Unit 3 Module 4 Labor A&A (Exam 3) Flashcards by Kimberly Diane Hill

What fetal position is associated with a more difficult delivery?
A. Occiput Anterior
B. Occiput Posterior
C. Occiput Transverse
D. Occiput Superior

B. Occiput Posterior

The back of the baby’s head is facing the spine aka “sunny side up”

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Which of the following is the preferred fetal position for delivery?
A. Occiput Superior
B. Occiput Posterior
C. Occiput Anterior
D. Occiput Transverse

C. Occiput Anterior

The back of the baby’s head is facing the anterior abdomen

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AROM is best defined as:
A. Amniotic rupture of muscle
B. Artificial rupture of membranes
C. Acute rupture of membranes
D. Abnormal rupture of membranes

B. Artificial rupture of membranes

“Amniotomy”

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What does the acronym SROM stand for?
A. Surgical rupture of membranes
B. Scheduled rupture of membranes
C. Sudden release of mucus plug
D. Spontaneous rupture of membranes

D. Spontaneous rupture of membranes

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New Terminology Matching

Example: G2 P0101
Gravida (pregnancies) and then the numbers after the Para you have TPAL

A → 2 Term >37wks

B → 1 Preterm <37wks

C → 3 Abortions (Miscarriage or other loss)

D → 4 Living Children

Therefore a G2 P0101 = G2 pregnancies, P = 0 term births, 1 preterm, 0 abortions and 1 living child

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What does G4 P2102 indicate?
A. 4 pregnancies, 2 term births, 1 preterm, 0 abortions, 2 living children
B. 4 pregnancies, 2 term births, 1 abortion, 0 preterm, 2 living children
C. 4 pregnancies, 1 term birth, 2 preterm, 0 abortions, 2 living children

A. 4 pregnancies, 2 term births, 1 preterm, 0 abortions, 2 living children

Gravida, Para = (Term, Preterm, Abortions, Living)

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Which of the following is a function of intact amniotic membranes?
A. Stimulates uterine contractions
B. Allows oxygen exchange to the fetus
C. Prevents maternal weight gain
D. Protects uterine contents from bacteria

D. Protects uterine contents from bacteria

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What is one major risk if the amniotic sac remains ruptured for more than 12 hours?
A. Chorioamnionitis
B. Protection of the fetus
C. Normal birth
D. OP presentation of fetus

A. Chorioamnionitis

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What is the typical duration of the first stage of labor for a primiparous patient?
A. 2–4 hours
B. 5–8 hours
C. 8–12 hours
D. 12–16 hours

C. 8–12 hours

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What is the typical duration of the first stage of labor for a multiparous patient?
A. 2–4 hours
B. 5–8 hours
C. 8–12 hours
D. 10–14 hours

B. 5–8 hours

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First stage - Latent phase

Which of the following statements is TRUE regarding the latent phase of labor?
A. It begins after the cervix is fully dilated
B. It includes rapid fetal descent and minor dilation
C. It involves minor cervical dilation and effacement
D. It involves effacement and rapid fetal dscent

C. It involves minor cervical dilation and effacement (cervical thinning out)

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Which of the following best describes cervical dilation during the first stage - latent phase of labor?
A. 0–1 cm
B. 2–4 cm
C. 5–7 cm
D. 8–10 cm

B. 2–4 cm

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In the first stage of labor, the latent phase is characterized by:
Select 2
A. Contractions every 8-10min
B. Contraction duration of 30–40 seconds
C. Cervical dilation from 4 to 7 cm
D. Contraction duration of 30-60 seconds
E. Contractions every 5-7min

B. Contractions lasting 30–40 seconds
E. Contractions every 5-7min

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First Stage - Active Phase

What cervical dilation range defines the active phase of labor?
A. 0–2 cm
B. 2–4 cm
C. 4–6 cm
D. Up to 10 cm

D. Up to 10 cm (complete)

Cervical dilation ‘ramps up’

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Which of the following contraction patterns is consistent with the active phase?
A. Every 10–15 minutes, lasting 20 seconds
B. Every 5–7 minutes, lasting 30–40 seconds
C. Every 2–5 minutes, lasting 50–70 seconds
D. Every 60seconds, lasting 2 minutes

C. Every 2–5 minutes, lasting 50–70 seconds

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Second stage

What is the typical duration range of the second stage of labor?
A. 5–60 minutes
B. 15–120 minutes
C. 2–6 hours
D. 30–180 minutes

B. 15–120 minutes

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Which of the following marks the beginning of the second stage of labor?
A. Delivery of the placenta
B. Cervical dilation of 4 cm
C. Full cervical dilation to 10 cm
D. Rupture of membranes

C. Full cervical dilation to 10 cm

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During the second stage of labor, how often do contractions typically occur and how long do they last?
A. Every 5.5–7 minutes, lasting 30–40 seconds
B. Every 3–4.5 minutes, lasting 40–60 seconds
C. Every 2–3.5 minutes, lasting 50–70 seconds
D. Every 1.5–2 minutes, lasting 60–90 seconds

D. Every 1.5–2 minutes, lasting 60–90 seconds

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Which of the following occurs during the second stage of labor?
A. Cervical effacement
B. Fetal descent
C. Formation of the mucus plug
D. Placental separation

B. Fetal descent through the birth canal

Ace Ventura pet detective :)

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The second stage of labor ends with:
A. Full cervical dilation
B. Expulsion of the placenta
C. Delivery of the fetus
D. Onset of active labor

C. Delivery of the fetus

Pushing only happens once the cervix is completely dilated!

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When is the second stage of labor considered prolonged?
A. If it lasts longer than 1-2 hour
B. If it lasts longer than 2-3 hours
C. If it lasts longer than 3–4 hours
D. If it lasts longer than 5-6 hours

C. If it lasts longer than 3–4 hours

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Which of the following are risks associated with a prolonged second stage of labor?
Select 2
A. Cephalopelvic disproportion
B. Postpartum hemorrhage
C. Elevated blood glucose
D. Polyhydramnios
E. Hypocalcemia

A. Cephalopelvic disproportion
B. Postpartum hemorrhage

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Which fetal or maternal outcomes are possible with a prolonged second stage of labor?
Select 3
A. NICU admission
B. Neonatal hypoglycemia
C. Severe umbilical cord compression
D. Polycythemia
E. Maternal trauma

A. NICU admission
C. Severe umbilical cord compression
E. Maternal trauma (physical & emotional)

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Which of the following are increased risks due to a prolonged second stage?
Select 2

A. Uterine fibroids
B. Increased risk for infection
C. Ovarian cyst rupture
D. Retained placenta
E. Fetal trauma

B. Increased risk for infection - d/t aminiotic sac rupture for long time - chorio
E. Fetal trauma

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# Third stage When does the third stage of labor begin? A. With the onset of active labor B. With full cervical dilation C. After delivery of the placenta D. After delivery of the baby

D. After delivery of the baby ## Footnote Slide 10

What event marks the end of the third stage of labor? A. Delivery of the fetus B. Delivery of the placenta C. Uterine involution D. Cord clamping

B. Delivery of the placenta ## Footnote Slide 10

The third stage of labor is considered prolonged if it lasts longer than: A. 10 minutes B. 20 minutes C. 30 minutes D. 60 minutes

C. 30 minutes ## Footnote Slide 10

# Fourth Stage True or False The fourth stage is considered the 1st hour postpartum

True ## Footnote Slide 11

The fourth stage of labor is the time of highest risk for _____. A. Umbilical cord prolapse B. Uterine rupture C. Uterine atony D. Cervical insufficiency

C. Uterine atony ## Footnote Slide 11

Which of the following is the primary clinical concern during the fourth stage of labor? A. Postpartum hemorrhage B. Hypertension C. Fetal distress D. Premature rupture of membranes

A. Postpartum hemorrhage (PPH) *Especially if their 2nd stage of labor has been prolonged* ## Footnote Slide 11

Which of the following best describes labor pain? A. Predictable and mild B. Uniform and easily managed C. Caused only by fetal distress D. Variable and complex

D. Variable and complex ## Footnote slide 13

Which factors can affect the perception and intensity of labor pain? Select 3 A. Genetic influence B. Natural vs. induced labor C. Amniotic fluid index D. Fetal weight percentile E. Pelvic size and shape

A. Genetic influence B. Natural vs. induced labor (augmented with pitocin) E. Pelvic size and shape ## Footnote Slide 13

Which of the following are TRUE statements about labor pain? Select 2 A. It is always mild during natural labor B. It is influenced by fetal presentation C. Women rarely report pain during pushing D. Severe during contractions & pushing E. It is more intense with a smaller pelvis

B. It is influenced by fetal presentation D. Severe during contractions & pushing ## Footnote slide 13

# Labor pain: Stage 1 During the first stage of labor, _______ are stimulated due to _______ of the **lower uterine segment and cervix.** A. Baroreceptors; pressure and stretching B. Mechanoreceptors; stretching and distention C. Chemoreceptors; inflammation and distention D. Mechanoreceptors; pressure and temperature

B. Mechanoreceptors; stretching and distention ## Footnote slide 15

What type of pain is experienced during the first stage of labor? A. Somatic pain B. Neuropathic pain C. Sharp localized pain D. Visceral pain

