Ch20: Pain Management

Question 139525
Id:
139525
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The laboring patient has rated her pain at 9 on a scale of 110, and she requests IV pain medication. She has
refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol)
for administration to the patient. Which action should the nurse complete next?
Stimulus
Answer
Choice 1
Advise the woman as to the actions and contraindications associated with

butorphanol tartrate and obtain her consent for administration of the
medication.
Rationale 1
Prior to administration of medication, the nurse must explain the

pharmacologic effects of the medication and obtain consent for
administration.
Answer 1
true
Choice 2
Offer the woman epidural anesthesia once more and describe the
effectiveness of this method of labor pain control.
Rationale 2
The woman has refused epidural anesthesia but is authorized to receive

butorphanol tartrate. The nurses next step is to advise the woman as to the
actions and contraindications associated with butorphanol tartrate and obtain
her consent for administration of the medication.
Answer 2
false
Choice 3
Obtain maternal vital signs and assess the fetal heart rate (FHR).
Rationale 3
Prior to obtaining maternal vital signs and assessing FHR, the nurse should
advise the woman as to the actions and contraindications associated with
butorphanol tartrate and obtain her consent for administration of the
medication.
Answer 3
false
Choice 4
Administer oxygen via face mask at 6 to 10 liters per minute.
Rationale 4
Routine oxygen administration is not indicated for administration of
butorphanol tartrate to an asymptomatic patient in labor. The nurses next

step is to advise the woman as to the actions and contraindications associated
with butorphanol tartrate and obtain her consent for administration of the
medication.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Physiological Integrity
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Planning
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Topical SubCategory:
Pearson Nursing Taxonomy #:
Taxonomy Category Comments:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Source Chapter Number:
Source Chapter Title:
Source Au Title Ed:
Source Usage:
Chapter 20_LO01_Q01
Writer First Name:
admin
Writer Last Name:

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Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
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Standard 1:
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LO01 - Describe the use, administration, dose, onset of action, adverse

effects, and contraindications of systemic drugs that promote pain relief
during labor in determining the nursing care management of the woman in
labor and her fetus.
Question 139526
Id:
139526
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A patient has just been admitted for labor and delivery. She is having mild contractions every 15 minutes
lasting 30 seconds. The patient wants to have a medication-free birth. When discussing medication
alternatives, the nurse should be sure the patient understands that:
Stimulus
Answer
Choice 1
In order to respect her wishes, no medication will be given.
Rationale 1
It is important to respect the patients wishes when possible. Once the effects
are explained, it is still the patients choice whether to receive medication.
Answer 1
false
Choice 2
Pain relief will allow a more enjoyable birth experience.
Rationale 2
While pain relief can lead to a more enjoyable experience, it might be the
view of the nurse but not the mother.
Answer 2
false
Choice 3
The use of medications allows the patient to rest and be less fatigued.
Rationale 3
While pain relief can allow the mother to be less fatigued, it might be the
view of the nurse but not the mother.
Answer 3
false
Choice 4
Maternal pain and stress can have a more adverse effect on the fetus than
would a small amount of analgesia.
Rationale 4
The decision not to medicate should be an informed one, and it is possible

that the patient does not know about the effects pain and stress can have on
the fetus. Once the effects are explained, it is still the patients choice
whether to receive medication.
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:
Pharmacological and Parenteral Therapies
Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 20_LO01_Q02

