Chapter 7 - Test Questions

Leifer: Introduction to Maternity & Pediatric Nursing, 6th Edition Chapter 07: Nursing Management of Pain During Labor and Birth Test Bank MULTIPLE CHOICE 1. While teaching the childbirth preparation class, the nurse explains that the patient’s expression of labor pain: a. reduces the patient’s perception of pain. b. is intensified by the vertex position of the fetus. c. is influenced by culture. d. can be completely controlled by nonpharmacological techniques. ANS: C Culture influences how women feel about birth and what is an acceptable response to pain. DIF: Cognitive Level: Knowledge REF: p. 160 OBJ: 3 TOP: Cultural Influences on Pain KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physiological Adaptation 2. a. b. c. d.

Chemical substances produced in the body that act as natural pain relievers are: endorphins. morphine. codeine. atropine.

ANS: A Endorphins are natural body substances that are similar to morphine and may explain why laboring women need smaller doses of analgesia. DIF: Cognitive Level: Knowledge REF: p. 159 OBJ: 1 TOP: Endorphins KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Physiological Adaptation 3. A nurse instructs a woman’s labor coach to comfort her by firmly pressing on her lower back. This technique is called: a. sacral pressure. b. distraction. c. effleurage. d. conscious relaxation. ANS: A Sacral pressure refers to firm pressure against the lower back to relieve some of the pain of back labor. DIF:

Cognitive Level: Comprehension

REF: p. 161, Box 7-1

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OBJ: 6 TOP: Nonpharmacological Pain Management KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 4. A woman who is 6 cm dilated has the urge to push. The nurse would instruct the woman to __________ during the contraction. a. use slow-paced breathing b. hold her breath and push c. blow in short breaths d. use rapid-paced breathing ANS: C If a laboring woman feels the urge to push before the cervix is fully dilated, then she is taught to blow in short breaths to avoid bearing down. DIF: Cognitive Level: Analysis REF: p. 163 OBJ: 5 TOP: Stair-Step Breathing Pattern KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 5. Several hours into labor, a woman complains of dizziness, numbness, and tingling of her hands and mouth. The nurse recognizes these as symptoms of: a. hypertension. b. anxiety. c. anoxia. d. hyperventilation. ANS: D Hyperventilation is sometimes a problem if a woman is breathing rapidly. DIF: Cognitive Level: Analysis REF: p. 164, Box 7-2 OBJ: 5 TOP: Hyperventilation KEY: Nursing Process Step: Assessment MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease 6. The appropriate nursing action to take when a laboring woman hyperventilates is to: a. help her breathe into her cupped hands. b. place her flat on her back. c. initiate oxygen at 2 liters via mask. d. notify the doctor. ANS: A Measures to combat hyperventilation include breathing into cupped hands or a paper bag or holding breath for a few seconds. All of these techniques decrease PCO2. DIF: Cognitive Level: Application REF: p. 164, Box 7-2 OBJ: 5 TOP: Nonpharmacological Pain Management

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KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 7. A woman in the transition phase of labor requests a narcotic analgesic medication for pain relief. The nurse explains that giving a narcotic analgesic medication at this stage of labor will: a. cause medication given at later stages to be ineffective. b. have no complications for the mother or infant. c. result in respiratory depression to the newborn. d. speed up labor and increase pain. ANS: C The risk of narcotic analgesics is that they cross the placenta and can cause fetal respiratory depression. DIF: Cognitive Level: Analysis REF: p. 165 TOP: Opioids KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Reduction of Risk

OBJ: 7

8. To comfort a woman who is tensing her muscles with contractions, the nurse would guide the labor coach to: a. offer warm liquids to the patient. b. encourage the patient to pant. c. engage the patient in conversation. d. assist the patient to the knee-chest position. ANS: B Panting relaxes the abdominal wall and distracts the patient. It would not be helpful to offer fluids or to attempt conversation during contractions. Walking intensifies contractions. DIF: Cognitive Level: Application REF: p. 163 OBJ: 5 TOP: Panting KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 9. After the physician discussed general anesthesia with a woman in labor, the nurse determines that the woman understood the explanation when she says food and fluids are restricted for several hours prior to delivery to prevent: a. nausea and vomiting. b. vomiting and aspiration. c. abdominal cramping. d. intestinal obstruction. ANS: B The major adverse effect of general anesthesia is aspiration of stomach contents. DIF:

