Question 1

The charge nurse is reviewing the plans of care for four clients in labor. Which care plan requires additional information before implementing?

Accepted Answer

D

Question 2

A client in labor who is requesting an epidural asks if the baby will be harmed. How should the nurse respond?

Accepted Answer

It is important for the nurse to provide accurate information to the client. Option A is not accurate, as there are potential side effects of epidural anesthesia on the baby, such as a temporary decrease in heart rate. Option C is not sufficient, as monitoring blood pressure alone does not assess the baby's well-being. Option D is not accurate, as IV fluids do not prevent potential side effects of epidural anesthesia on the baby. Option B is the best choice, as it acknowledges the potential side effects of epidural anesthesia on the baby but reassures the client that the healthcare team will continuously monitor the baby's well-being and intervene if necessary.

Question 3

A client at 39 weeks' gestation is having a cesarean birth with general anesthesia. Which potential challenge is most relevant to the anesthesia care of this client?

Accepted Answer

During general anesthesia, the client's airway needs to be secured with endotracheal intubation. However, maternal anatomical changes and uterine size at 39 weeks can make intubation more challenging, especially in cases of emergency cesarean birth.

Question 4

A client in labor wants to have a medication-free birth. What should the nurse include when discussing alternatives to pain medication with this client?

Accepted Answer

Explaining the potential risks and benefits of pain medication versus natural pain management can help the client make an informed decision. It is important to convey that while medication can provide relief, it may also have potential side effects that could impact the mother and baby. Emphasizing the benefits of natural pain management methods, such as movement, breathing, and relaxation techniques, can also be helpful.  The nurse should avoid option A, as it does not provide useful information or support the client's wishes. Option B may not be helpful to a client who strongly desires a medication-free birth. Option C suggests that medication is necessary to have an enjoyable birth experience, which may not be accurate for all clients.

Question 5

A client experiencing contractions every 8 to 20 minutes that last 20 to 30 seconds requests pain medication. What should the nurse state as the effect of analgesics given at this time?

Accepted Answer

The answer of A client experiencing contractions every 8 to...

Question 6

A client in labor is concerned about needing a cesarean section and being asleep during the birth of her baby. Which nursing response is most appropriate?

Accepted Answer

Option B validates the client's concerns while providing accurate information. It reassures the client that a cesarean section may not require general anesthesia, and encourages further discussion with the healthcare provider to address her concerns. Option A is incorrect as it is a statement without any explanation, while Option C is not acceptable as it does not address the client's current concerns. Option D is incorrect as it assumes that the client will need general anesthesia and does not address the client's concern of being asleep during the birth of her baby.

Question 7

A postpartum client who received spinal anesthesia for the delivery has not voided for 5 hours and is concerned about nerve damage. How should the nurse respond about this concern?

Accepted Answer

Spinal anesthesia can temporarily affect the control over bladder function, leading to a delay in the ability to urinate. This is a common and expected effect, not necessarily indicative of nerve damage.

Question 8

The blood pressure of a client receiving continuous epidural anesthesia for labor has changed from 132/78 mmHg to 78/42 mmHg. What action should the nurse perform first?

Accepted Answer

The answer of The blood pressure of a client receiving...

Question 9

A client in labor is being prepared for epidural anesthesia. What should the nurse expect to perform in order to prevent the most common complication associated with this anesthesia?

Accepted Answer

The most common complication associated with epidural anesthesia is hypotension. Rapidly infusing 500 to 1000 mL of intravenous fluids before administering the epidural anesthesia can help prevent hypotension by filling the vascular system and maintaining blood pressure. A, B, and C are not effective measures for preventing hypotension associated with epidural anesthesia.

Question 10

Prior to receiving lumbar epidural anesthesia, in which position should the nurse place the client in labor?

Accepted Answer

Prior to receiving lumbar epidural anesthesia, the client should be positioned sitting on the edge of the bed with the back slightly curved and feet on a stool. This position helps the client to arch the back and open the spinal spaces, making it easier for the anesthesiologist to insert the epidural needle.

Question 11

A client in labor received a dose of meperidine (Demerol) for pain control. Which assessment findings should the nurse suspect are adverse effects of this medication? Select all that apply.

