woman oxygen.

d.

Decrease the intravenous infusion rate.

ANS: B

Feedback

A

The woman needs to maintain the supine position for proper dispersal of the medication. However, placing a wedge under the hip will relieve compression of the vena cava.

B

Tilting the womans pelvis to the left side relieves compression of the vena cava and compensates for a lower blood pressure without interfering with dispersal of the epidural medication.

C

Oxygen administration will not improve placental blood flow.

D

The intravenous infusion rate needs to be increased to prevent hypotension.

PTS: 1 DIF: Cognitive Level: Application REF: p. 409 | Table 18-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

19. The most important nursing intervention for the patient who has received an epidural narcotic is

a.

Monitoring respiratory rate hourly

b.

Administering analgesics as needed

c.

Monitoring blood pressure every 4 hours

d.

Assessing the level of anesthesia

ANS: A

Feedback

A

The possibility of respiratory depression exists for up to 24 hours after administration of an epidural narcotic.

B

Epidural narcotic should be enough pain relief that further medication is not necessary. Administering any other narcotic may cause an overdose.

C

The patients blood pressure needs to be monitored. However, that is not the major concern with this medication.

D

The epidural narcotic should provide pain relief, but not anesthesia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 409 | Table 18-2

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

20. One of the greatest risks to the mother during administration of general anesthesia is

a.

Respiratory depression

b.

Uterine relaxation

c.

Inadequate muscle relaxation

d.

Aspiration of stomach contents

ANS: D

Feedback

A

Respirations can be altered during general anesthesia, and the anesthesiologist will take precautions to maintain proper oxygenation.

B

Uterine relaxation can occur with some anesthesia, but this can be monitored and prevented.

C

Inadequate muscle relaxation can be altered. This is not the greatest risk for the mother.

D

Aspiration of acidic gastric contents and possible airway obstruction is a potentially fatal complication of general anesthesia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 407

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

21. To provide optimal care to the intrapartum woman, the nurse understands that the least favorable maternal position for labor is

a.

Supine

b.

Sitting

c.

Lying on the side

d.

Standing

ANS: A

Feedback

A

The supine position allows the heavy uterus to compress the inferior vena cava and can reduce placental blood flow, compromising fetal oxygen supply.

B

The sitting position allows gravity to assist in the descent of the fetus.

C

The side-lying position is comfortable for most mothers, and it allows for adequate placental blood flow.

D

Standing and walking may be comfortable for some women. This does not prevent adequate placental blood flow and can be encouraged if there are no other contraindications.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 404

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

22. A newborn infant weighing 8 lb (3632 g) needs naloxone (Narcan). This infant should receive approximately _____ mg.

a.

0.36

b.

3.6

c.

0.03

d.

0.3

ANS: A

Feedback

A

The recommended neonatal dose of naloxone is 0.1 mg/kg.

B

This dose is too large for this infant.

C

This dose is too small and would not be effective.

D

This dose is too small.

PTS: 1 DIF: Cognitive Level: Application REF: p. 399 | Table 18-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

23. To assist the woman after delivery of the infant, the nurse knows that the blood patch is used after spinal anesthesia to relieve

a.

Hypotension

b.

Headache

c.

Neonatal respiratory depression

d.

Loss of movement

ANS: B

Feedback

A

Hypotension is prevented by increasing fluid volume before the procedure.

B

The subarachnoid block may cause a postspinal headache due to loss of cerebrospinal fluid from the puncture in the dura. When blood is injected into the epidural space in the area of the dural puncture, it forms a seal over the hole to stop leaking of cerebrospinal fluid.

C

Neonatal respiratory depression is not an expected outcome with spinal anesthesia.

D

Loss of movement is an expected outcome of spinal anesthesia.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 409 | Table 18-2

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

24. What is the first type of breathing technique used in labor?

a.

Slow-paced

b.

Modified-paced

c.

Patterned-paced

d.

Pant-blow

ANS: A

Feedback

A

Breathing for the first stage of labor consists of a cleansing breath and various breathing techniques known as paced breathing. The first type used in labor is the slow-paced.