Cognitive Level: Analysis

REF: p. 169, Table 7-2

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OBJ: 7 TOP: General Anesthesia KEY: Nursing Process Step: Evaluation MSC: NCLEX: Physiological Integrity: Reduction of Risk 10. The initial nursing action immediately after the anesthesiologist administers epidural block for a laboring woman is to assess: a. bladder for distention. b. blood pressure. c. sensation in the lower extremities. d. intravenous fluid flow rate. ANS: B Blood pressure is checked every 5 minutes when the epidural block is first begun. Bladder assessment is also important but not an initial assessment. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 168, Table 7-2 6 TOP: Epidural Block Nursing Process Step: Implementation NCLEX: Physiological Integrity: Reduction of Risk

11. A woman in labor has had an epidural block for pain relief. The nurse will be assessing carefully for the associated side effect of: a. reduced fetal heart rate. b. long, intense contractions. c. sudden leg cramps. d. bladder distention. ANS: D A side effect of an epidural block is urine retention because the anesthesia interferes with the woman’s ability to have an urge to void. The patient may have to be catheterized. DIF: OBJ: KEY: MSC:

Cognitive Level: Analysis REF: p. 168, Table 7-2 7 TOP: Epidural Block Nursing Process Step: Assessment NCLEX: Physiological Integrity: Reduction of Risk

12. A narcotic antagonist used to reverse narcotic-induced respiratory depression is: a. hydroxyzine (Vistaril). b. phenobarbital. c. naloxone (Narcan). d. nitrous oxide. ANS: C Naloxone (Narcan) is used to reverse respiratory depression caused by narcotics. DIF:

Cognitive Level: Knowledge

REF: p. 165

OBJ: 7

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TOP: Narcotic Antagonist KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Reduction of Risk 13. A woman received a subarachnoid block before delivery. In order to prevent the associated side effect of this type of anesthesia, the nurse would include in the teaching plan that the patient should: a. restrict oral fluids. b. keep legs flexed. c. walk with assistance as soon as possible. d. lie flat for several hours. ANS: D The woman would be advised to remain flat for several hours after the block to decrease the chance of postspinal headache. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 169, Table 7-2 7 TOP: Subarachnoid Block Nursing Process Step: Planning NCLEX: Physiological Integrity: Reduction of Risk

14. A woman requests a pudendal block to manage her labor pain. The nurse realizes that the woman needs further explanation about the pudendal block when she says: a. “I’m having a contraction. Can I get the pudendal block now?” b. “I’ll get the pudendal block right before I deliver.” c. “The nurse midwife will insert the needles into my vagina.” d. “It takes a few minutes after the medicine is administered to make me feel numb.” ANS: A The pudendal block does not block pain from contractions and is given just before birth. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 166, Table 7-2 7 TOP: Pudendal Block Nursing Process Step: Evaluation NCLEX: Physiological Integrity: Basic Care and Comfort

15. An 18-year-old primigravida is 4 cm dilated and her contractions are 5 minutes apart. She received little prenatal care and had no childbirth preparation. She is crying loudly and shouting, “Please give me something for the pain. I can’t take the pain!” What is the priority nursing diagnosis? a. Pain related to uterine contractions b. Knowledge deficit related to the birth experience c. Ineffective coping related to inadequate preparation for labor d. Risk for injury related to lack of prenatal care ANS: A The most important issue for this woman, at this time, is effective pain management.

