Chapter 16 Flashcards
An 18-year-old pregnant woman, gravida 1, is admitted to the labour and birth unit with moderate contractions every 5 minutes that last 40 seconds. The woman states, “My contractions are so strong that I don’t know what to do.” What should the nurse do?
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
Each woman’s pain during childbirth is unique and is influenced by a variety of physiological, psychosocial, and environmental factors. A critical issue for the nurse is how support can make a difference in the pain of the woman during labour and birth. Assessing for fetal well-being includes no information that would indicate fetal distress or a logical reason to be overly concerned about the well-being of the fetus. The left lateral position is used to alleviate fetal distress, not maternal stress. The nurse has an obligation to provide physical, emotional, and psychosocial care and support to the labouring woman. This patient clearly needs support.
Nursing care measures are commonly offered to women in labour. Which nursing measure reflects application of the gate-control theory?
a. Massaging the woman’s back
b. Changing the woman’s position
c. Giving the prescribed medication
d. Encouraging the woman to rest between contractions
ANS: A
According to the gate-control theory, pain sensations travel along sensory nerve pathways to the brain, but 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 hypothetical gate in the spinal cord, thus preventing pain signals from reaching the brain. The perception of pain is thereby diminished. Changing the woman’s position, giving prescribed medication, and encouraging rest do not reduce or block the capacity of nerve pathways to transmit pain, according to the gate-control theory
A woman in active labour receives an analgesic, an opioid agonist. Which medication relieves severe, persistent, or recurrent pain; creates a sense of well-being; overcomes inhibitory factors; and may even relax the cervix but should be used cautiously in women with cardiac disease?
a. Meperidine (Demerol)
b. Promethazine (Phenergan)
c. Sufentanil citrate (Sufenta)
d. Nalbuphine (Nubain)
ANS: A Sufentanil citrate (Sufenta) is becoming the most commonly used opioid agonist analgesic for women in labour. Meperidine hydrochloride (Demerol) used to be the most commonly used opioid agonist analgesic for women in labour, but it is no longer the preferred choice because other medications have fewer adverse effects. Phenergan is an ataractic (tranquilizer) that may be used to augment the desirable effects of the opioid analgesics but has few of the undesirable effects of those drugs. Nubain is an opioid agonist-antagonist analgesic.
A labouring woman received fentanyl citrate (Sublimaze) intravenously 90 minutes before she gave birth. Which medication should be available to reduce the postnatal effects of Sublimaze on the neonate?
a. Meperidine (Demerol)
b. Promethazine (Phenergan)
c. Naloxone (Narcan)
d. Nalbuphine (Nubain)
ANS: C
An opioid antagonist can be given to the newborn as one part of the treatment for neonatal narcosis, which is a state of central nervous system (CNS) depression in the newborn produced by an opioid. Opioid antagonists such as naloxone (Narcan) can promptly reverse the CNS depressant effects, especially respiratory depression. Demerol is no longer recommended for use in Canada. Promethazine and nalbuphine do not act as opioid antagonists to reduce the postnatal effects of Sublimaze on the neonate.
A woman in labour has just received an epidural block. What is the most important nursing intervention?
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
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. Intravenous fluids are increased for a woman receiving an epidural to prevent hypotension. The nurse observes for signs of fetal bradycardia. The nurse monitors for signs of maternal tachycardia secondary to hypotension.
The nurse should be aware that a plan to achieve adequate pain relief without maternal risk is most effective if which of the following occurs?
a. The mother gives birth without any analgesic or anaesthetic.
b. The mother and family’s priorities and preferences are incorporated into the plan.
c. The primary health care provider determines the best pain relief for the mother and family.
d. The nurse informs the family of all alternative methods of pain relief available in the hospital setting.
ANS: B
The assessment of the woman, her fetus, and her labour is a joint effort of the nurse and the primary health care providers, who consult with the woman about their findings and recommendations. The needs of each woman are different, and many factors must be considered before a decision is made whether pharmacological methods, nonpharmacological methods, or a combination of the two will be used to manage labour pain.