Accepted Answer

1. Nausea is an adverse effect of meperidine. 2. Pruritus is an adverse effect of meperidine. 3. Sedation is an adverse effect of meperidine. 4. Bradycardia is an adverse effect of fentanyl. 5. Hypotension is an adverse effect of nalbuphine hydrochloride and fentanyl.

Question 12

Which nursing action can prevent or detect common side effects of epidural anesthesia? Select all that apply.

Accepted Answer

Preloading the client with a rapid infusion of IV fluids can prevent hypotension, a common side effect of epidural anesthesia. Assisting the client to empty the bladder before the anesthesia is started can prevent urinary retention, another common side effect. Monitoring the fetal heart rate (FHR) for late deceleration and decrease in rate can help to detect fetal distress, which can occur due to maternal hypotension or other complications of epidural anesthesia. Continuing the client on oral fluids only is not sufficient to prevent hypotension, and the use of intermittent FHR monitoring may not be adequate for detecting fetal distress during epidural anesthesia.

Question 13

A client in labor who rates pain as 9 on a scale from 1 to 10 requests pain medication after refusing epidural anesthesia. What action should the nurse take prior to administering butorphanol tartrate (Stadol) as prescribed?

Accepted Answer

The answer of A client in labor who rates pain...

Question 14

The newborn of a client who received nalbuphine hydrochloride (Nubain) for pain control was born less than an hour after the medication was given and is exhibiting signs of respiratory depression. Which medication should the nurse prepare to administer to the newborn?

Accepted Answer

Naloxone (Narcan) is an opioid antagonist and can reverse the respiratory depression caused by nalbuphine hydrochloride (Nubain). Fentanyl (Sublimaze), pentobarbital (Nembutal), and butorphanol tartrate (Stadol) are all opioids and could potentially compound the respiratory depression in the newborn.

Question 15

A client in labor is having a pudendal block. For which adverse effects should the nurse assess this client? Select all that apply.

Accepted Answer

The answer of A client in labor is having a...

Question 16

A client in labor who is receiving a continuous infusion of a local anesthetic through an epidural catheter asks if ear ringing is supposed to occur. What is the most likely cause of the client's complaint?

Accepted Answer

Ear ringing (tinnitus) can be a symptom of local anesthetic toxicity, which occurs when the blood levels of the local anesthetic become too high. This can happen due to excessive dosage or accidental intravascular injection.

Question 17

The newborn of a client who received butorphanol tartrate (Stadol) 20 minutes before delivery is demonstrating respiratory depression. The infant, weighing 9.9 lb, is prescribed naloxone (Narcan)
0)1 mg/kg. How many milliliters of the medication should the nurse administer to the newborn? (Calculate to the hundredth decimal point.)

Accepted Answer

The answer of The newborn of a client who received...

Question 18

A client in labor needs an emergency cesarean section. What should the nurse include when preparing this client for rapid induction of labor? Select all that apply.

Accepted Answer

Placing a wedge under the right hip prevents aortocaval compression. Inserting an indwelling urinary catheter is necessary for bladder drainage during surgery. An intravenous infusion catheter is needed for medication and fluid administration. Preoxygenating with 100% oxygen helps prevent hypoxia during anesthesia induction.

Question 19

The nurse is preparing a client in labor for an emergency cesarean section. Which medication should the nurse expect to be prescribed to prevent the effects of aspirated gastric contents? Select all that apply.

Accepted Answer

Famotidine (Pepcid) and Cimetidine (Tagamet) are H2 receptor antagonists that reduce the production of stomach acid, which can help prevent the effects of aspirated gastric contents by reducing acidity. Metoclopramide (Reglan) increases the speed of gastric emptying, which can also help prevent aspiration of gastric contents by reducing the volume of content in the stomach.

Question 20

The nurse has presented a teaching session on pain relief options to a prenatal class. Which client statement indicates that additional teaching is needed?

Accepted Answer

General anesthesia is not usually recommended for a cesarean section because it can affect the baby's breathing and requires a longer recovery time for the mother. Regional anesthesia, like an epidural or spinal block, is the preferred choice for a cesarean section.

Quiz 19: Pharmacologic Pain Management