B

Modified-paced breathing is used when the slow-paced breathing is no longer effective.

C

Patterned-paced breathing is used later in the labor and has the woman focusing on a pattern of breathing.

D

Pant-blow breathing can be used to prevent pushing before the cervix is completely dilated.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 394

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

25. When instructing the woman in early labor, the nurse teaches her that an important aspect of proper breathing technique is

a.

Breathing no more than three times the normal rate

b.

Beginning and ending with a cleansing breath

c.

Holding the breath no longer than 10 seconds

d.

Adhering exactly to the techniques as they were taught

ANS: B

Feedback

A

It is important to prevent hyperventilation; however, the cleansing breaths are the most important aspect of the breathing techniques.

B

The cleansing breath helps the woman clear her mind to focus on relaxing and signals the coach that the contraction is beginning or ending.

C

The woman should hold her breath for no more than 6 to 8 seconds.

D

The woman needs to be flexible and change her breathing techniques as needed to keep her comfortable.

PTS: 1 DIF: Cognitive Level: Application REF: p. 394

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

26. Which patient is most likely to experience pain during labor?

a.

Gravida 2 who has not attended childbirth preparation classes

b.

Gravida 2 who is anxious because her last labor was difficult

c.

Gravida 1 whose fetus is in a breech presentation

d.

Gravida 3 who is using Lamaze breathing techniques

ANS: B

Feedback

A

The gravida 2 has previous experience and this will decrease anxiety.

B

Anxiety affects a womans perception of pain. Tension during labor causes tightening of abdominal muscles, impeding contractions, and increasing pain by stimulation of nerve endings.

C

This woman will have more pain than if the infant is in vertex. Also, there is an increased likelihood that she will have a cesarean section and not go through labor.

D

The gravida 3 has previous experience and has prepared herself for the labor.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 391

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

27. Which type of cutaneous stimulation involves massage of the abdomen?

a.

Thermal stimulation

b.

Imagery

c.

Mental stimulation

d.

Effleurage

ANS: D

Feedback

A

Thermal stimulation is the use of warmth to provide comfort, such as showers and baths.

B

Imagery involves the woman creating a relaxing mental scene and dissociating herself from the painful aspects of labor.

C

Mental stimulation occupies the womans mind and competes with pain stimuli.

D

Effleurage is massage usually performed on the abdomen during contractions.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 392

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

28. Which intervention may be most helpful for the patient experiencing most of her labor pain in her back?

a.

Lying supine with head slightly elevated

b.

Having the support person apply firm pressure to the sacrum

c.

Sitting upright with the legs straight

d.

Having the nurse massage the upper back during a contraction

ANS: B

Feedback

A

This would put more pressure onto the lower back area and decrease placental profusion.

B

Firm pressure against the sacrum may be helpful in relieving the discomfort associated with back labor.

C

This position would put more pressure onto the lower back area.

D

The massage should be in the lower back where the pain is located.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 393

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

29. Which technique could the support person use when the laboring woman appears to be losing control?

a.

Have the nurse take over the role of support.

b.

Tell the woman that she is causing stress to her baby and herself.

c.

Wait for the contraction to end and discuss the problem with her.

d.

Make eye contact with the woman and breathe along with her.

ANS: D

Feedback

A

The woman already has a trusting relationship with the support person so they should stay in that position if possible.

B

Imagery involves the woman creating a relaxing mental scene and dissociating herself from the painful aspects of labor.

C

Mental stimulation occupies the womans mind and competes with pain stimuli.

D

Making eye contact and breathing along with the laboring woman to help pace her breathing will assist her in remaining calm.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 394-395

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. While developing an intrapartum care plan for the patient in early labor, it is important that the nurse recognize that psychosocial factors may influence a womans experience of pain. These include (select all that apply)

a.

Culture

b.

Anxiety and fear

c.

Previous experiences with pain

d.

Intervention of caregivers

e.

