Maternity Nursing Chap 10

Question 1

________ pain originates in the body organs during labor and birth. This type of pain results from cervical changes and uterine ischemia. It is located over the lower portion of the abdomen and radiates to the lumbar area of the back and down the thighs.

Answer 1

-visceral

Question 2

________ pain is well localized. During labor and birth this type of pain is experienced as perineal discomfort that results from stretching and distention of perineal tissue to allow passage of the fetus and from traction on the peritoneum and uterocervical supports during contractions.

Answer 2

-somatic

Question 3

_______ pain is felt in areas of the body other than the area of pain origin. Pain originating in the abdominal viscera is felt in the abdominal wall, lumbosacral area of the back, iliac crest, gluteal area, thighs, and lower back.

Answer 3

-referred

Question 4

The _________ theory of pain is based on the principle that pain sensations travel along sensory nerve pathways to the brain but only a limited number of sensations or messages can travel through these never pathways at one time. Pain relief techniques based on this theory include massage or stroking, music, imagery, and concentration on breathing and relaxation techniques.

Answer 4

-gate control

Question 5

_________ are endogenous opioids secreted by the pituitary gland that act on the central and peripheral nervous systems to reduce pain.

Answer 5

-endorphins

Question 6

Three major childbirth preparation methods taught in the US are __________, ___________, and __________.

Answer 6

• dick Read
• lamaze
• Bradley

Question 7

Breathing techniques provide ________, thereby reducing the perception of pain and helping the woman maintain control throughout contractions. Slow paced breathing is breathing at approximately half the woman’s normal breathing rate. It is usually the first technique used in early labor.

Answer 7

-distraction

Question 8

As contractions increase in frequency and intensity, chest breathing is used, with breathing becoming more _________ in depth and increasing to about twice the normal breathing rate.

Answer 8

-shallow

Question 9

A _________ should begin and end each breathing technique and contraction.

Answer 9

-cleansing breath

Question 10

A breathing technique using a pattern of breaths and puffs in a ratio of 4:1, 6:1, or 8:1 is used to enhance concentration during the _________ phase of the first stage of labor. An undesirable effect of this type of breathing might be hyperventilation or rapid, deep respirations, which can result in respiratory alkalosis, as exhibited by the symptoms of lightheadedness, dizziness, tingling of fingers, or circumoral numbness. It can be overcome by having the woman breathe into a paper bag or cupped hand. This enables the woman to rebreathe carbon dioxide and replace the bicarbonate ions.

Answer 10

-transition

Question 11

__________, or light stroking of the abdomen or other body part in rhythm with breathing during contractions and counterpressure, or steady pressure against the lower back especially during back labor, are two

Answer 11

-effleurage

Question 12

Factors influencing response to pain:

Answer 12

• culture
• anxiety and fear
• previous experience with pain and with childbirth
• childbirth preparation activities
• comfort measures
• secretion of endorphins
• support
• history of substance abuse
• history of sexual abuse
• pain and tolerance
• perception

Question 13

Abolition of pain perception by interrupting nerve impulses going to the brain (loss of sensation, partial or complete, and sometimes loss of consciousness occurs)?

Answer 13

-anesthesia

Question 14

Method to repair a tear in the dura mater around the spinal cord as a result of spinal anesthesia?

Answer 14

-epidural blood patch causing

Question 15

Single injection subarachnoid anesthesia useful for pain control during birth but not for labor?

Answer 15

-spinal block/anesthesia

Question 16

Systemic analgesic that provides analgesia without significant maternal or neonatal respiratory depression?

Answer 16

-opioid agonist antagonist

Question 17

Used for rapid perineal anesthesia for performing and repairing an episiotomy?

Answer 17

-local infiltration anesthesia

Question 18

Medication such as a barbiturate that can be used to relieve anxiety and induce sleep in prodromal or early latent labor?

Answer 18

-sedative

Question 19

Analgesic potentiators such as tranquilizers?

Answer 19

-ataractics

Question 20

Drug that reverses effects of opioids including neonatal narcosis (central nervous system depression of the newborn)?

Answer 20

-opioid antagonist

Question 21

Medications such as opioid agonists that are administered intramuscularly or intravenously for pain relief during labor?