D. Visceral pain "diffuse- not specific" ## Footnote Slide 15

Which characteristics describe the nerve fibers involved in transmitting the first stage labor pain? Select 2 A. Unmyelinated B. Myelinated C. A-delta fibers D. C fibers E. Large-diameter sensory fibers

A. Unmyelinated D. C fibers **Small** ## Footnote Slide 15

Pain signals from the **first stage** of labor enter the spinal cord at levels _____. A. T4–T6 B. L3–L5 C. T10–L1 D. S2–S4

C. T10–L1 ## Footnote slide 15

What is one reason why visceral pain from labor can be difficult to treat with opioids? A. It is transmitted through thick, myelinated nerves B. It is not mediated by neural pathways C. It is hard to localize D. It does not activate mechanoreceptors

C. It is hard to localize "could be from the back, sacrum, abdomen" ## Footnote Slide 16

Pain during the active phase of labor is primarily carried through spinal levels associated with _______. A. T12–L1 B. L1–L3 C. S1–S3 D. L3–L5

A. T12–L1 ## Footnote Slide 16

Pain from the first stage of labor can be challenging to treat with _________ due to its diffuse nature, but may respond to blockade of peripheral __________. A. Muscle relaxants; afferents B. Opioids; afferents C. Corticosteroids; efferents D. Antiemetics; efferents

B. Opioids; afferents ## Footnote Slide 16

# Labor pain: Stage 2 Which type of pain becomes more prominent during the second stage of labor? A. Visceral pain B. Neuropathic pain C. Somatic pain D. Referred pain

C. Somatic pain **Still have visceral pain as contractions continue** ## Footnote Slide 19

Somatic pain during the second stage of labor is transmitted by _______ fibers, which are _______. A. C fibers; unmyelinated B. B fibers; sympathetic C. A-beta fibers; unmyelinated D. A-delta fibers; myelinated

D. A-delta fibers; myelinated ## Footnote Slide 19

Which nerve is primarily responsible for transmitting second stage labor pain? A. Sciatic nerve B. Pudendal nerve C. Femoral nerve D. Ilioinguinal nerve

B. Pudendal nerve ## Footnote Slide 19

Somatic labor pain in the second stage is generally described as: A. Diffuse and aching B. Dull and poorly localized C. Sharp and easily localized D. Burning and radiating

C. Sharp and easily localized ## Footnote Slide 19

Which factors contribute to second-stage somatic pain? select 2 A. Compression of perineal structures B. Cervical dilation C. Stretching of the pelvis D. Uterine involution E. Rupture of membranes

A. Compression of perineal structures C. Stretching of the pelvis ## Footnote Slide 19

Second-stage pain travels through spinal segments from _______ to _______, reflecting sacral nerve involvement. A. T10 to L1 B. T12 to S4 C. L3 to S1 D. T6 to L2

B. T12 to S4 Sacral dermatomes ## Footnote Slide 19

# Labor pain management Which of the following describe the role of a doula? Select 3 A. Provides emotional support B. Administers IV fluids C. Offers physical comfort measures D. Performs vaginal exams E. Serves as an advocate for the patient

A. Provides emotional support C. Offers physical comfort measures E. Serves as an advocate for the patient ## Footnote Slide 22

What is a key difference between a doula and a nurse? A. Doulas perform deliveries B. Doulas are typically non-medical support persons C. Doulas administer medications D. Doulas assist only in emergency care

B. Doulas are typically non-medical support persons They do not perform deliveries ## Footnote Slide 22

Which of the following are considered complementary therapies for labor pain? Select 2 A. Hypnosis B. Amniotomy C. IV narcotics D. Aromatherapy E. Spinal anesthesia

A. Hypnosis D. Aromatherapy ## Footnote Slide 23

Which complementary approaches may be used for emotional and physical support during labor? (select 2) A. Continuous fetal monitoring B. Music C. Foley catheter insertion D. Fundal massage E. Acupressure

B. Music E. Acupressure *..one of my friends watched Bob Ross painting videos on Youtube during her labor..* ## Footnote Slide 23

Complementary therapies such as _______ and _______ may help reduce anxiety and promote comfort during labor. A. Pitocin; IV fluids B. Oxygen; fundal pressure C. Antibiotics; Foley catheter D. Reflexology; massage

D. Reflexology; massage ## Footnote Slide 23

Intradermal sterile water injections are a form of _______, which can trigger natural _______ release. A. Massage; serotonin B. Noxious stimulation; endorphin C. Heat therapy; cortisol D. Reflexology; dopamine

B. Noxious stimulation; endorphin ## Footnote Slide 24

Which of the following are effective non-pharmacologic strategies for managing back pain in labor? Select 3 A. Counterpressure B. Stadol C. Peanut ball D. Epidural anesthesia E. Supine positioning F. Swaying

A. Counterpressure C. Peanut ball F. Swaying Position changes ## Footnote Slide 24

Which theory explains why techniques like squeezing a comb may reduce labor pain? A. Gate control theory B. Inflammatory theory C. Central sensitization theory D. Somatic referral theory

A. Gate control theory * Small fibers: carry pain signals -> Gate opens = pain * Large fibers: Carry touch/pressure signals -> Gate closes= Pain reduced **Physiologic distraction** - Squeezing the comb activates large fibers and helps reduce pain by closing the gate. ## Footnote Slide 24

Which of the following best describes the concept of counterirritation in labor pain management? A. Applying pressure to the cervix to stimulate labor B. Distracting stimulus to reduce perception of pain C. Administering opioids to reduce inflammatory pain D. Using epidural anesthesia to interrupt nerve transmission

B. Distracting stimulus to reduce perception of pain ## Footnote Slide 24

# Inhaled Anesthetics Which of the following inhaled agents is **currently** used for labor pain management? A. Chloroform B. Sevoflurane C. Nitrous oxide D. Isoflurane

C. Nitrous oxide ## Footnote Slide 25

Who was historically known for using chloroform during labor for Queen Victoria👸🏼? A. Joseph Lister B. John Snow C. Ignaz Snow D. William Morton E. Hodor

B. John Snow | This guy ## Footnote Slide 25

Why must **sub-anesthetic** concentrations be used for inhaled labor analgesia? A. To avoid uterine hyperstimulation B. To keep the partner alert C. To ensure the parturient remains conscious D. To prevent fetal scalp swelling

C. To ensure the parturient remains conscious Partner/Coach is ALWAYS in verbal contact ## Footnote Slide 25

During labor, nitrous oxide is used in a way that allows the patient to “_______” themselves. A. Inject B. Stimulate C. Sedate D. Dose

D. Dose ## Footnote Slide 25

In ________, Stanislav Klikovitch described the use of nitrous oxide (N₂O) for labor analgesia in ________. A. 1865; England B. 1881; Russia C. 1902; France D. 1873; Germany

B. 1881; Russia ## Footnote Slide 26

Which of the following best describes the mechanism of nitrous oxide in labor analgesia? A. Inhibition at NMDA glutamate receptors B. Direct stimulation of oxytocin receptors C. Blocking of GABA receptors D. Inhibition of voltage-gated calcium channels

A. Inhibition at NMDA glutamate receptors ## Footnote Slide 26

Which of the following is TRUE about nitrous oxide use in labor? Select 2 A. It decreases uterine contractility B. It does not cause neonatal depression C. It causes neonatal depression D. It is associated with spinal cord suppression E. It does not reduce uterine contractility

B. It does not cause neonatal depression E. It does not reduce uterine contractility ## Footnote Slide 26

Which of the following receptors are **stimulated** by nitrous oxide during labor analgesia? Select 4 A. Opioid receptors B. Dopaminergic receptors C. Muscarinic receptors D. Histaminergic receptors E. ⍺2-adrenergic receptors F. β2-antagonist receptors G. ⍺1-adrenergic receptors

A. Opioid receptors B. Dopaminergic receptors E. ⍺2-adrenergic receptors G. ⍺1-adrenergic receptors ## Footnote Slide 26

What is the typical gas ratio used when patient is self administering nitrous oxide for labor analgesia? A. 25% nitrous / 75% oxygen B. 100% nitrous C. 50% nitrous / 50% oxygen D. 75% nitrous / 25% oxygen

C. 50% nitrous / 50% oxygen ## Footnote Slide 27

Which best describes the activation mechanism of a nitrous oxide system during labor? A. Activated by continuous flow B. Triggered by anesthetist using a button C. Activated by patient’s negative pressure D. Administered via automatic ventilator

C. Activated by patient’s negative pressure **Demand valve connected to face mask or mouthpiece** ## Footnote Slide 27

What prevents overdose when using nitrous oxide during labor? A. Intermittent delivery through IV tubing B. Timer-controlled release C. Rapid metabolism in the liver D. Fast onset and offset

D. Fast onset and offset "Patient just drops the mask and they wake up" ## Footnote Slide 27

What happens to nitrous oxide use in some facilities after an epidural is placed? A. It is converted to continuous administration B. It is discontinued C. It is given through the epidural catheter D. The concentration is increased

B. It is discontinued ## Footnote Slide 27

Which of the following are true side effects or precautions with nitrous oxide use during labor? Select 3 A. May cause paresthesias B. Causes muscle rigidity C. Can cause dry mouth and dizziness D. Always requires general anesthesia backup E. Issues with nausea