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Test Bank

DIF: TOP: KEY: MSC:

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Cognitive Level: Analysis REF: p. 164 OBJ: 3 Pain as a Priority Nursing Process Step: Nursing Diagnosis NCLEX: Physiological Integrity: Basic Care and Comfort

16. The nurse who encourages the gate control theory of pain control would advise a woman in labor and her partner to use which nonpharmacological method of pain management? a. Slow abdominal breathing b. Guided relaxation c. Listening to music d. Massage ANS: D According to the gate control theory, stimulating large-diameter nerve fibers temporarily interferes with conduction of impulses through small-diameter fibers. Massage is a technique that stimulates large-diameter fibers and “closes the gate.” DIF: Cognitive Level: Analysis REF: p. 159 OBJ: 5 TOP: Gate Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 17. When a pregnant woman arrives at the labor suite, she tells the nurse that she wants to have an epidural for delivery. The nurse is aware that a contraindication to an epidural block is: a. abnormal clotting. b. previous cesarean delivery. c. history of migraine headaches. d. history of diabetes mellitus. ANS: A An epidural block is not used if a woman has abnormal blood clotting. DIF: OBJ: KEY: MSC:

Cognitive Level: Application REF: p. 168, Table 7-2 7 TOP: Epidural Block Nursing Process Step: Assessment NCLEX: Physiological Integrity: Reduction of Risk

18. The nurse coaches the primigravida not to bear down until the cervix is completely dilated because premature bearing down can cause: a. increased use of oxygen. b. cervical laceration. c. uterine rupture. d. compression of the cord. ANS: B

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Bearing down against a cervix that is not dilated can cause edema and laceration to the cervix. DIF: Cognitive Level: Application REF: p. 163 OBJ: 6 TOP: Cervical Laceration KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Reduction of Risk 19. The nurse explains that the Dick-Read method of childbirth preparation is based on: a. mild sedation throughout labor. b. relaxation techniques. c. skin stimulation. d. deep massage. ANS: B The Dick-Read method depends on the use of relaxation techniques to reduce the discomforts of labor. DIF: Cognitive Level: Comprehension REF: p. 160 OBJ: 4 TOP: Dick-Read Method KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 20. The nurse who is instructing a Lamaze class on abdominal breathing tells a patient that because her baseline respiratory rate is 22 breaths per minute, her rate while performing slow breathing should be no lower than: a. 9. b. 11. c. 15. d. 20. ANS: B The range of respirations should be no lower than half of the base rate and no more rapid than double the base rate. DIF: OBJ: KEY: MSC:

Cognitive Level: Comprehension REF: p. 161, Box 7-1 4 TOP: Lamaze Method Nursing Process Step: Implementation NCLEX: Physiological Integrity: Basic Care and Comfort

21. The nurse defines the least amount of sensation that one perceives as pain as: a. tolerance. b. threshold. c. level. d. abatement. ANS: B

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Pain threshold is the least amount of sensation that one perceives as pain. Thresholds are different for each individual. DIF: Cognitive Level: Knowledge REF: p. 159 OBJ: 1 TOP: Pain Threshold KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 22. A sign to alert the nurse to the need of pain relief in an uncomplaining labor patient would be: a. frequently asking for ice chips. b. facial grimacing. c. changing positions in bed. d. covering her face with her hands. ANS: B Facial grimacing may be an indicator of unexpressed pain. DIF: Cognitive Level: Comprehension REF: p. 164 OBJ: 3 TOP: Nonverbal Pain Expressing KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 23. When the patient who received an epidural block asks why her blood pressure is taken so often, the nurse’s best response would be to explain that the frequent blood pressure assessments: a. ensure that unsafe levels of hypertension do not occur. b. help assess for the need for further pain relief. c. monitor the progress of labor. d. ensure adequate placental perfusion. ANS: D The hypotension that accompanies an epidural block may cause inadequate perfusion of the placenta, leading to fetal hypoxia. DIF: OBJ: KEY: MSC:

Cognitive Level: Comprehension REF: p. 167, Table 7-2 7 TOP: Disadvantage of Epidural Block Nursing Process Step: Implementation NCLEX: Physiological Integrity: Reduction of Risk

MULTIPLE RESPONSE 24. The nurse reminds the expectant parent that which typical types of classes are available to help prepare for parenthood? Select all that apply. a. Infant care b. Breastfeeding c. Gestational diabetes d. Sources of financial aid

