Chapter 17: Maximizing Comfort for the Laboring Woman

Question 1

1.An 18-year-old pregnant woman, gravida 1, para 0, is admitted to the labor and birth unit with
moderate contractions every 5 minutes that last 40 seconds. The client states, “My contractions
are so strong, I don’t know what to do.” Before making a plan of care, what should the nurse’s
first action be?

Answer 1

Recognize that pain is personalized for each individual.

Question 2

2. A woman who is pregnant for the first time is dilated 3 cm and having contractions every 5
   minutes. She is groaning and perspiring excessively; she states that she did not attend childbirth
   classes. What is the optimal intervention for the nurse to provide at this time?

Answer 2

Assist her with simple breathing and relaxation instructions.

Question 3

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

Answer 3

Massage the woman’s back.

Question 4

4.Breathing patterns are taught to laboring women. Which breathing pattern should the nurse
support for the woman and her coach during the latent phase of the first stage of labor if the
couple has attended childbirth preparation classes?

Answer 4

Slow-paced breathing

Question 5

5.A laboring woman has received meperidine (Demerol) intravenously (IV), 90 minutes before
giving birth. Which medication should be available to reduce the postnatal effects of meperidine
on the neonate?

Answer 5

Naloxone (Narcan)

Question 6

6.What should the laboring client who receives an opioid antagonist be told to expect?

Answer 6

Her pain will return.

Question 7

7.A client is in early labor, and her nurse is discussing the pain relief options she is considering.
The client states that she wants an epidural “no matter what!” What is the nurse’s best response?

Answer 7

“The type of analgesia or anesthesia used is determined, in part, by the stage of your labor
and the method of birth.”

Question 8

8.What is the role of the nurse as it applies to informed consent?

Answer 8

Act as a client advocate, and help clarify the procedure and the options.

Question 9

9.A first-time mother is concerned about the type of medications she will receive during labor.
The client is in a fair amount of pain and is nauseated. In addition, she appears to be very
anxious. The nurse explains that opioid analgesics are often used along with sedatives. How
should the nurse phrase the rationale for this medication combination?

Answer 9

“Sedatives enhance the effect of the pain medication.”

Question 10

10.The nurse should be cognizant of which physiologic effect of pain?

Answer 10

Predominant pain of the first stage of labor is visceral pain that is located in the lower
portion of the abdomen.

Question 11

11.Which statementcorrectlydescribes the effects of various pain factors?

Answer 11

Levels of pain-mitigating beta-endorphins are higher during a spontaneous, natural
childbirth.

Question 12

12.Nurses with an understanding of cultural differences regarding likely reactions to pain may be
better able to help their clients. Which clients may initially appear very stoic but then become
quite vocal as labor progresses until late in labor, when they become more vocal and request pain
relief?

Answer 12

Hispanic

Question 13

13.Anxiety is commonly associated with pain during labor. Which statement regarding anxiety
iscorrect?

Answer 13

Severe anxiety increases tension, increases pain, and then, in turn, increases fear and
anxiety, and so on.

Question 14

14.Which statement isnotan expected outcome for the client who attends a reputable childbirth
preparation program?

Answer 14

Childbirth preparation programs guarantee a pain-free childbirth.

Question 15

15.Maternity nurses often have to answer questions about the many, sometimes unusual, ways
people have tried to make the birthing experience more comfortable. Which information
regarding nonpharmacologic pain relief isaccurate?

Answer 15

Electrodes attached to either side of the spine to provide high-intensity electrical impulses
facilitate the release of endorphins.

Question 16

16.The nurse should be cognizant of which important information regarding nerve block
analgesia and anesthesia?

Answer 16

Most local agents are chemically related to cocaine and end in the suffix –caine.

Question 17

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

Answer 17

An application of nitrous oxide gas is administered for pain relief.

Question 18

18.According to professional standards (the Association of Women’s Health, Obstetric and
Neonatal Nurses [AWHONN], 2007), which actioncannotbe performed by the nonanesthetist
registered nurse who is caring for a woman with epidural anesthesia?

Answer 18

Initiating epidural anesthesia

Question 19

19.Conscious relaxation is associated with which method of childbirth preparation?

Answer 19

Grantly Dick-Read childbirth method

Question 20

20.A woman in labor has just received an epidural block. What is themostimportant nursing
intervention at this time?

Answer 20

Monitor the maternal blood pressure for possible hypotension.

Question 21

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

Answer 21

Help her breathe into a paper bag.

Question 22

22.A client is experiencing back labor and complains of intense pain in her lower back. Which
measure wouldbestsupport this woman in labor?

Answer 22

Counterpressure against the sacrum

Question 23

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

Answer 23

She has thrombocytopenia.

Question 24

24.Which alterations in the perception of pain by a laboring client should the nurse understand?

Answer 24

Sensory pain for nulliparous women is often greater than for multiparous women during
early labor.

Question 25

25.The nurse should be aware of what important information regarding systemic analgesics
administered during labor?

Answer 25

Effects on the fetus and newborn can include decreased alertness and delayed sucking.

Question 26

26.Developing a realistic birth plan with the pregnant woman regarding her care is important for
the nurse. How would the nurse explain the major advantage of nonpharmacologic pain
management?

Answer 26

No side effects or risks to the fetus are involved.

Question 27

27.What is the correct terminology for the nerve block that provides anesthesia to the lower
vagina and perineum?

Answer 27

Pudendal

Question 28

28.The obstetric nurse is preparing the client for an emergency cesarean birth, with no time to
administer spinal anesthesia. The nurse is aware of and prepared for the greatest risk of
administering general anesthesia to the client. What is this risk?

Answer 28

Aspiration of stomach contents

Question 29

29.What is the rationale for the use of a blood patch after spinal anesthesia?

Answer 29

Headache

Question 30

1.Maternal hypotension is a potential side effect of regional anesthesia and analgesia. What
nursing interventions could the nurse use to increase the client’s blood pressure?(Select all that
apply.)

Answer 30

b. Place the woman in a lateral position.
c. Increase IV fluids.
d. Administer oxygen.

Question 31

2.Which alternative approaches to relaxation have proven successful when working with the
client in labor?(Select all that apply.)

Answer 31

a. Aromatherapy
b. Massage
c. Hypnosis
e. Biofeedback

Question 32

3.A woman has requested an epidural block for her pain. She is 5 cm dilated and 100% effaced.
The baby is in a vertex position and is engaged. The nurse increases the woman’s IV fluid for a
preprocedural bolus. Before the initiation of the epidural, the woman should be informed

regarding the disadvantages of an epidural block. Which concerns should the nurse share with
this client?(Select all that apply.)a. Ability to move freely is limited.
b. Orthostatic hypotension and dizziness may occur.

Answer 32

a. Ability to move freely is limited.
b. Orthostatic hypotension and dizziness may occur.
d. Higher body temperature may occur.

Question 33

4.The class of drugs known as opioid analgesics (butorphanol, nalbuphine) is not suitable for
administration to women with known opioid dependence. The antagonistic activity could
precipitate withdrawal symptoms (abstinence syndrome) in both mothers and newborns. Which
signs would indicate opioid or narcotic withdrawal in the mother?(Select all that apply.)

Answer 33

a. Yawning, runny nose
c. Chills or hot flashes
e. Irritability, restlessness

Question 34

5.While developing an intrapartum care plan for the client in early labor, which psychosocial
factors would the nurse recognize upon the client’s pain experience?(Select all that apply.)

Answer 34

a. Culture
b. Anxiety and fear
c. Previous experiences with pain
e. Support systems