A. May cause paresthesias C. Can cause dry mouth and dizziness E. Issues with nausea ## Footnote Slide 28

What serious complication can result from combining opioids and nitrous oxide? Select 2 A. Elevated blood pressure B. Seizure activity C. Hypoxia D. Excessive uterine contractions E. Loss of protective airway reflexes

C. Hypoxia E. Loss of protective airway reflexes (aspiration risk d/t patient being considered full stomach) Decreased LOC ## Footnote Slide 28

Which nerve block can be used to augment nitrous oxide analgesia during labor? A. Pudendal nerve block B. Sciatic nerve block C. Saphenous nerve block D. Femoral nerve block

A. Pudendal nerve block ## Footnote Slide 28

# Volatile Anesthetics Which of the following is a key requirement when using volatile agents for labor? A. Continuous fetal monitoring only B. Obstetrician must be present C. Anesthesia provider must be present D. Nitrous oxide must be administered simultaneously

C. Anesthesia provider must be present ## Footnote Slide 29

# True or False Isoflurane, Sevoflurane are not as good as Nitrous oxide for Labor analgesia

False

Volatile anesthetics cause _______ of uterine smooth muscle, which is _______ dependent. A. Constriction; time B. Relaxation; dose C. Relaxation; pH D. Spasm; temperature

B. Relaxation; dose ## Footnote Slide 29

Why is a scavenging system required when using volatile anesthetics? A. To prevent overdose in the fetus B. To recycle the gas C. To mix with oxygen D. To reduce environmental pollution

D. To reduce environmental pollution ## Footnote Slide 29

What is a significant maternal side effect of volatile anesthetics during labor? A. Increased uterine tone B. Maternal alertness C. Loss of airway reflexes and amnesia D. Fetal bradycardia

C. Loss of airway reflexes and amnesia ## Footnote Slide 29

Volatile agents may be used for deliveries that require _______. A. Cesarean section only B. Spontaneous delivery C. Instrumentation D. Water birth

C. Instrumentation Or a twin birth in the Operating Room.. | Freeman addition to lecture ## Footnote Slide 29

Acetaminophen is a _______ analgesic that works through _______ inhibition of COX enzymes. A. Sedative; strong B. Multimodal; weak C. Single-use; selective D. Antispasmodic; irreversible

B. Multimodal; weak COX 1 & COX2 ## Footnote Slide 30

The maximum effect of acetaminophen occurs approximately _______ after administration. A. 1 hour B. 30 minutes C. 15 minutes D. 90 minutes

A. 1 hour ## Footnote Slide 30

Ketamine provides analgesia primarily through which receptor mechanism? A. GABA-A agonism B. NMDA receptor antagonism C. Alpha-2 adrenergic stimulation D. Mu opioid receptor activation

B. (Noncompetetive) NMDA receptor antagonism | Nice read refresher ## Footnote Slide 31

Ketamine is contraindicated in which patient population? Select 2 A. Patients with preeclampsia B. Patients with asthma C. Patients receiving spinal anesthesia D. Patients undergoing cesarean delivery E. Patients with hypertension

A. Patients with preeclampsia E. Patients with hypertension ## Footnote Slide 31

Ketamine is a _______ derivative and acts as a noncompetitive NMDA receptor antagonist. A. Morphine B. Barbiturate C. Phencyclidine D. Diazepam

C. Phencyclidine ## Footnote Slide 31

Which of the following effects may a patient experience with ketamine? Select 3 A. Increased blood pressure B. Decreased blood pressure C. Hallucinations D. Decreased Heart rate E. Increased Heart rate

A. Increased blood pressure C. Hallucinations 🍄 E. Increased Heart rate | "trippin' down the k-hole" ## Footnote Slide 31

When might ketamine be especially useful in obstetric anesthesia? A. During a long cesarean section B. For cervical ripening C. During early labor induction D. During fetal scalp electrode placement

A. During a long cesarean section "A good time to use ketamine is during cesarean sections when neuraxial anesthesia is wearing off" ## Footnote Slide 31

What is the typical onset time after IV ketamine administration? A. 1 minute B. 45 seconds C. 30 seconds D. 15 minutes

C. 30 seconds ## Footnote Slide 32

What is the duration of effect after a single IV dose of ketamine? A. 1–2 minutes B. 5–10 minutes C. 15–30 minutes D. 45–60 minutes

B. 5–10 minutes ## Footnote Slide 32

**IM** ketamine has an onset of _______ minutes and a duration of _______ minutes. A. 2–8; 10–20 B. 1–3; 30–60 C. 10–15; 45–60 D. 5–10; 60–90

A. 2–8; 10–20 ## Footnote Slide 32

# Benzodiazepines Benzodiazepines bind to a specific site on the _______ receptor, enhancing inhibitory neurotransmission. A. NMDA B. Dopamine C. GABA D. Nicotinic

C. GABA ## Footnote Slide 33

Which of the following are true about IV benzodiazepine use in labor? Select 3 A. Causes amnesia B. Maternal respiratory depression C. Does not cross the placenta D. Increases neonatal tone E. Crosses the placenta

A. Causes amnesia B. Maternal respiratory depression E. Crosses the placenta ## Footnote Slide 33

Which of the following are potential effects on neonatals due to the use of maternal benzodiazepine use during labor? Select 3 A. Neonatal hypotonicity B. Decreased thermoregulation C. Hyperreflexia D. Enhanced alertness E. Respiratory depression

A. Neonatal hypotonicity B. Decreased thermoregulation E. Respiratory depression ## Footnote Slide 33

# Opioids Which of the following is an advantage of using IV or IM opioids for labor analgesia? Select 2 A. Low cost B. No placental transfer C. Requires specialized monitoring D. Ease of administration E. No risk of nausea

A. Low cost D. Ease of administration No need for specialized equipment or personnel ## Footnote Slide 34

Which of the following are disadvantages of IV/IM opioid use in labor? Select 2 A. Itching B. Requires an anesthesia provider C. Placental transfer to fetus D. Always leads to prolonged labor E. Improves fetal tone

A. Itching C. Placental transfer to fetus Sedation, N/V ## Footnote Slide 34

Meperidine is _______ soluble, allowing it to cross the placenta _______. A. Water; poorly B. Lipid; readily C. Protein; slowly D. Ionized; minimally

B. Lipid; readily ## Footnote Slide 35

Meperidine can cause multiple side effects, including _______ and _______. A. Seizures; fever B. Tachycardia; urinary retention C. Vomiting; bronchospasm D. Respiratory depression; itching

D. Respiratory depression; itching ## Footnote Slide 35

Which of the following is a significant active metabolite of meperidine? A. Norhydromorphone B. Norfentanyl C. Normeperidine D. Noroxycodone

C. Normeperidine | can cause seizures ## Footnote Slide 35

The active metabolite of morphine, _____, can **accumulate** in neonates and contribute to respiratory depression. A. Morphine-6-glucuronide B. Morphine sulfate C. Norfentanyl D. Normeperidine

A. Morphine-6-glucuronide ## Footnote Slide 36

Morphine is a _______ opioid, contributing to its _______ onset. A. Lipophilic; rapid B. Hydrophilic; slower C. Hydrophobic; unpredictable D. Fat-soluble; faster

B. Hydrophilic; slower ## Footnote Slide 36

Which of the following is true about fentanyl? A. It has multiple active metabolites B. It is hydrophilic and has a slow onset C. It does not cross the placenta D. It is lipophilic and works quickly

D. It is lipophilic and works quickly ## Footnote Slide 37

One consideration with repeated fentanyl doses is that the drug may _______. A. Accumulate B. Cause uterine atony C. Convert to normeperidine D. Lose potency

A. Accumulate ## Footnote Slide 37

# True or False Fentanyl has multiple metabolites

False It has No metabolites ## Footnote Slide 37

# Remifentanil What is the typical PCA bolus dose of remifentanil for labor analgesia? A. 5–10mcg with 1-3 min lockout B. 10–20mcg with 2-5 min lockout C. 20–40mcg with 2–3 min lockout D. 50–100mcg with 6-10 min lockout

C. 20–40mcg with 2–3 min lockout ## Footnote Slide 38

What is the primary method of metabolism for remifentanil? A. Hepatic cytochrome P450 enzymes B. Renal excretion C. Glucuronidation D. Plasma esterases

D. Plasma esterases ## Footnote Slide 38

Which of the following best describes remifentanil's duration? A. Prolonged effect B. Ultra-short acting C. Moderate duration D. Unpredictable

B. Ultra-short acting ## Footnote Slide 38

What is the half life of butorphenol? A. 4-6 hours B. 1-2 hours C. 3-6 hours D.5-7 hours

A. 4-6 hours ## Footnote slide 39

# True or false Butorphenol is known for improved analgesic score over fentanyl

true ## Footnote slide 39

What is the half life of nalbuphine A. 4 hours B. 5 hours C. 2 hours D. 3.5 hours

B. 5 hours ## Footnote slide 39

What can Nalbuphine cause? A. fetal decelerations B. fetal tachycardia C. fetal demise D. fetal bradycardia

D. fetal bradycardia ## Footnote slide 39

What can help with fetal bradycardia caused by Nalbuphine A.Glycopyrolate B. Epinephrine C. Naloxone D. Phenylephrine