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e. Yoga ANS: A, B, C Prenatal classes include such topics as infant care, breastfeeding, gestational diabetes, exercising, and sibling and grandparent preparation. Yoga and financial information are not traditional content for prenatal instruction. DIF: Cognitive Level: Comprehension REF: p. 157 OBJ: 2 TOP: Prenatal Classes KEY: Nursing Process Step: Implementation MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation 25. What breathing technique(s) would the nurse teach the prenatal patient to help her focus during labor in order to reduce pain? Select all that apply. a. First stage breathing b. Abdominal breathing c. Fourth stage breathing d. Modified pace breathing e. Patterned paced breathing ANS: OBJ: KEY: MSC:

A, B, D, E DIF: Cognitive Level: Comprehension REF: p. 163 6 TOP: Breathing Exercises Nursing Process Step: Implementation NCLEX: Physiological Integrity: Basic Care and Comfort

26. How does the pain of childbirth differ from other types of pain? Select all that apply. a. Childbirth pain is part of a normal process. b. Childbirth pain seldom needs narcotic relief. c. Position changes relieve pain and facilitate delivery. d. Childbirth pain declines following birth. e. Childbirth pain is self-limited. ANS: OBJ: KEY: MSC:

A, C, D, E DIF: Cognitive Level: Application REF: p. 159 3 TOP: Childbirth Pain Nursing Process Step: Planning NCLEX: Physiological Integrity: Basic Care and Comfort

27. Which are nonpharmacological forms of pain relief? Select all that apply. a. Skin stimulation b. Diversion and distraction c. Breathing techniques d. Exercise e. Yoga ANS: A, B, C

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Skin stimulation, diversion and distraction, and breathing techniques are the bases of nonpharmacological pain control. Although exercise and practices such as yoga and pilates are beneficial, they are not means of pain control. DIF: Cognitive Level: Application REF: p. 158 OBJ: 5 TOP: Nonpharmacological Pain Control KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Basic Care and Comfort 28. Which position(s) and exercise(s) will the nurse teach as beneficial in combating discomfort in the later stages of pregnancy? Select all that apply. a. Leg lifts b. Pelvic rock c. Tailor sitting d. Sit-ups e. Shoulder curling ANS: B, C, E Pelvic rock, tailor sitting, and shoulder curling are beneficial to the muscles that will have to adapt to the extra weight and changed posture of later pregnancy. Leg lifts and sit-ups are not beneficial because they both increase intraabdominal pressure. DIF: Cognitive Level: Application REF: p. 158 OBJ: 4 TOP: Helpful Exercises KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 29. The nurse points out the major advantages of nonpharmacological pain control methods. What are they? Select all that apply. a. They sedate the mother. b. They do not slow labor. c. They do not dull the excitement of the birth experience. d. They do not have the potential to cause allergic reactions. e. They do not have to be delayed until labor is well established. ANS: B, C, D, E All the options mentioned are benefits of nonpharmacological pain control methods with the exception of sedating the mother. DIF: TOP: KEY: MSC:

Cognitive Level: Application REF: p. 160 OBJ: 5 Advantages of Nonpharmacological Pain Control Nursing Process Step: Implementation NCLEX: Physiological Integrity: Basic Care and Comfort

COMPLETION 30. The nurse clarified that the amount of pain a person is willing to endure is referred to as ______________ ______________.

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ANS: pain tolerance Pain tolerance is the amount of pain a person is willing to endure. Pain threshold is the point at which pain is perceived. Pain threshold is relatively consistent from person to person, but pain tolerance differs greatly. DIF: Cognitive Level: Comprehension REF: p. 159 OBJ: 1 TOP: Pain Tolerance KEY: Nursing Process Step: Implementation MSC: NCLEX: Physiological Integrity: Physiological Adaptation 31. The massage technique that stimulates the large-diameter fibers in order to block impulses from the small-diameter fibers is ____________________. ANS: effleurage Effleurage stimulates the large-diameter fibers and blocks the pain impulses from the smalldiameter fibers. DIF: Cognitive Level: Comprehension REF: p. 162, Figure 7-3 OBJ: 6 TOP: Effleurage KEY: Nursing Process Step: N/A MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

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