Chapter 7: Nursing Management of Pain During Labor and Birth My Nursing Test Banks

Chapter 7: Nursing Management of Pain During Labor and Birth

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. While teaching the child birth preparation class, the nurse explains to the class that labor pains:

a.

Lower a womans tolerance for pain

b.

Are intensified by the vertex position of the fetus

c.

Are influenced by cultural factions

d.

Can be completely controlled by nonpharmacological techniques

ANS: C

Several psychosocial factors alter a womans experience during labor. These variables interrelate with one another and with physical factors. The vertex position is the normal position and does not increase pain. Pain is an integral part of labor and cannot be completely eliminated by any means.

DIF: Cognitive Level: Knowledge REF: Text Reference: 158

OBJ: Objective: 2 TOP: Topic: Factors That Influence Labor Pain

KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. Chemical substances produced in the body that act as natural pain relievers are:

a.

Endorphins

b.

Morphine

c.

Codeine

d.

Atropine

ANS: A

Endorphins are natural body substances that are similar to morphine.

DIF: Cognitive Level: Knowledge REF: Text Reference: 158

OBJ: Objective: 2 TOP: Topic: Factors that Influence Labor Pain

KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. A nurse instructs a womans labor coach to comfort her by firmly pressing on her lower back. This technique is called:

a.

Sacral pressure

b.

Distraction

c.

Effleurage

d.

Conscious relaxation

ANS: A

Sacral pressure refers to firm pressure against the lower back to relieve some of the pain of back labor.

DIF: Cognitive Level: Comprehension REF: Text Reference: 160

OBJ: Objective: 7 TOP: Topic: Nonpharmacological Pain Management

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

4. A woman who is 6 cm dilated has the urge to push. The nurse would instruct the woman to:

a.

Use slow-paced breathing during the contraction

b.

Hold her breath and push during the contraction

c.

Blow in short breaths during the contraction

d.

Use rapid-paced breathing during the contraction

ANS: C

If a laboring woman feels the urge to push before the cervix is fully dilated, then she is taught to blow in short breaths to avoid bearing down.

DIF: Cognitive Level: Analysis REF: Text Reference: 160-161

OBJ: Objective: 7 TOP: Topic: Nonpharmacological Pain Management

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. Several hours into labor, a woman complains of blurred vision, numbness, and tingling of her hands and mouth. The nurse recognizes these as symptoms of:

a.

Hypertension

b.

Anxiety

c.

Anoxia

d.

Hyperventilation

ANS: D

Hyperventilation is sometimes a problem if a woman is breathing rapidly.

DIF: Cognitive Level: Analysis REF: Text Reference: 161, Box 7-3

OBJ: Objective: 5 TOP: Topic: Nonpharmacological Pain Management

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

6. The appropriate nursing action to take when a laboring woman hyperventilates is to:

a.

Help her breathe into her cupped hands

b.

Place her flat on her back

c.

Initiate oxygen at 2 liters via a mask

d.

Notify the doctor

ANS: A

Measures to combat hyperventilation include breathing into cupped hands or a paper bag.

DIF: Cognitive Level: Application REF: Text Reference: 163

OBJ: Objective: 7 TOP: Topic: Nonpharmacological Pain Management

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

7. A woman in the transition phase of labor requests a narcotic analgesic medication for pain relief. The nurse explains that giving a narcotic analgesic medication at this stage of labor will:

a.

Cause medication given at later stages ineffective

b.

Have no complications for the mother or baby

c.

Result in respiratory depression to the newborn

d.

Speed up labor and increase pain

ANS: C

The risk of narcotic analgesics is that they cross the placenta and can cause the infants breathing to be sluggish. This is most likely if the drug is administered shortly before birth.

DIF: Cognitive Level: Analysis REF: Text Reference: 163

OBJ: Objective: 8 TOP: Topic: Pharmacological Pain Management

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

8. To comfort a woman who is tensing her muscles with contractions, the nurse would guide the labor coach to:

a.

Offer warm liquids to the patient

b.

Encourage patient to pant

c.

Engage the patient in conversation

d.

Direct the patient in progressive relaxation

ANS: D

Promoting relaxation underlies nonpharmacological and pharmacological techniques for pain relief. The nurse or labor coach can help the woman relax her muscles when they become tense.