C. Naloxone ## Footnote slide 39

Which drug will suppress uterine contractions, promote premature constriction of fetal ductus arteriosus and inhibit platelet aggregation? A. toradol B. fentanyl C. stadol D. nubain

A. toradol | NSAIDS ## Footnote slide 40

What is the goal of the paracervical block? A. block transmision to the postcervical ganglion B. block transmision to the intracervical ganglion C. block transmission thru paracervical ganglion D. facilitate transmission thru paracervical ganglion

C. block transmission thru paracervical ganglion ## Footnote slide 41

The paracervical block is normally administered by the _______ provider. A. Doula B. nurse C. anesthesia D. OB

D. OB provider ## Footnote slide 41

The paracervical block is for short term pain relief in the ________ stage of labor A.first B.second C.third D.fourth

A. First

What are the 3 complications associated with the paracervical block? (select 3) A. maternal bradycardia B. injection into fetal scalp C. maternal LAST D. syncope E. rupture of membrane

B. injection into fetal scalp C. maternal LAST D. syncope also fetal LAST and fetal bradycardia ## Footnote slide 41

Which complication is considered the MOST severe fetal complication A. fetal demise B. fetal LAST C. fetal bradycardia D. fetal tachycardia

B. Fetal LAST ## Footnote slide 41

What is the most COMMON fetal complication A. fetal demise B. fetal LAST C. fetal bradycardia D. fetal tachycardia

C. fetal bradycardia ## Footnote slide 41

Which patient populations is the paracervical block contraindicated in(select 2) A. uteroplacental insufficiency B. stage 2 of labor C. non-reassuring fetal heart rate D. anterior placenta

A. uteroplacental insufficiency C. non-reassuring fetal heart rate ## Footnote slide 41

The pudendal nerve block will (select 2) A. minimize bleeding B. reduce fetal movement C. have rapid absorption of LA D. minimize urge to push

C. have rapid absorption of LA D. minimize urge to push ## Footnote slide 43

The pudendal nerve block is an alternative to pharmacologic pain management in the _____ stage of labor A. first B. second C. third D. fourth

B. second ## Footnote slide 43

What are the 3 risk factors of the pudendal nerve block (select 3) A. injection into pudendal artery B.LAST C. fetal trauma or injections of LA D. maternal bradycardia E. fetal tachycardia

A. injection into pudendal artery B.LAST C. fetal trauma or injections of LA ## Footnote slide 43

What is the only form of analgesia that provides complete analgesia for both stages of labor? A. opioids B.moderate anesthesia C. general anesthesia D. neuraxial anesthesia

D. neuraxial anesthesia ## Footnote slide 44

# true or false Anesthesia consent is needed after the intervention

false ... before " we normally do it when they come into the hospital" ## Footnote slide 44

What is a preprocedural assessment required for neuroaxial anesthesia in healthy parturients A. airway B. routine lab C. plt count D. EF

A. airway Routine lab testing is not required for HEALTHY partuients ## Footnote slide 44

What medications should you have in the neuroaxial cart? (select 2) A. precedex B. vasopressors C. glycopyrolate D. emergency meds

B. vasopressors (ephedrine, phenylephrine) D. emergency meds (atropine, epi, naloxone, calcium chloride, sodium bicarb) ## Footnote slide 45

# True or false Induction agents and muscle relaxants need to be apart of preparation for neuroaxial anesthesia

true

Which of the following are also required for preparation of neuroaxial anesthesia? (select 4) A. Sevoflurane B. intralipids C. ambu bag, O2, facemask D. suction E. airway equipment F. neostigmine

B. intralipids C. ambu bag, O2, facemask D. suction E. airway equipment ## Footnote slide 46

Which of the following statements are true? A. NPO status is not required for neuroaxial anesthesia B. Informed consent is best during active labor C. IV access is not optional D. It is not necessary to preload or co load patient with fluids

C. IV access is not optional NPO status for liquids and solids is needed Informed consent is best before onset of labor or early labor You do need to preload or co-load patient with fluids ## Footnote slide 47

When monitoring a neuroaxial patient, blood pressure should be monitored how frequently? A. 1-5 min during initial stage of dosing then 15 min after initial 20-30 min B. 2-4 min during initial stage of dosing then 20 min after initial 30-40 min C. 1-5 min during initial stage of dosing then 20 min after initial 30-40 min D. 2-4 min during initial stage of dosing then 15 min after initial 20-30 min

A. 1-5 min during initial stage of dosing then 15 min after initial 20-30 min ## Footnote slide 48

Which of the following are required monitoring devices for neuroaxial anesthesia (select 2) A. EKG B. blood pressure C. pulse ox D. arterial line

B. blood pressure C. pulse ox | hosptial/ anesthesia department policy ## Footnote slide 48

What monitoring is required on the fetal side when doing neuroaxial anesthesia (select 2) A. Fetal heart tones B. fetal blood pressure C. none is required D. fetal HR

A. fetal heart tones D. fetal HR continuous monitoring during and after, document pre and post FHR ## Footnote slide 49

What are the 2 positions for neuroaxial anesthesia A. supine B. prone C. sitting D. lateral

C. sitting D. lateral ## Footnote slide 50

What is the advantage of sitting position for neuroaxial anesthesia A. midline identification B. less risk of intravascular catheter C. easier for parturient

A. midline identification B and C is lateral advantages B because epidural veins decompressed ## Footnote slide 50

Where is the apex of thoracic curvature shifted to from T8 A. T7 B.T4 C. T6 D. T10

C. T6 increased risk for cephalad spread ## Footnote slide 51

What does epidural vein engorgement cause in the pregnant patient (select 2) A. smaller epidural space B. larger epidural space C. risk for venous cannulation D. decreased risk for venous cannulation

A. smaller epidural space C. risk for venous cannulation ## Footnote slide 51

Having lumbar lordosis in pregnancy can lead to? (select 2) A. Touffiers line decreased B. decreased intervertebral gap C.increased intervertebral gap D. forward rotation of pelvis

B. decreased intervertebral gap - tight spaces D. forward rotation of pelvis -touffier's line elevated ## Footnote slide 52

# ... I'm sorry for this one Which of the following are absolute contraindications for neuraxial anesthesia? 1.patient refusal 2.elevated ICP d/t mass lesion 3.local anesthetic allergy 4.uncooperative patient 5.language barrier w/o interpreter 6.severe fetal decompression 7.severe maternal cardiac dz 8.uncontrolled hemorrhage w/ hypovolemia 9.epidural site skin/soft tissue infection 10.active coagulopathy 11.untreated systemic infection 12.preexisting neurologic deficit 13.moderate to severe bleeding issues/ clotting disorder 14.anticoagulation 15.skeletal anomalies 16.hardware in spine

1.patient refusal - absolute 4.uncooperative patient -absolute 8.uncontrolled hemorrhage w/ hypovolemia - absolute 9.epidural site skin/soft tissue infection- absolute 13.moderate to severe bleeding issues/ clotting disorder - absolute 14.anticoagulation- absolute ## Footnote slide 53 and 54 see you got 2 slide out of the way

What can happen if you place neuroaxial too early? (select 3) A. risk for instrumented delivery B. prolonged second stage of labor C. Patient not longer get into good position D. risk for epidural becoming ineffective E.patient can no longer stay still

A. risk for instrumented delivery B. prolonged second stage of labor D. risk for epidural becoming ineffective and needing to be replaced ## Footnote slide 55

What can happen if you place neuroaxial too late? (select 2) A. risk for instrumented delivery B. prolonged second stage of labor C. Patient not longer get into good position D. risk for epidural becoming ineffective E.patient can no longer stay still

C. Patient not longer get into good position E.patient can no longer stay still ## Footnote slide 56

# True or false There's 6 options for neuroaxial anesthesia

false: 5 options ## Footnote slide 57

All the following are the options for neuraxial anesthesia except ... A. epidural B. dural puncture epidural C. combined spinal- epidural D.paracervical block E. single shot spinal/intrathecal F.continuous spinal/ intrathecal

D. paracervical block ... thats not neuraxial ## Footnote slide 57

Where is the placement for continous labor epidural (select 3) A. L3-4 B. L2-3 C. L4-5 D. L1-2

A. L3-4 B. L2-3 C. L4-5 ## Footnote slide 59

What are 3 advantages for the continuous labor epidural (select 3) A. amount of local anesthetic/ opioids required B.continuous analgesia C. catheter for c-section use D.no dural puncture required E. faster onset of analgesia

B.continuous analgesia C. catheter for c-section use D.no dural puncture required ## Footnote slide 59

Disadvantages of continuous labor epidural incude all the following except (select 2) A.slower onset B. increased risk for PDPH C.amount of local anesthetic/ opioids required D. risk of sacral "sparing" or slow blockade E. greater risk for maternal LAST F. increased risk for fetal bradycardia G. greater fetal drug exposure

B. increased risk for PDPH F. increased risk for fetal bradycardia ## Footnote slide 60

Epidural technique includes A. aspiration of blood B. aspiration of clear fluid C. prone position D. loss of resistance

D. loss of resistance Air or saline ## Footnote slide 62

# true or false Saline has shown evidence to be superior over air for loss of resistance

False ## Footnote slide 62

What are 2 risk factors for loss of resistance using air (select 2) A. patchy block B. pneumocephalus C. increased need for opioids D. increased spread of block