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
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Standard 1:
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Standard 5:
Standard 6:
LO01 - Describe the use, administration, dose, onset of action, adverse

effects, and contraindications of systemic drugs that promote pain relief
during labor in determining the nursing care management of the woman in
labor and her fetus.
Question 139527
Id:
139527
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The nurse has presented a teaching session on pain relief options to a prenatal class. Which patient statement
indicates that additional teaching is needed?
Stimulus
Answer
Choice 1
An epidural can be continuous or one dose.
Rationale 1
Epidural anesthesia can be administered in a single dose or via continuous

infusion.
Answer 1
false
Choice 2
General anesthesia is usually recommended for a patient who delivers by

way of cesarean section.
Rationale 2
Compared to general anesthesia, spinal anesthesia is usually the anesthetic of

choice indicated in the management of patients undergoing cesarean section.
Answer 2
true
Choice 3
Narcotics can be given through a patients epidural infusion catheter.
Rationale 3
To provide analgesia for approximately 24 hours after the birth, the analgesia
provider may inject an opioid, such as morphine sulfate (Duramorph) or
fentanyl (Sublimaze), into the epidural space immediately after the birth
Answer 3
false
Choice 4
A pudendal block usually works well to control pain during episiotomy

repair.
Rationale 4
A pudendal block technique is given in the second stage of labor for the
provision of perineal anesthesia for the latter part of the first stage of labor,
the second stage, birth, and episiotomy repair.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Health Promotion and Maintenance
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Evaluation
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 20_LO02 _Q03

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
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Learning Outcome 3:
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Standard 6:
LO02 - Compare the major types of regional analgesia and anesthesia,

including area affected, advantages, disadvantages, contraindications,
techniques, and nursing care management of the laboring woman and her
fetus.
Question 139528
Id:
139528
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The charge nurse is reviewing the plans of care for four laboring patients. Which care plan requires immediate
reconsideration for revision?
Stimulus
Answer
Choice 1
Administration of epidural anesthesia to a woman who is in the first stage of

labor and has a shellfish allergy
Rationale 1
A lumbar epidural relieves pain associated with the first and second stages of
labor. An allergy to shellfish is not a contraindication to epidural anesthesia.
Answer 1
false
Choice 2
Administration of a spinal anesthetic to a woman who is scheduled for

vaginal delivery of her baby
Rationale 2
Spinal anesthetics may be used to provide anesthesia for cesarean birth and
occasionally for vaginal birth.
Answer 2
false
Choice 3
Administration of epidural anesthesia to a woman with a history of vomiting

secondary to hyperemesis gravidarum
Rationale 3
Contraindications to epidural anesthesia include severe hypovolemia of any

etiology. This patient with hyperemesis gravidarum should be evaluated for
severity of dehydration prior to administration of epidural anesthesia.
Answer 3
true
Choice 4
Administration of a spinal anesthetic to a woman with a history of irritable

bowel syndrome (IBS)
Rationale 4
Irritable bowel syndrome (IBS) does not represent a contraindication to

spinal anesthesia.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Assessment
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
admin
Special Handling:
Comments:
Meta 4
Learning Outcome 1:

fetus.
Learning Outcome 2:
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Standard 1:
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Standard 6:
Question 139529
Id:
139529
Type:
MCMA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
Which of the following nursing actions can prevent or detect common side effects of epidural anesthesia?
Standard Text
Select all that apply.
Stimulus
Answer
Choice 1
Preloading the patient with a rapid infusion of IV fluids
Rationale 1
Hypotension can be prevented by preloading with rapid IV infusion followed

by continuous IV infusion. Variability of FHR and late decelerations can
occur if maternal hypotension occurs. Continuing FHR monitoring is
essential.
Answer 1
true
Choice 2
Continuing the patient on p.o. fluids only to prevent hypotension
Rationale 2

essential.
Answer 2
false
Choice 3
Monitoring the FHR for late deceleration and decrease in rate
Rationale 3

essential.
Answer 3
true
Choice 4
Use of intermittent FHR monitoring so the patient can use the birthing ball
Rationale 4

essential.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:
Nursing/Integrated
Concepts:
Nursing Process: Implementation
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Source Au Title Ed:
Source Usage:
Writer First Name:
admin
Writer Last Name:

Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
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Learning Outcome 6:
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Learning Outcome 9:
Standard 1:
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fetus.
Question 139530
Id:
139530
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring patient in which
of the following positions?
Stimulus
Answer
Choice 1
On her right side in the center of the bed with her back curved
Rationale 1
Especially in pregnant women, this position is not ideal for facilitating

access to the epidural space.
Answer 1
false
Choice 2
Lying prone with a pillow under her chest
Rationale 2
This position is not consistent with access to the epidural spaces.
Answer 2
false
Choice 3
On her left side with the bottom leg straight and the top leg slightly flexed
Rationale 3
This position is not consistent with access to the epidural spaces.
Answer 3
false
Choice 4
Sitting on the edge of the bed with her back slightly curved and her feet on a
stool
Rationale 4
Sitting on the edge of the bed with the back slightly curved and the feet on a
stool allows the epidural spaces to be accessed more easily.
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:
Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
admin
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

fetus.
Question 139531
Id:
139531
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The laboring patient requests pain medication. Her contractions are lasting 2030 seconds and are occurring
every 820 minutes. The nurse would explain that analgesics given at this time would likely cause:
Stimulus
Answer
Choice 1
Fetal respiratory depression.
Rationale 1
Pain medication given before established labor does not cause fetal
respiratory depression unless the mother delivers within an hour of receiving
the medication. This is not likely if labor is not established.
Answer 1
false
Choice 2
Decreased analgesic effectiveness at the end of labor.
Rationale 2
Medication given early in the labor process does not become less effective at
the end of labor.
Answer 2
false
Choice 3
Maternal hypotension.
Rationale 3
Analgesics might lower the blood pressure, but this effect does not cause the
contraction pattern to be altered.
Answer 3
false
Choice 4
Prolonged labor.
Rationale 4
Pain medication given before labor becomes established is likely to prolong

the labor process.
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:
Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

fetus.
Question 139532
Id:
139532
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
During her hospital admission, the laboring patient explicitly refused all pain medications and a labor epidural.
Once dilated to 5 cm, the patient complains of intolerable discomfort and asks the nurse, If I have an epidural,
how will you make sure it doesnt hurt my baby? The best response by the nurse is:
Stimulus
Answer
Choice 1
Well monitor your baby continuously so we can recognize and treat any
changes that may be related to the epidural.
Rationale 1
Continuous electronic fetal monitoring to assess fetal status is indicated in

the care of pregnant women who receive epidural anesthesia and allows for a
more direct assessment of fetal status than does frequent monitoring of
maternal BP and pulse, which are also indicated in the care of this patient.
Answer 1
true
Choice 2
Epidural anesthesia is very safe and there are no potential side effects that
can affect your baby.
Rationale 2
While proficient administration and monitoring of epidural anesthesia allows

for a high degree of safety with this technique, maternal hypotension
associated with epidural anesthesia may produce harmful fetal effects.
Answer 2
false
Choice 3
Well assess your blood pressure every 15 minutes to make sure the
epidural is not having any negative effects on your baby.
Rationale 3
While frequent monitoring of maternal blood pressure and pulse are

indicated in the care of a patient who receives a labor epidural, continuous
electronic fetal monitoring is also indicated for assessment of fetal status and
allows for a more direct fetal assessment.
Answer 3
Choice 4
false
Before your epidural is placed, well administer IV fluid to you in order to
prevent the epidural from causing you problems.
Rationale 4
While administration of a bolus of IV fluid is indicated in preparation for

epidural placement and reduces the risk for maternal hypotension, this
intervention neither guarantees the prevention of related complications nor
allows for assessment of fetal status.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Analyzing
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Source Au Title Ed:
Source Usage:
Writer First Name:
admin
Writer Last Name:

Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

fetus.
Question 139533
Id:
139533
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The anesthesia provider has just administered an epidural anesthetic in a laboring patient and local anesthesia
is continuously infusing via the epidural catheter. Suddenly, the patient asks, Why are my ears ringing? What
is the most likely cause of the patients complaint?
Stimulus
Answer
Choice 1
Hypotension
Rationale 1
Although maternal hypotension is associated with epidural anesthesia, a

sensation of ringing in the ears is associated with local anesthetic toxicity.
Answer 1
false
Choice 2
Allergic reaction
Rationale 2
Sensation of ringing in the ears is associated with local anesthetic toxicity.
Answer 2
false
Choice 3
Dehydration
Rationale 3
Answer 3
false
Choice 4
Local anesthetic toxicity
Rationale 4
Answer 4
true
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Assessment
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
admin
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
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Standard 1:
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LO03 - Explain the possible complications of regional anesthesia in nursing

care management of the laboring woman and her fetus.
Question 139534
Id:
139534
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The nurse is caring for a laboring patient who is receiving continuous epidural anesthesia via infusion. The
maternal blood pressure decreases from 132/78 to 78/42. Which intervention should the nurse implement first?
Stimulus
Answer
Choice 1
Increase the flow rate of infusion of intravenous crystalloid solution.
Rationale 1
If hypotension occurs secondary to epidural anesthesia, the nurse increases

the IV flow rate, ensures or verifies left uterine displacement, and
administers oxygen. If blood pressure is not restored in 1 to 2 minutes,
ephedrine, 5 to 10 mg IV, is administered.
Answer 1
true
Choice 2
Verify the patient is positioned to promote left uterine displacement.
Rationale 2

Answer 2
false
Choice 3
Administer oxygen.
Rationale 3

Answer 3
false
Choice 4
Administer ephedrine 5 to 10 mg intravenously.
Rationale 4


Answer 4
false.
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
admin
Royalty:
Stakes:
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

Question 139535
Id:
139535
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
During admission, a laboring patient tells the nurse, Im so afraid Ill need a cesarean section. I dont want to
be asleep for surgery when my baby is born! Which of the following nursing responses is most appropriate?
Stimulus
Answer
Choice 1
If a cesarean section is needed, that doesnt necessarily mean youll need to

go to sleep for surgery.
Rationale 1
While general anesthesia may be needed for cesarean birth and for surgical
intervention with some complications, in modern obstetrics, general
anesthesia is used in less than 1% of all obstetric births.
Answer 1
true
Choice 2
Your anesthesia provider will require that you go to sleep for surgery.
Rationale 2
General anesthesia may be needed for cesarean birth and for surgical
intervention with some complications. However, in modern obstetrics, spinal
anesthesia is often administered for delivery via cesarean section, while
general anesthesia is used in less than 1% of all obstetric births.
Answer 2
false
Choice 3
Well do our best to make sure you deliver vaginally, so you dont need to
have a cesarean section.
Rationale 3
Reassuring the patient in this manner does not address the erroneous belief
that general anesthesia is mandatory for women undergoing cesarean section.
Answer 3
false
Choice 4
If you need a cesarean section, the anesthesia provider will awaken you as
soon as possible after delivery so that you can see your baby quickly.
Rationale 4
Reassuring the patient in this manner does not address the erroneous belief
that general anesthesia is mandatory for women undergoing cesarean section.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
admin
Stakes:
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
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LO05 Describe the major complications of general anesthesia during labor

in nursing care management of the woman in labor and her fetus.
Question 139536
Id:
139536
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
A laboring patient has received an order for epidural anesthesia. In order to prevent the most common
complication associated with this procedure, the nurse would expect to do which of the following?
Stimulus
Answer
Choice 1
Observe fetal heart rate variability.
Rationale 1
Administering a fluid bolus prior to an epidural generally prevents maternal

hypotension, which is the most common side effect of an epidural.
Answer 1
false
Choice 2
Rapidly infuse 5001,000 ml of intravenous fluids.
Rationale 2

hypotension, which is the most common disadvantage to the procedure.
Answer 2
true
Choice 3
Place the patient in the semi-Fowlers position.
Rationale 3