DIF: Cognitive Level: Application REF: Text Reference: 157, Box 7-2

OBJ: Objective: 7 TOP: Topic: Nonpharmacological Pain Management

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. After the physician discussed general anesthesia with a woman in labor, the nurse determines the woman understood the explanation when she says food and fluids are restricted for several hours prior to delivery to prevent:

a.

Nausea and vomiting

b.

Vomiting and aspiration

c.

Abdominal cramping

d.

Abdominal obstruction

ANS: B

The major adverse side effect of general anesthesia is aspiration of stomach contents.

DIF: Cognitive Level: Analysis REF: Text Reference: 164, Table 7-2, 167

OBJ: Objective: 8 TOP: Topic: Pharmacological Pain Management-General Anesthesia

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

10. The initial nursing action immediately after an epidural block is initiated for a laboring woman would be to:

a.

Palpate the bladder for distention

b.

Measure the womans blood pressure

c.

Assess sensation in the lower extremities

d.

Decrease intravenous fluid flow rate

ANS: B

Blood pressure is checked every 5 minutes when the epidural block is first begun.

DIF: Cognitive Level: Application REF: Text Reference: 164, Table 7-2, 165

OBJ: Objective: 8 TOP: Topic: Pharmacological Pain Management-Epidural Block

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

11. A woman in labor has had an epidural block for pain relief. The nurse will be assessing carefully for the associated side effect of:

a.

Drop in fetal heart rate

b.

Long, intense contractions

c.

Sudden leg cramps

d.

Marked hypotension

ANS: D

The most common side effect of an epidural block is maternal hypotension.

DIF: Cognitive Level: Analysis REF: Text Reference: 164, Table 7-2,165

OBJ: Objective: 8 TOP: Topic: Pharmacological Pain Management-Epidural Block

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

12. A narcotic antagonist used to reverse narcotic-induced respiratory depression is:

a.

Hydroxyzine (Vistaril)

b.

Phenobarbital

c.

Naloxone (Narcan)

d.

Nitrous oxide

ANS: C

Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics.

DIF: Cognitive Level: Knowledge REF: Text Reference: 163

OBJ: Objective: 7 TOP: Topic: Pharmacological Pain Management

KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Reduction of Risk

13. A woman received a subarachnoid block before delivery. In order to prevent the associated side effect of this type of anesthesia, the nurse would include in the teaching plan that the patient should:

a.

Restrict oral fluids

b.

Keep legs flexed

c.

Walk with assistance as soon as possible

d.

Lie flat on her back for several hours

ANS: D

The woman would be advised to remain flat for several hours after the block to decrease the chance of postspinal headache.

DIF: Cognitive Level: Application REF: Text Reference: 167

OBJ: Objective: 7 TOP: Topic: Pharmacological Pain Management

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk

14. A woman requests a pudendal block to manage her labor pain. The nurse realizes that the woman needs further explanation about the pudendal block when she says:

a.

Im having a contraction. Can I get the pudendal block now?

b.

Ill get the pudendal block right before I deliver.

c.

The nurse midwife will insert the needles into my vagina.

d.

It takes a few minutes after the medicine is administered to make me feel numb.

ANS: A

The pudendal block does not block pain from contractions and is given just before birth.

DIF: Cognitive Level: Application REF: Text Reference: 164, Table 7-2, 165

OBJ: Objective: 7 TOP: Topic: Pharmacological Pain Management

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

15. An 18-year-old primigravida is 4 cm dilated and her contractions are 5 minutes apart. She received little prenatal care. She had no childbirth preparation. She is crying loudly and shouting, Please give me something for the pain. I cant take the pain. What is the priority nursing diagnosis?

a.

Pain related to uterine contractions

b.

Knowledge deficit related to the birth experience

c.

Ineffective coping related to inadequate preparation for labor

d.

Risk for injury related to lack of prenatal care

ANS: A

The most important issue for this woman, at this time, is effective pain management.

DIF: Cognitive Level: Analysis REF: Text Reference: 168

OBJ: Objective: 2 TOP: Topic: Childbirth and Pain

KEY: Nursing Process Step: Nursing Diagnosis

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

16. The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management?

a.

Slow abdominal breathing

b.

Guided relaxation

c.

Listening to music

d.

Massage

ANS: D

According to the gate control theory, stimulating large-diameter nerve fibers temporarily interferes with conduction of impulses through small-diameter fibers. Massage is a technique that stimulates large-diameter fibers and closes the gate.

DIF: Cognitive Level: Analysis REF: Text Reference: 159

OBJ: Objective: 2 TOP: Topic: Factors That Influence Pain

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

17. When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an epidural for delivery. The nurse is aware that the factor that would be a contraindication to an epidural block is:

a.