A. patchy block B. pneumocephalus ## Footnote slide 62

What is the standard test dose for epidural A.lidocaine 1.5% + 1:200K epi x3mL B.bupivacaine 1.5% + 1:200K epi x3mL C.lidocaine 4% + 1:200K epi x3mL D.lidocaine 1.5% + 1:400K epi x2mL

A.lidocaine 1.5% + 1:200K epi x3mL ## Footnote slide 63

What is the point in standard test dose for epidural A. to ensure the pain will go away immediately B. to make sure there is not allergy to the local C. because its fun D. recognize malpositioned epidural catheter

D. recognize malpositioned epidural catheter | risk for systemic toxicity is low ## Footnote slide 63

What could you see a change in with epidural test dose? select 3 A. change in contractions B.change in HR 20bpm in 1 min C. change in pain level D. change in O2 saturation E. circumoral numbness F. tinnitus

B. change in HR (increase 20bpm w/in 1 min)- is it due to epi or contractions? E. circumoral numbness F. tinnitus ## Footnote slide 63 and 64

# True or false Intrathecal placement will be detected by motor blockage in 5-6 min with warm or heavy legs

False- Intrathecal: motor blockade in 3-5 min/ warm or heavy legs due to high dose of lido in intrathecal space, risk for high spinal ## Footnote slide 64

What is the primary advantage of intrathecal (spinal) medication in combination with an epidural catheter placement? A) Longer duration of action B) Rapid onset of analgesia C) Higher doses of local anesthetics D) Increased risk of failed epidural

B. rapid onset of analgesia | low doses of local and opioid ## Footnote slide 65

How quickly does the onset of analgesia occur after a single shot of intrathecal medication? A) 30 minutes B) 1 hour C) 2-5 minutes D) 10 minutes

c. 2-5 min ## Footnote slide 65

Which of the following is an advantage of using a low dose of local anesthetic and opioid in the intrathecal medication? A) Faster recovery time B) Increased risk of side effects C) decreased analgesia D) Continuous analgesia via epidural catheter

D. Continuous analgesia via epidural catheter ## Footnote slide 65

What is one of the potential uses of the epidural catheter after the intrathecal medication is administered? A) Use for cesarean section (C-section) B) Anesthesia for general surgery C) Pain management during labor D) Nerve block for extremities

A) Use for cesarean section (C-section) ## Footnote slide 65

Which of the following is associated with a decreased incidence when using intrathecal medication followed by the placement of an epidural catheter? A) Risk of complications during surgery B) Incidence of failed epidural C) Duration of the anesthesia effect D) The need for additional medications

B) Incidence of failed epidural ## Footnote slide 65

What is a potential risk associated with intrathecal medication and epidural catheter placement in terms of fetal health? A) Increased risk of fetal tachycardia B) No effect on fetal heart rate C) Decreased fetal oxygenation D) Increased risk of fetal bradycardia

D) Increased risk of fetal bradycardia ## Footnote slide 66

What factor contributes to the increased risk of fetal bradycardia during this procedure? A) Degree of sympathetic block and maternal hypotension B) Maternal hypothermia C) Use of high doses of anesthetic D) Maternal fever

A) Degree of sympathetic block and maternal hypotension ## Footnote slide 66

What is a potential complication that may increase after the administration of intrathecal medication and placement of an epidural catheter? A) Postpartum depression B) Postdural puncture headache (PDPH) C) Nerve damage D) Postoperative bleeding

B) Postdural puncture headache (PDPH) ## Footnote slide 66

What is one of the risks associated with postpartum care following intrathecal medication and epidural catheter placement? A) Increased risk of fever B) Increased maternal hemorrhage C) Decreased recovery time D) Increased risk of postpartum neuraxial infection

D) Increased risk of postpartum neuraxial infection ## Footnote slide 66

What is a challenge in ensuring proper epidural catheter placement after intrathecal medication is administered? A) The catheter may be too deep to provide effective analgesia B) Increased risk of puncturing the spinal cord C) Uncertainty about "correct" catheter placement until block regression D) Risk of catheter migration during the procedure

C) Uncertainty about "correct" catheter placement until block regression ## Footnote slide 66

# True or false With a dural puncture epidural there is medication injected.

False similar to CSE but NO medications injected ## Footnote slide 67

Which of the following is an advantage of the Dural Puncture Epidural (DPE) technique compared to a traditional epidural without a DPE? A) Increased risk of postpartum neuraxial infection B) Faster onset of analgesia C) Increased risk of maternal hypotension D) Increased risk of PDPH

B) Faster onset of analgesia ## Footnote slide 67

What is a benefit of the Dural Puncture Epidural in terms of medication delivery? A) Decreased risk of sacral analgesia B) Decreased efficacy of medications C) No transdural migration of medications D) Transdural migration of medications injected into the epidural space

D) Transdural migration of medications injected into the epidural space ## Footnote slide 67

In comparison to Combined Spinal Epidural (CSE), the Dural Puncture Epidural (DPE) technique has which of the following advantages? A) Decreased risk of maternal hypotension and fetal bradycardia B) Increased risk of fetal bradycardia C) Faster onset of labor D) Increased risk of postpartum neuraxial infection

A) Decreased risk of maternal hypotension and fetal bradycardia ## Footnote slide 67

What is a major disadvantage of the Dural Puncture Epidural (DPE)? A) Faster onset of sacral analgesia B)Decreased risk of maternal hypotension C)Increased risk of PDPH (Post-Dural Puncture Headache) D) Decreased risk of postpartum neuraxial infection

C)Increased risk of PDPH (Post-Dural Puncture Headache) Increased risk for postpartum neuroaxial infection ## Footnote slide 67

For a labor intrathecal or spinal analgesia, the _____________ is based on local anesthetic and opioid administered. A. levels blocked B. duration of action C. risk of infection D. size of needle

B. duration of action ## Footnote slide 68

Advantages of single shot spinal/ intrathecal include (select 3) A. delayed sacral analgesia B. rapid onset of analgesia C. continuous medication infusion D. immediate sacral analgesia E. Low local anesthetic and opioid dosages

B. rapid onset of analgesia D. immediate sacral analgesia E. Low local anesthetic and opioid dosages ## Footnote slide 68

Disadvantages of single shot spinal intrathecal include all the following except A. limited duration of analgesia B. immediate sacral analgesia C. increased risk of maternal HoTN and fetal bradycardia D. increased risk of PDPH E. increased risk of postpartum neuroaxial infection

B. immediate sacral analgesia Limited duration based on local anesthetic and opioid PDPH dependent on needle type, size, and attempts ## Footnote slide 69

Continuous spinal anesthesia is typically used: A) Electively for routine labor analgesia B) After unintentional dural puncture with a Tuohy needle C) Only in patients requiring general anesthesia D) For all patients undergoing a cesarean section

B) After unintentional dural puncture with a Tuohy needle ## Footnote slide 70

Which of the following is an advantage of continuous spinal anesthesia? A) Requires large doses of local anesthetic B) Cannot be used for patients requiring a cesarean section C) Has a slow onset of analgesia D) Provides continuous analgesia

D) Provides continuous analgesia low dose of LA/ opioid rapid onset can be used in patients requiring C-section ## Footnote slide 70

A major disadvantage of continuous spinal anesthesia is: A) Risk of mistaken identity between spinal catheter and epidural catheter B) Low risk of PDPH (Post-Dural Puncture Headache) C) Slow onset of analgesia D) Limited use in cesarean sections

A) Risk of mistaken identity between spinal catheter and epidural catheter high risk for PDPH ## Footnote slide 70

Which of the following is a potential complication of continuous spinal anesthesia? A) Increased risk of fetal bradycardia B) Large dural puncture leading to an increased risk of PDPH C) Difficulty in providing continuous analgesia D) Prolonged onset of analgesia

B) Large dural puncture leading to an increased risk of PDPH ## Footnote slide 70

Epidural local anesthetics block which type of pain? A) Only visceral pain B) Only somatic pain C) Both visceral and somatic pain D) Only pain from cervical dilation

C) Both visceral and somatic pain ## Footnote slide 71

Epidural local anesthetics block visceral pain, which includes: (select 2) A) Descent of the fetus into the birth canal B)Cervical dilation C) Lower uterine segment distention D) Somatic pain from uterine contractions

B)Cervical dilation C) Lower uterine segment distention ## Footnote slide 71

Epidural local anesthetics help block somatic pain, which is associated with: A) Cervical dilation B) Lower uterine segment distention C) Uterine contractions D) Descent of the fetus into the birth canal

D) Descent of the fetus into the birth canal ## Footnote slide 71

What are the most commonly used drugs for labor (select 2) A. Bupivacaine B. Ropivacaine C. Lidocaine D. Tetracaine

A. Bupivacaine B. Ropivacaine ## Footnote slide 71

Which of the following is an advantage of bupivacaine in epidural anesthesia? A) It causes significant motor and sensory block together B) It provides a differential block with separation between motor and sensory effects C) It causes rapid tachyphylaxis D) It has a very short duration of action

B) It provides a differential block with separation between motor and sensory effects Long duration of action Lack of tachyphylaxis ## Footnote slide 72