Answer 3
false
Choice 4
Teach the patient appropriate breathing techniques.
Rationale 4

Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:
Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
Comments:
admin
Meta 4
Learning Outcome 1:
Learning Outcome 2:
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Question 139537
Id:
139537
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
After receiving nalbuphine hydrochloride (Nubain), a womans labor progresses rapidly, and the baby is born
less than one hour later. The baby exhibits signs of respiratory depression. Which medication should the nurse
be prepared to administer to the newborn?
Stimulus
Answer
Choice 1
Fentanyl (Sublimaze)
Rationale 1
Narcan is the only choice that is an opiate antagonist, which would reverse
the effects of the Nubain.
Answer 1
false
Choice 2
Butorphanol tartrate (Stadol)
Rationale 2
Answer 2
false
Choice 3
Naloxone (Narcan)
Rationale 3
Answer 3
true
Choice 4
Pentobarbital (Nembutal)
Rationale 4
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Applying
Client Need:
Client Need Sub:
Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
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Standard 1:
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Standard 5:
Standard 6:
LO05 - Explain the major complications of general anesthesia during labor in

nursing care management of the woman in labor and her fetus.
Question 139538
Id:
139538
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
The patient at 39 weeks gestation is undergoing a Cesarean birth due to breech presentation. General
anesthesia is being used. Which potential challenge is most relevant to the anesthesia care of this patient?
Stimulus
Answer
Choice 1
Hypotension due to the intense blockade of sympathetic fibers
Rationale 1
Regional anesthesia, including epidural anesthesia, is associated with an

intense blockade of sympathetic fibers that results in a high incidence of
hypotension.
Answer 1
false
Choice 2
Difficulty with maternal intubation
Rationale 2
Difficulty with maternal intubation is a primary challenge of general

anesthesia care for pregnant patients.
Answer 2
true
Choice 3
Broad ligament hematoma
Rationale 3
Broad ligament hematoma is a complication associated with pudendal

blockade.
Answer 3
false
Choice 4
Fetal depression that is fetal depression inversely proportional to maternal

anesthetic depth and duration
Rationale 4
Fetal depression associated with general anesthesia is directly proportional to

maternal anesthetic depth and duration.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Nursing Process: Evaluation
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 20_LO04_Q14

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
Special Handling:
admin
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:
LO05 - Explain the major complications of general anesthesia during labor in

nursing care management of the woman in labor and her fetus.
Question 139539
Id:
139539
Type:
MCSA
Calculator
:
false
Question
Title:
Difficulty
Level:
Question Stem
Following spinal anesthesia for delivery of her baby, a woman reports an inability to void urine. As the nurse
palpates the womans bladder the woman says, Its been five hours since I had my spinal and I still cant
empty my bladder. Do I have nerve damage? How should the nurse respond?
Stimulus
Answer
Choice 1
Spinal anesthesia can sometimes cause nerve damage.
Rationale 1
Although nerve damage is a rare occurrence in relation to spinal anesthesia,

there is no objective data to suggest that this woman has experienced nerve
damage. Restoration of bladder control may take 8 to 12 hours following a
spinal anesthetic.
Answer 1
false
Choice 2
It may be several hours before youre able to control your urination.
Rationale 2
Restoration of bladder control may take 8 to 12 hours following a spinal

anesthetic.
Answer 2
true
Choice 3
You should be able to control your bladder by now. Ill ask the anesthesia
provider to visit with you.
Rationale 3
Restoration of bladder control may take 8 to 12 hours following a spinal

anesthetic.
Answer 3
false
Choice 4
You are probably dehydrated. Please increase your water intake.
Rationale 4
There is no data to suggest the woman is dehydrated. Rather, she is likely

demonstrating a common side effect of spinal anesthesia. Restoration of
bladder control may take 8 to 12 hours following a spinal anesthetic.
Answer 4
false
Global Rationale
Meta 1
Cognitive Level:
Evaluating
Client Need:
Client Need Sub:

Nursing/Integrated
Concepts:
Content Area:
Content Area
Sub:
Meta 2
Clinical Domain:
Topical Category:
Key
Terms:
Strategy:
Meta 3
Reference:
Source Id:
Chapter 20_LO02_Q15

Source Au Title Ed:
Source Usage:
Writer First Name:
Writer Last Name:
Royalty:
Stakes:
admin
Special Handling:
Comments:
Meta 4
Learning Outcome 1:
Learning Outcome 2:
Learning Outcome 3:
Learning Outcome 4:
Learning Outcome 5:
Learning Outcome 6:
Learning Outcome 7:
Learning Outcome 8:
Learning Outcome 9:
Standard 1:
Standard 2:
Standard 3:
Standard 4:
Standard 5:
Standard 6:

fetus.

Ch20: Pain Management

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Question 139525

Advise the woman as to the actions and contraindications associated with

Prior to administration of medication, the nurse must explain the

The woman has refused epidural anesthesia but is authorized to receive

Administer oxygen via face mask at 6 to 10 liters per minute.

Routine oxygen administration is not indicated for administration of

butorphanol tartrate to an asymptomatic patient in labor. The nurses next

Client Need Sub:

Nursing Process: Planning

Writer First Name:

Writer Last Name:

LO01 - Describe the use, administration, dose, onset of action, adverse

In order to respect her wishes, no medication will be given.

Pain relief will allow a more enjoyable birth experience.

The decision not to medicate should be an informed one, and it is possible

Client Need Sub:

Pharmacological and Parenteral Therapies

Nursing Process: Planning

Source Chapter Number:

LO01 - Describe the use, administration, dose, onset of action, adverse

An epidural can be continuous or one dose.

Epidural anesthesia can be administered in a single dose or via continuous

General anesthesia is usually recommended for a patient who delivers by

Compared to general anesthesia, spinal anesthesia is usually the anesthetic of

Narcotics can be given through a patients epidural infusion catheter.

A pudendal block usually works well to control pain during episiotomy

Health Promotion and Maintenance

Client Need Sub:

Nursing Process: Evaluation

Chapter 20_LO02 _Q03

Source Chapter Number:

LO02 - Compare the major types of regional analgesia and anesthesia,

Administration of epidural anesthesia to a woman who is in the first stage of

Administration of a spinal anesthetic to a woman who is scheduled for

Administration of epidural anesthesia to a woman with a history of vomiting

Contraindications to epidural anesthesia include severe hypovolemia of any

Administration of a spinal anesthetic to a woman with a history of irritable

Irritable bowel syndrome (IBS) does not represent a contraindication to

Client Need Sub:

Nursing Process: Assessment

Chapter 20_LO02 _Q04

Source Chapter Number:

LO02 - Compare the major types of regional analgesia and anesthesia,

Preloading the patient with a rapid infusion of IV fluids

Hypotension can be prevented by preloading with rapid IV infusion followed

Continuing the patient on p.o. fluids only to prevent hypotension

Hypotension can be prevented by preloading with rapid IV infusion followed

Monitoring the FHR for late deceleration and decrease in rate

Hypotension can be prevented by preloading with rapid IV infusion followed

Hypotension can be prevented by preloading with rapid IV infusion followed

Client Need Sub:

Pharmacological and Parenteral Therapies

Nursing Process: Implementation

Chapter 20_LO02 _Q05

Writer Last Name:

LO02 - Compare the major types of regional analgesia and anesthesia,

Especially in pregnant women, this position is not ideal for facilitating

Lying prone with a pillow under her chest

This position is not consistent with access to the epidural spaces.

This position is not consistent with access to the epidural spaces.

Client Need Sub:

Pharmacological and Parenteral Therapies

Nursing Process: Implementation