A low platelet count

b.

Previous cesarean delivery

c.

A history of migraine headaches

d.

A history of diabetes mellitus

ANS: A

An epidural block is not used if a woman has abnormal blood clotting.

DIF: Cognitive Level: Application REF: Text Reference: 164, Table 7-2

OBJ: Objective: 6 TOP: Topic: Epidural Block

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

18. The nurse coaches the primigravida not to bear down until the cervix is completely dilated because premature bearing down can cause:

a.

Increased use of oxygen

b.

Cervical laceration

c.

Uterine rupture

d.

Compression of the cord

ANS: B

Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix.

DIF: Cognitive Level: Application REF: Text Reference: 161

OBJ: Objective: 6 TOP: Topic: Cervical Laceration

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

19. The nurse explains that the Dick-Read method of childbirth preparation is based on:

a.

Mild sedation throughout labor

b.

Relaxation techniques

c.

Slow abdominal breathing

d.

Deep massage

ANS: B

The Dick-Read method depends on the use of relaxation techniques to reduce the discomforts of labor.

DIF: Cognitive Level: Comprehension REF: Text Reference: 159

OBJ: Objective: 4 TOP: Topic: Dick-Read Method

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

20. The nurse who is instructing a Lamaze class on abdominal breathing tells a patient that because her baseline respiratory rate is 22, her rate while performing slow breathing should be no lower than:

a.

9

b.

10

c.

15

d.

20

ANS: B

The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate.

DIF: Cognitive Level: Comprehension REF: Text Reference: 159

OBJ: Objective: 4 TOP: Topic: Lamaze Method

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

1. The nurse discussing nonpharmacological forms of pain relief will focus on methods of:

Select all that apply.

a.

Skin stimulation

b.

Diversion and distraction

c.

Breathing techniques

d.

Exercise

e.

Yoga

ANS: A, B, C

Skin stimulation, diversion and distraction, and breathing techniques are the bases of nonpharmacological pain control. Although exercise and such practices as yoga and Pilates are beneficial, they are not means of pain control.

DIF: Cognitive Level: Application REF: Text Reference: 156

OBJ: Objective: 7 TOP: Topic: Nonpharmacological pain control

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

2. The nurse encourages the women in the childbirth preparation class to practice various positions and exercises that will be beneficial in combating discomfort in the later stages of pregnancy. Those exercises are:

Select all that apply.

a.

Leg lifts

b.

Pelvic rock

c.

Tailor sitting

d.

Sit-ups

e.

Shoulder curling

ANS: B, C, E

Pelvic rock, tailor sitting, and shoulder curling are beneficial to the muscles that will have to adapt to the extra weight and changed posture of later pregnancy. Leg lifts and sit-ups are not beneficial because they both increase intraabdominal pressure.

DIF: Cognitive Level: Application REF: Text Reference: 156

OBJ: Objective: 4 TOP: Topic: Helpful Exercises

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse points out that the major advantages of nonpharmacological pain control methods are that they do not:

Select all that apply.

a.

Sedate the mother

b.

Slow labor

c.

Dull the excitement of the birth experience

d.

Have allergy potential

e.

Have to be delayed until labor is well established

ANS: A, B, C, D, E

All the options mentioned are benefits of nonpharmacological pain control methods.

DIF: Cognitive Level: Application REF: Text Reference: 159

OBJ: Objective: 6 TOP: Topic: Advantages of Nonpharmacological Pain Control

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION

1. The nurse clarified that the amount of pain a person is willing to endure is referred to as _____ ______________.

ANS: pain tolerance

DIF: Cognitive Level: Comprehension REF: Text Reference: 156

OBJ: Objective: 2 TOP: Topic: Pain Tolerance

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

NOT: Rationale: Pain tolerance is the amount of pain a person is willing to endure. Pain threshold is the point at which pain is perceived. Pain threshold is relatively consistent from person to person, but pain tolerance differs greatly.

2. The massage technique that stimulates the large-diameter fibers in order to block impulses from the small-diameter fibers is ____________________.

ANS: effleurage

DIF: Cognitive Level: Comprehension REF: Text Reference: 159

OBJ: Objective: 6 TOP: Topic: Effleurage

KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

NOT: Rationale: Effleurage stimulates the large-diameter fibers and blocks the pain impulses from the small-diameter fibers.

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