What is a key feature of bupivacaine in terms of its effects on motor neurons? A) It blocks both motor and sensory neurons equally B)It has no effect on motor neurons C) It only blocks A-α motor neurons D) It spares A-α motor neurons while blocking sensory neurons

D) It spares A-α motor neurons while blocking sensory neurons ## Footnote slide 72

One advantage of bupivacaine is: A) It has a long duration of action B) It has a short duration of action, ideal for short procedures C) It causes rapid tachyphylaxis D) It causes significant placental transfer

A) It has a long duration of action ## Footnote slide 72

Which of the following is true regarding the safety of bupivacaine? A) High concentrations of bupivacaine are unlikely to cause toxicity B) It causes significant tachyphylaxis with repeated doses C) It has limited placental transfer D) It readily crosses the blood-brain barrier

C) It has limited placental transfer ## Footnote slide 72

Which of the following is an advantage of bupivacaine regarding toxicity? A) High concentrations are likely to cause toxicity B) Low concentrations of bupivacaine are unlikely to cause toxicity C) It causes toxicity in both high and low concentrations D) It has a high risk of toxicity regardless of the concentration

B) Low concentrations of bupivacaine are unlikely to cause toxicity ## Footnote slide 72

Disadvantages of Bupivacaine include (select 2) A. slow onset time B. fast onset C. risk of CV and neuro toxicity D. risk of renal toxicity

A. slow onset time C. risk of CV and neuro toxicity ## Footnote slide 73

What is the onset time of Bupivacaine A. 13-17min B. 10-15min C. 20-30min D. 15-20min

B. 10-15min ## Footnote slide 73

Latency is improved with _______ opioid A. hydrophilic B. lipophobic C. highly protein bound D. lipophilic

D. lipophilic ## Footnote slide 73

# Amide Which factors influence the concentration and dose of Bupivacaine? (Select 4) A. Provider B. Practice setting C. Fetal gender D. Parturient height and weight E. Stage and progression of labor

A. Provider B. Practice setting D. Parturient height and weight E. Stage and progression of labor ## Footnote Slide 74

# Amide When using a ___ concentration of Bupivacaine, a ___ volume is typically administered. A. higher, smaller B. lower, larger C. lower, smaller D. higher, larger

B. lower, larger When using a **lower** concentration of Bupivacaine, a **larger** volume is typically administered. *10-20 mL depending on concentration* ## Footnote Slide 74

# Amide The initial dose of Bupivacaine is usually followed by a ____ infusion. A. bolus B. rescue C. maintenance D. spinal

C. maintenance ## Footnote Slide 74

# Amide Which of the following are advantages of Ropivacaine compared to Bupivacaine? (Select 2) A. Fast onset time (3–5 minutes) B. Better separation of sensory and motor block C. Lower risk of heart and nerve toxicity D. Works faster when given with a lipophilic opioid E. More fat-soluble, so lower risk of toxicity

B. Better separation of sensory and motor block C. Lower risk of heart and nerve toxicity ## Footnote Slide 75

# Amide Which of the following are considered disadvantages or limitations of Ropivacaine? Select 3) A. Slower onset time (10–15 minutes) B. Requires co-administration with hydrophilic opioids to be effective C. Potential for cardiovascular and neurologic toxicity D. Latency can be improved with lipophilic opioids E. Higher toxicity risk than lidocaine in equal doses

A. Slower onset time (10–15 minutes) C. Potential for cardiovascular and neurologic toxicity D. Latency can be improved with lipophilic opioids ## Footnote Slide 75

# Amide When using a lower concentration of Ropivacaine, a ___ volume is typically administered. A. larger B. smaller C. fixed D. concentrated

A. larger *10 – 20 mL depending on concentration* ## Footnote Slide 75

# Amide The initial dose of Ropivacaine is usually followed by a ____ infusion. A. bolus B. rescue C. maintenance D. spinal

C. maintenance ## Footnote Slide 75

# Amide Which of the following are reasons Lidocaine is not ideal for labor analgesia? (Select 4) A. Poor differential block B. Risk of tachyphylaxis C. Increased placental transfer D. Very short duration of action E. Ion trapping in the fetus

**A. Poor differential block** *Significant motor involvement / blockade Dependent on concentration & dose* **B. Risk of tachyphylaxis** **C. Increased placental transfer** **E. Ion trapping in the fetus** ## Footnote Slide 76

# Amide To identify a non-functional epidural catheter, Lidocaine is commonly given at a concentration of ____ in a volume of ____. A. 0.5%, 2–5 mL B. 1%, 10–15 mL C. 2%, 5–10 mL D. 1.5%, 3–5 mL

C. 2%, 5–10 mL ## Footnote Slide 77

# Amide When rapid sacral analgesia is needed, Lidocaine can be given at a concentration of ____ in a volume of ____. A. 0.5–1%, 5–10 mL B. 1–2%, 10–20 mL C. 2%, 2–4 mL D. 0.25%, 15–20 mL

A. 0.5–1%, 5–10 mL ## Footnote Slide 77

# Amide For instrumented vaginal delivery or perineal repair, Lidocaine is typically given at a concentration of ____ with or without ____ in a volume of ____. A. 0.5–1%, fentanyl, 3–5 mL B. 2–3%, morphine, 10–15 mL C. 1.5–2%, epinephrine, 5–10 mL D. 0.25–0.5%, bupivacaine, 2–4 mL

C. 1.5–2%, epinephrine, 5–10 mL ## Footnote Slide 77

# Amide For emergent operative delivery, Lidocaine is typically given at a concentration of ____ in a volume of ____ mixed with ___ to speed up onset. A. 1%, 5 mL, fentanyl B. 2%, 10–15 mL, bicarbonate C. 0.5%, 20 mL, epinephrine D. 2.5%, 15 mL, dextrose

**B. 2%, 10–15 mL, bicarbonate** *2 ml Bicarb mixed in a syringe of 18ml 2% Lido speeds up onset* ## Footnote Slide 77

# Ester The primary advantages of 2-Chloroprocaine include its ____ onset and ___ duration of action. A. slow, long B. rapid, short C. moderate, extended D. delayed, prolonged

B. rapid, short **Rapid** onset **Short** duration of action ## Footnote Slide 77

# True or False 2-Chloroprocaine provides a strong differential block, making it ideal for labor analgesia.

**False** 2-Chloroprocaine provides a **poor** differential block ## Footnote Slide 78

# Ester One disadvantage of 2-Chloroprocaine is that it interferes with the action of ___ and ____. A. Lidocaine B. Ropivacaine C. Bupivacaine D. Opioids E. Spinal anesthesia

C. Bupivacaine D. Opioids ## Footnote Slide 78

# Ester In which of the following clinical situations is Chloroprocaine considered useful? A. Routine epidural maintenance during labor B. Emergent instrumented or operative delivery and perineal repair C. Long-duration cesarean section under spinal anesthesia D. Postpartum pain management via PCA

B. Emergent instrumented or operative delivery and perineal repair *2-3% x 10 mL* ## Footnote Slide 79

Which of the following are benefits of epidural opioid use? (Select 3) A. Decreases latency B. Improves quality of analgesia C. Increases the required dose of local anesthetic D. Prolongs duration of analgesia E. Slows the onset of analgesia

A. Decreases latency B. Improves quality of analgesia D. Prolongs duration of analgesia ## Footnote Slide 80

___ opioids like fentanyl/sufentanil have a faster onset, while ___ opioids like morphine have a slower onset but provide longer postoperative pain relief. A. Hydrophilic, lipophilic B. Lipophilic, hydrophilic C. Ionized, non-ionized D. Natural, synthetic

B. Lipophilic, hydrophilic **Lipophilic** will have faster onset (fentanyl/sufentanil) vs **hydrophilic **(morphine) will have a later onset ## Footnote Slide 80

Clonidine is an ____ used as an epidural additive to enhance analgesia. The typical initial dose is ____. A. alpha-1 blocker, 25–50 mcg B. alpha-2 agonist, 75–100 mcg C. beta-1 agonist, 50–75 mcg D. calcium channel blocker, 100–150 mcg

B. alpha-2 agonist, 75–100 mcg ## Footnote Slide 81

Which of the following are advantages of epidural Clonidine use? (Select 4) A. Analgesic effect B. No motor blockade C. Increased requirement for local anesthetic D. Improved block quality and duration E. Decreases local anesthetic requirement

A. Analgesic effect B. No motor blockade D. Improved block quality and duration E. Decreases local anesthetic requirement ## Footnote Slide 81

Epidural Clonidine may cause maternal ____ and ____, along with an increased risk of maternal ____. A. hypotension, reflex tachycardia, nausea B. hypotension, bradycardia, sedation C. hypotension, dizziness, nausea D. hypotension, hypertension, respiratory depression

B. hypotension, bradycardia, sedation ## Footnote Slide 81

Dexmedetomidine is an ____ used as an epidural additive. Its optimal dose range is ____ mcg/mL. A. alpha-1 antagonist, 1–2 B. alpha-2 agonist, 0.25–0.5 C. beta-1 blocker, 2–4 D. NMDA antagonist, 0.5–1.0