A woman in the active phase of the first stage of labour 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. What should the nurse do?
a. Notify the woman’s 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
This woman is experiencing the side effects of hyperventilation, which include the symptoms of lightheadedness, 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.
A woman is experiencing intense labour pain in her lower back. Which would be an effective relief measure for this woman?
a. Counterpressure against the sacrum
b. Pant-blow (breaths and puffs) breathing techniques
c. Effleurage
d. Conscious relaxation or guided imagery
ANS: A
Counterpressure is steady pressure applied by a support person to the sacral area with the fist or heel of the hand. This technique helps the woman cope with the sensations of internal pressure and pain in the lower back. The pain management techniques of pant-blow and conscious relaxation or guided imagery are usually helpful for contraction per the gate-control theory. Effleurage is helpful as a method of distraction.
What should the labouring woman be taught if she is receiving an opioid antagonist?
a. Her pain will decrease.
b. Her pain will return.
c. She will feel less anxious.
d. She will no longer feel the urge to push.
ANS: B
The woman should be told that the pain that was relieved by the opioid analgesic will return with administration of the opioid antagonist. Opioid antagonists, such as Narcan, promptly reverse the central nervous system (CNS) depressant effects of opioids. In addition, the antagonist counters the effect of the stress-induced levels of endorphins. An opioid antagonist is especially valuable if labour is more rapid than expected and birth is anticipated when the opioid is at its peak effect.
Women who receive an epidural during labour are at an increased risk for which of the following?
a. Hypertension
b. Hyperthermia
c. Decreased oxytocin requirements
d. Decreased oxygen requirements
ANS: B
The patient receiving an epidural is at risk of hyperthermia. The patient is also at risk for hypotension, not hypertension. There is an increased oxytocin requirement with an epidural. There is an increased oxygen requirement with an epidural.
Which of the following reflects the role of the nurse with regard to informed consent?
a. Inform the patient about the procedure and have her sign the consent form.
b. Act as a patient advocate and provide clarification.
c. Call the physician to see the patient.
d. Witness the signing of the consent form.
ANS: B
Nurses play a part in the informed consent process by clarifying and describing procedures or by acting as the woman’s advocate and asking the primary health care provider for further explanations. The physician is responsible for informing the woman of her options, explaining the procedure, and advising the patient about potential risk factors. The physician must be present to explain the procedure to the patient. However, the nurse’s responsibilities go further than simply asking the physician to see the patient
A first-time mother is concerned about the type of medications she will receive during labour. 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 for which of the following reasons?
a. “The two together work 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
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. A potentiator may cause the two drugs to work together more effectively, but it does not ensure maternal or fetal complications. 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 labour and birth. “This is what the doctor has ordered for you” may be true, but it is not an acceptable comment for the nurse to make.
To help patients manage discomfort and pain during labour, nurses should be aware of which of the following?
a. The predominant pain of the first stage of labour 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 labour is more generalized and related to fatigue.
d. Pain during the third stage is a somewhat milder version of the second stage.
ANS: A
This pain comes from cervical changes, distension of the lower uterine segment, and uterine ischemia. 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. Second-stage labour pain is intense, sharp, burning, and localized. Third-stage labour pain is similar to that of the first stage
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 labour 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 β-endorphins are higher during a spontaneous, natural childbirth.
ANS: D
Higher endorphin levels help women tolerate pain and reduce anxiety and irritability. Higher prostaglandin levels correspond to more severe labour pains. Upright positions in labour usually result in improved comfort and less pain. Moving freely to find a more comfortable position is important for reducing pain and muscle tension
Nurses with an understanding of cultural differences regarding likely reactions to pain are better able to help patients. Women from which of the following ethnic groups would be most likely to be stoic in response to labour pain?
a. Chinese women
b. Arab or Middle Eastern women
c. First Nations women
d. African-Canadian women
ANS: C
First Nations women are often stoic in response to labour pain. Chinese women may not show reactions to pain. Medical interventions must be offered more than once. Arab or Middle Eastern women may be vocal in response to labour pain from the start. They may prefer pain medications. African-Canadian women may express pain openly; use of medications for pain is more likely to vary with the individual.