Answer 21

-systemic analgesia

Question 22

Alleviation of pain sensation or raising of the pain threshold without loss of consciousness?

Answer 22

-analgesia

Question 23

Relief from pain of uterine contractions and birth by injecting a local anesthetic and/or opioid agonist such as fentanyl into the peridural space?

Answer 23

-epidural block

Question 24

Anesthetic that eliminates pain in the lower vagina, vulva, and perineum, making it useful for episiotomy birth, and forceps- or vacuum-assisted birth?

Answer 24

-pudendal block

Question 25

Factors influencing effect of systemic analgesics on fetus:

Answer 25

• maternal dosage
• pharmacokinetics of the specific drug
• route
• time when administered during labor

Question 26

Fetal effects of systemic analgesics:

Answer 26

• central nervous system (CNS) depression as a result of the direct effect of the drug when it crosses the placenta and/or the indirect effect of maternal hypotension and hypoventilation resulting from the action of the drug on maternal functions
• CNS depression slows the fetal heart rate, decreases variability, and leads to respiratory depression and hypoxia

Question 27

True or False: Somatic pain occurs as a result of perineal stretching and pressure exerted by the presenting part on the pelvic organs and structures.

Answer 27

True

Question 28

True or False: A woman’s perception of her birth experience as “good” or “bad” is influenced by the degree to which she believes she has met her personal goals related to coping with pain effectively.

Answer 28

True

Question 29

True or False: Water therapy can be used even if the laboring woman’s membranes are ruptured.

Answer 29

True

Question 30

True or False: Water therapy can worsen the pain associated with “back” labor.

Answer 30

False: soothing, relaxing, and comforting

Question 31

True or False: Barbituates given without an analgesic when a laboring woman is experiencing pain can magnify pain perception because the woman’s normal coping mechanisms may be blunted.

Answer 31

True

Question 32

True or False: Intramuscular administration of analgesics during labor offers a more predictable onset of pain relief.

Answer 32

False:

Question 33

True or False: Naloxone (Narcan) is contraindicated if a woman has an opioid dependency because it may cause symptoms of withdrawl.

Answer 33

True

Question 34

True or False: Before initiating her epidural anesthesia, a woman should be adequately hydrated using an intravenous (IV) solution of 5% glucose in water.

Answer 34

False:

Question 35

True or False: Epidural anesthesia is useful as a pain relief measure for both labor and birth.

Answer 35

True

Question 36

True or False: Keeping the woman in a flat position for at least 8 hours after birth is the most effective way to prevent headaches following a spinal block.

Answer 36

False:

Question 37

True or False: The woman can be assisted into a sitting position for the induction of both spinal anesthesia and lumbar epidural block.

Answer 37

True

Question 38

True or False: Maternal hypotension is a major adverse reaction to both spinal anesthesia and epidural block

Answer 38

True

Question 39

The use of ataractics can potentiate the action of analgesics. An ataractic that the nurse might expect to give to a laboring woman would be:

a. naloxone (Narcan)
b. hydroxyzine (Vistaril)
c. butorphanol tartrate (Stadol)
d. fentanyl (Sublimaze)

Answer 39

b. hydroxyzine (Vistaril)

Question 40

The doctor has ordered meperidine (Demerol) 25 mg IV q2-3h prn for pain associated with labor. In fulfilling this order, the nurse should know that:

a. the onset of the effect of this analgesic after IV administration is approximately 10 mins
b. the dosage of the analgesic is too high for IV administration, necessitating a new order
c. respiratory depression of the woman or fetus is not a concern with this analgesic
d. the newborn should be observed for respiratory depression if birth occurs within 4 hours after administration

Answer 40

d. the newborn should be observed for respiratory depression if birth occurs within 4 hours after administration

Question 41

An anesthesiologist is preparing to begin a continuous epidural block using a combination of local anesthetic and narcotic analgesic as a pain relief measure for a laboring woman. A nursing measure related to this type of nerve block would be to:

a. assist the woman into a modified Sims or upright position with her back curved
b. keep the woman in a semirecumbent position after administration to ensure equal distribution of the pharmacologic agents
c. assess the woman for headaches, especially after birth
d. assist the woman to the bathroom to urinate at least every 2 hours during labor to prevent bladder distention

Answer 41

a. assist the woman into a modified Sims or upright position with her back curved