B. alpha-2 agonist, 0.25–0.5 mcg/mL ## Footnote Slide 82

Which of the following are benefits of epidural Dexmedetomidine? (select 3) A. Decreases local anesthetic requirements B. Increases latency C. Prolongs duration of block D. Shortens latency E. Reduces need for opioid additives

A. Decreases local anesthetic requirements C. Prolongs duration of block D. Shortens latency ## Footnote Slide 82

At ____ concentrations, Dexmedetomidine is associated with an increased risk of maternal _____. A. low, agitation B. moderate, hypotension C. higher, sedation D. standard, nausea

C. higher, sedation At **higher** concentrations, Dexmedetomidine is associated with an increased risk of maternal **sedation**. ## Footnote Slide 82

Continuous epidural infusion provides a ____ level of anesthesia and can be administered ____ the addition of opioids. A. variable, only with B. stable, with or without C. intermittent, only without D. incomplete, after opioid effects wear off

B. stable, with or without Continuous epidural infusion provides a **stable** level of anesthesia and can be administered **with or without** the addition of opioids ## Footnote Slide 83

Which of the following are features of an epidural continuous infusion system? (Select 3) A. Designated infusion pump B. Injection ports for emergency access C. Color-coded and labeled tubing D. Decreased risk of contamination E. Must always contain opioids

A. Designated infusion pump C. Color-coded and labeled tubing D. Decreased risk of contamination ## Footnote Slide 83

Which of the following are true about Patient-Controlled Epidural Analgesia (PCEA)? (select 3) A. Similar to IV PCA B. Can be used with or without background infusion C. Increases demand on anesthesia provider D. Improves patient control over analgesia E. Requires constant manual bolusing by provider

A. Similar to IV PCA B. Can be used with or without background infusion D. Improves patient control over analgesia *Significant decrease in repeat dosing by provider* ## Footnote Slide 85

Which of the following are potential disadvantages of PCEA? (select 3) A. Pump programming errors B. Inappropriate patient clientele C. Decreased patient autonomy D. Non-patient initiated boluses E. Excessive sedation due to background infusion

A. Pump programming errors * Bolus dose volume * Lockout interval * Background infusion rate * Max allowable dose/hour B. Inappropriate patient clientele D. Non-patient initiated boluses ## Footnote Slide 86

Adding a background infusion to PCEA can lead to ____ analgesia and ____ maternal satisfaction, but it may also result in an ____ total drug dose. A. poorer, decreased, reduced B. better, increased, increased C. inconsistent, improved, lower D. stronger, unchanged, minimal

B. better, increased, increased *Better analgesia & increased maternal satisfaction *Increased total drug dose | Slide 87

What is a major disadvantage of periodic bolus dosing for epidural anesthesia? A. Reduced need for provider involvement B. Increased patient mobility C. Recurring regression of analgesia D. Consistent drug delivery

C. Recurring regression of analgesia ## Footnote Slide 88

Periodic bolus dosing often leads to ____ provider and maternal satisfaction and ____ provider workload. A. increased, decreased B. decreased, increased C. unchanged, stable D. improved, lower

B. decreased, increased * **Decreased** provider & maternal satisfaction * **Increased** provider workload ## Footnote Slide 88

Large bolus doses (8–12 mL of local anesthetic ± opioid) may result in ____ and increased risk of ____. A. prolonged labor, tachycardia B. dense motor blockade, hemodynamic instability C. light anesthesia, fetal bradycardia D. minimal motor impact, sedation

B. dense motor blockade, hemodynamic instability ## Footnote Slide 88

The two baricity options for spinal Bupivacaine used in labor are ____ (%) and ____ (%). A. Hyperbaric, 0.75%, Isobaric, 0.5% B. Isobaric, 0.75%, Hyperbaric, 0.5% C. Hypobaric, 0.5%, Isobaric, 0.75% D. Isobaric, 0.25%, Hyperbaric, 0.75%

A. Hyperbaric, 0.75%, Isobaric, 0.5% ## Footnote Slide 89

Ropivacaine is ____ used for spinal analgesia in the U.S., and when it is, the solution is typically ____ at a concentration of ____. A. commonly, hyperbaric, 0.75% B. not typically, isobaric, 0.5% C. routinely, isobaric, 0.25% D. widely, hypobaric, 1%

B. not typically, isobaric, 0.5% ## Footnote Slide 89

Which of the following is NOT explicitly listed as a factor influencing spinal/intrathecal dosing for labor? A. Provider judgment B. Hospital/anesthesia department policy C. Patient height and desired anesthetic level D. Patient weight and body mass index

D. Patient weight and body mass index ## Footnote Slide 90

A 5’6” female requiring T10 block = ~1.7ml 0.75% bupivacaine. Calculate the dosage.

0.75% solution x 10 = 7.5 mg/L 7.5mg/mL×1.7mL= **12.75mg** ## Footnote Slide 90-91

Spinal opioids produce analgesia without causing ____, ____, or ____. A. numbness, motor blockade, sympathectomy B. sedation, nausea, vomiting C. hypotension, tachycardia, bradycardia D. respiratory depression, weakness, ataxia

A. numbness, motor blockade, sympathectomy *May be used as solo agent. More commonly used as an additive to a spinal* ## Footnote Slide 92

Spinal opioids work by blocking afferent input from ____ and ____ fibers to the spinal cord. A. A-alpha, B B. C, D C. A-delta, C D. B, gamma

C. A-delta, C ## Footnote Slide 92

# True or False Spinal opioids block efferent impulses while leaving afferent sensory input unaffected.

FALSE Spinal opioids block **afferent** (sensory) input from A-delta and C fibers, but do not affect **efferent** (motor) impulses. ## Footnote Slide 92

Which of the following are true regarding spinal dexmedetomidine? (select 3) A. Typical dose range is 2.5–10 mcg B. It decreases latency of block onset C. It is primarily used to treat hypotension D. It prolongs the duration of analgesia E. It increases motor blockade at low doses

A. Typical dose range is 2.5–10 mcg B. It decreases latency of block onset D. It prolongs the duration of analgesia ## Footnote Slide 93

Which of the following are true about spinal epinephrine use? (select 3) A. Dosed from 2.25–100 mcg B. Prolongs analgesia C. Shortens latency D. Higher doses can increase motor blockade E. Typically used for anxiolysis

A. Dosed from 2.25–100 mcg B. Prolongs analgesia D. Higher doses can increase motor blockade ## Footnote Slide 93

What is a key factor in determining a continuous spinal infusion dosing plan for labor? A. Insurance coverage B. Hospital policy and provider comfort level C. Patient eye color D. Type of IV fluids being administered

B. Hospital policy and provider comfort level *Initial bolus dose same as for CSE* ## Footnote Slide 94

Continuous spinal infusion dosing for labor typically uses ____ bupivacaine or ____ ropivacaine, with or without fentanyl 1–3 mcg/mL at a rate of 1–1.5 mL/hr. A. 0.1–0.25%, 0.3–0.4% B. 0.0625–0.125%, 0.1–0.2% C. 0.25–0.5%, 0.5–0.75% D. 0.02–0.05%, 0.06–0.08%

B. 0.0625–0.125%, 0.1–0.2% **0.0625 – 0.125% bupivacaine** **0.1–0.2% ropivacaine** ## Footnote Slide 94

Which of the following should be regularly assessed following a labor epidural or spinal? (Select 4) A. Quality of analgesia B. Maternal respiratory rate only C. Sensory level using cold or pinprick D. Progress of labor E. Intensity of motor blockade

A. Quality of analgesia C. Sensory level using cold or pinprick D. Progress of labor E. Intensity of motor blockade ## Footnote Slide 95

Post-intervention management includes regular assessment of maternal ___ and fetal ___ tracings. A. intake; movement B. blood sugar; oxygen saturation C. vital signs; heart rate (FHR) D. fluid output; scalp monitor

C. vital signs; heart rate (FHR) ## Footnote Slide 95

# True or False Patient teaching and managing expectations is a key component of post-intervention care during labor analgesia.

True ## Footnote Slide 95

What is the first step when addressing a patient’s complaint of pain during labor with an epidural in place? A. Administer 5 mL of lidocaine B. Give 100 mcg fentanyl C. Increase the infusion rate D. Assess the location of the epidural catheter

D. Assess the location of the epidural catheter ## Footnote Slide 96

Which of the following are essential factors to evaluate before intervening for a patient’s labor pain while receiving neuraxial analgesia? (select 2) A. Sensory level B. Labor progress C. Patient’s pain tolerance score D. Height and weight

**A. Sensory level** to cold or pinprick **B. Labor progress** (e.g., cervical dilation, fetal station) ## Footnote Slide 96

# True or False If a single-shot spinal dose fails, the recommended approach is to immediately repeat the intrathecal injection.

FALSE Redo intrathecal is generally not recommended due to PDPH risk. ## Footnote Slide 97

If a single-shot spinal/intrathecal fails, an alternative management strategy is to ___. A. Administer another spinal dose B. Place an epidural and dose per CLE guidelines C. Switch to general anesthesia D. Increase the IV fluids and wait

B. Place an epidural and dose per CLE guidelines ## Footnote Slide 97

Which of the following are appropriate management steps for continuous spinal dosing during labor? (Select 2) A. Use CLE guidelines for bolus dosing B. Assess catheter location C. Redo the intrathecal injection immediately D. Use spinal/intrathecal dosing guidelines

B. Assess catheter location D. Use spinal/intrathecal dosing guidelines ## Footnote Slide 97

Which of the following is a primary cause of hypotension during neuraxial anesthesia? A. Tachycardia B. Increased cardiac contractility C. Sympathetic blockade D. Decreased parasympathetic tone

C. Sympathetic blockade ## Footnote Slide 98

# True or False Hypotension after neuraxial anesthesia is often due to decreased venous return and peripheral vasodilation.