Support systems

ANS: A, B, C, E

Feedback

Correct

Culture: a womans sociocultural roots influence how she perceives, interprets, and responds to pain during childbirth. Some cultures encourage loud and vigorous expressions of pain, whereas others value self-control. The nurse should avoid praising some behaviors (stoicism) while belittling others (noisy expression). Anxiety and fear: extreme anxiety and fear magnify sensitivity to pain and impair a womans ability to tolerate it. Anxiety and fear increase muscle tension in the pelvic area, which counters the expulsive forces of uterine contractions and pushing efforts. Previous experiences with pain:fear and withdrawal are a natural response to pain during labor. Learning about these normal sensations ahead of time helps a woman suppress her natural reactions of fear regarding the impending birth. If a woman previously had a long and difficult labor, she is likely to be anxious. She may also have learned ways to cope and may use these skills to adapt to the present labor experience. Support systems: an anxious partner is less able to provide help and support to a woman during labor. A womans family and friends can be an important source of support if they convey realistic and positive information about labor and delivery.

Incorrect

Although this may be necessary for the well-being of the woman and her fetus, some interventions add discomfort to the natural pain of labor (i.e., fetal monitor straps).

PTS: 1 DIF: Cognitive Level: Application REF: pp. 390-391

OBJ: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

2. The nurse is caring for a laboring patient who develops a fever after she has had her epidural initiated. Fever with no apparent infection may occur in women who have epidural analgesia. The neonates temperature may be elevated as well, possibly leading to unnecessary treatment for neonatal sepsis. Possible explanations for epidural associated fever without infection include (select all that apply)

a.

Bladder distention

b.

Maternal hypotension

c.

Reduction of heat dissipation

d.

Vasodilation

e.

Shivering

ANS: C, D, E

Feedback

Correct

Heat dissipation is reduced as a result of decreased hyperventilation, sweating, and activity after the onset of pain relief. Vasodilation redistributes heat from the core to the periphery of the body, where it is lost to the environment. Shivering often occurs with sympathetic blockade accompanied by a dissociation between warm and cold sensations. In essence, the body believes that the temperature is lower than it actually is and turns up the thermostat.

Incorrect

Bladder distention is an anticipated effect of having an epidural. A womans bladder fills quickly because of the large quantity of IV solution, yet her sensation to void is reduced. Maternal hypotension is an expected side effect of epidural initiation.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 398

OBJ: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity

COMPLETION

1. Today the pregnant woman has a number of non-pharmacologic 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.

PTS: 1 DIF: Cognitive Level: Application REF: p. 393

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

2. Many methods of nonpharmacologic pain control become less effective after prolonged use. This is a process called _________.

ANS:

habituation

Offering a variety of techniques counters the effects of habituation. The nurse who understands how to apply a number of methods of pain relief can select those that will be most helpful to the individual woman in labor.

PTS: 1 DIF: Cognitive Level: Application REF: p. 391

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

TRUE/FALSE

1. The Joint Commission has recognized that pain management is an essential part of care in all health care settings. Since many women may desire an un-medicated birth, the pain management standards set by The Joint Commission do not apply in a labor setting. Is this statement true or false?

ANS: F

The nurse must still evaluate the patients level of pain and discuss nonpharmacologic comfort interventions that may be part of her birth plan. The patient has the right to effective pain management and must be competently and routinely assessed and managed. The woman may also change her plan for pain management as her labor progresses. Education of the woman and her family regarding postpartum pain control must also be included in her discharge teaching.

PTS: 1 DIF: Cognitive Level: Application REF: p. 391

OBJ: Nursing Process: Evaluation

MSC: Client Needs: Safe and Effective Care Environment

2. The use of hydrotherapy is an important nonpharmacologic modality to promote relaxation in labor. The nurse should offer the woman in labor a warm bath or shower (if no contraindications exist). The mild nipple stimulation that occurs in the water may intensify her contractions. Is this statement true or false?

ANS: T

Especially in a woman whose labor has slowed, the nipple stimulation will cause her posterior pituitary gland to secrete oxytocin. The release of this hormone may intensify labor contractions.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 393 | Box 18-1

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

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