True *also increased venous capacitance* ## Footnote Slide 98

Neuraxial anesthesia–induced hypotension is defined as SBP < ___ mmHg or a ___% decrease from baseline SBP. A. 120 mmHg; 10% B. 100 mmHg; 30% C. 90–100 mmHg; 20–30% D. 85 mmHg; 15%

C. 90–100 mmHg; 20–30% ## Footnote Slide 98

Which of the following are appropriate treatments for hypotension caused by neuraxial anesthesia? A. Increase IV fluid administration B. Positioning C. Administer vasopressors D. Administer beta blockers E. Decrease the epidural rate

A. Increase IV fluid administration B. Positioning patient with legs elevated or left uterine displacement C. Administer vasopressors ## Footnote Slide 98

Which of the following are signs of failed spinal or epidural analgesia? (select 3) A. Unilateral or asymmetric block B. Strong symmetrical bilateral motor block C. Catheter dislodged from epidural / subarachnoid space D. Patchy or absent block E. High thoracic level block

A. Unilateral or asymmetric block C. Catheter dislodged from epidural / subarachnoid space D. Patchy or absent block ## Footnote Slide 99

What is the most common side effect when opioids are administered via neuraxial anesthesia? A. Nausea B. Pruritus C. Respiratory depression D. Urinary retention

B. Pruritus *Central mu-opioid receptors* *Unrelated to histamine release* ## Footnote Slide 100

Which of the following are effective treatments for pruritus caused by neuraxial opioid administration? (select 3) A. Diphenhydramine B. Naloxone 40–80 mcg IV bolus C. Naltrexone 6 mg orally D. Ibuprofen E. Naloxone 1–2 mcg/kg/hr infusion

B. Naloxone 40–80 mcg IV bolus C. Naltrexone 6 mg orally E. Naloxone 1–2 mcg/kg/hr infusion *Centrally acting mu-opioid antagonist* ## Footnote Slide 100

Which of the following are recommended strategies to prevent an unintended dural puncture during epidural placement? (select 3) A. Advance the Tuohy needle during contractions B. Identify ligamentum flavum while advancing Tuohy C. Estimate the probable depth of the epidural space D. Keep Tuohy loaded with blood to ensure pressure E. Maintain control of the needle-syringe at all times

B. Identify ligamentum flavum while advancing Tuohy C. Estimate the probable depth of the epidural space E. Maintain control of the needle-syringe at all times *Advance Tuohy b/t contractions* *Clear Tuohy of blood clots* ## Footnote Slide 101

Which of the following are recommended treatments after an unintended dural puncture (wet tap)? (Select 3) A. Place an intrathecal catheter B. Reinject CSF from syringe C. Apply an epidural blood patch if headache develops D. Replace with an epidural catheter E. Perform immediate spinal anesthesia

A. Place an intrathecal catheter C. Apply an epidural blood patch if headache develops D. Replace with an epidural catheter *Do not reinject CSF from syringe – risk for contamination/pneumocephalus* ## Footnote Slide 101

Which local anesthetic is associated with increased risk of cardiovascular toxicity and is not recommended for epidural use ? A. Lidocaine 2% B. Ropivacaine 0.2% C. Bupivacaine 0.75% D. Chloroprocaine 3%

C. Bupivacaine 0.75% ## Footnote Slide 102

Intravascular cannulation risk increases due to _____ of epidural veins. A. Thrombosis B. Engorgement C. Vasospasm D. Hypovolemia

B. Engorgement ## Footnote Slide 102

Which of the following is NOT a typical symptom of local anesthetic systemic toxicity (LAST) due to intravascular catheter cannulation? A. Tinnitus B. Circumoral numbness C. Restlessness D. Diaphoresis E. Difficulty speaking F. Seizures G. Loss of consciousness (LOC)

D. Diaphoresis ## Footnote Siide 102

Which of the following are 2 appropriate treatments for local anesthetic systemic toxicity (LAST) caused by intravascular catheter cannulation? A. Lipid emulsion bolus 1.5 mL/kg over 2–3 minutes B. Administer benzodiazepines C. Administer 1 mg epinephrine IV push D. Increase patient stimulation to maintain alertness E. Observe only—intervention is not usually necessary

A. Lipid emulsion bolus 1.5 mL/kg over 2–3 minutes B. Administer benzodiazepines ## Footnote Slide 102

Which of the following is NOT a typical symptom or complication of a high spinal block accotding to lecture? A. Agitation and dyspnea B. Inability to speak C. Apnea D. Profound hypotension leading to loss of consciousness E. D. Bradycardia and poor oxygenation

E. D. Bradycardia and poor oxygenation ## Footnote Slide 103

Which of the following are 3 appropriate treatments for a high spinal block? A. Assist ventilation B. Volume resuscitation C. Administer vasopressors D. Administer opioids for sedation E. Reposition patient to upright to improve breathing

A. Assist ventilation B. Volume resuscitation C. Administer vasopressors ## Footnote Slide 103

Match the spinal level with its corresponding function or symptom

A → 2 (T1–T4 = Cardioaccelerator fibers) B → 3 (C3–C5 = Diaphragm) C → 1 (C8 = Pinky/hand numbness) ## Footnote Slide 104

The subdural space lies between the ____ and the ____. A. Pia mater and spinal cord B. Dura mater and arachnoid mater C. Arachnoid mater and pia mater D. Epidural space and dura mater

B. Dura mater and arachnoid mater ## Footnote Slide 105

# True or False Subdural blocks typically result in profound motor blockade with rapid onset.

False cause **minimal** motor blockade and have a **slower onset** (10–20 min) ## Footnote Slide 105

Which of the following findings is most characteristic of a subdural block? A. Immediate dense motor blockade B. Symmetric sensory block C. Cranial > caudal spread D. Low sensory level with complete motor loss

C. Cranial > caudal spread *May involve cranial nerves* ## Footnote Slide 105

Which of the following are characteristic findings of a subdural block? A. Dense bilateral motor blockade and rapid onset B. Symmetrical sensory level with minimal hypotension C. Unexpectedly high sensory block with patchiness and hypotension D. Localized motor blockade with preserved sensory function

C. Unexpectedly high sensory block with patchiness and hypotension ## Footnote Slide 105

Which of the following may be seen with a subdural block? (select 3) A. Horner’s syndrome B. Apnea C. Loss of consciousness (LOC) D. Hyperreflexia E. Increased cardiac output

A. Horner’s syndrome B. Apnea C. Loss of consciousness (LOC) ## Footnote Slide 105

Which group of symptoms is most consistent with *neurologic complications* following neuraxial anesthesia? A. Delayed gastric emptying Nausea/vomiting Shivering B. Back pain Excessive motor block Neuro deficits C. Urinary retention Maternal fever FHR abnormalities D. Meningitis Epidural hematoma/abscess Neuro deficits Maternal fever

D. Meningitis Epidural hematoma/abscess Neuro deficits Maternal fever ## Footnote Slide 106

Which of the following symptoms are most consistent with *gastrointestinal complications* of neuraxial anesthesia? A. Shivering FHR abnormalities Delayed gastric emptying B. Nausea/vomiting Delayed gastric emptying C. Neuro deficits Epidural abscess Urinary retention D. Back pain Maternal fever Meningitis

B. Nausea/vomiting Delayed gastric emptying *Assess blood pressure* *May be R/T neuraxial induced hypotension* ## Footnote Slide 106

Which of the following are primarily *musculoskeletal complications* of neuraxial anesthesia? A. Delayed gastric emptying Nausea Neuro deficits B. Back pain Excessive motor block Shivering C. Urinary retention Epidural hematoma Fever D. Meningitis LOC Nausea

B. Back pain Excessive motor block Shivering ## Footnote Slide 106

Which of the following symptoms are most consistent with other complications of neuraxial anesthesia? A. Urinary retention FHR abnormalities Epidural hematoma/abscess B. Nausea/vomiting Delayed gastric emptying Assess blood pressure C. Neuro deficits Epidural abscess Urinary retention D. Back pain Maternal fever Meningitis

A. Urinary retention FHR abnormalities Epidural hematoma/abscess ## Footnote Slide 106

figure out the test dose calculations? 3 ml 1.5% lidocaine

Step 1: Convert % concentration to mg/mL 1.5% lidocaine x 10 = 15 mg/mL Step 2: Multiply by volume 15 mg/mL × 3 mL = **45 mg** ## Footnote Slide 107

figure out the test dose calculations? 3 ml 1:200,000 epi

Step 1: Convert 1:200,000 concentration to mcg/mL 1,000,000 / 200,000 = 5 mcg/ml Step 2: Multiply by 3 mL 5 mcg/mL x 3mL = **15 mcg** ## Footnote Slide 107

Unit 3 Module 4 Labor A&A (Exam 3) Flashcards

(260 cards)