Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 22 Pharmacologic Pain Management

1. The nurse is caring for a client in labor who has a history of physical dependence on narcotics. Which consideration should the nurse take with regard to the administration of naloxone (Narcan)?
2. Inducing withdrawal symptoms
3. Prolonging respiratory depression
4. Exacerbating pruritis
5. Increasing the risk for fetal depression

Page Ref: 534

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify how opioid abuse, dependence, and addiction affects women's options for pharmacologic pain relief in labor and birth.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. An analgesic medication has been administered intramuscularly to a client in labor. How would the nurse evaluate if the medication was effective?
2. The client dozes between contractions.
3. The client is moaning during contractions.
4. The contractions decrease in intensity.
5. The contractions decrease in frequency.

Page Ref: 529

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 3 Describe the use of systemic analgesics to promote pain relief during labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A client is having contractions that last 20-30 seconds and that are occurring every 8-20 minutes. The client is requesting something to help relieve the discomfort of contractions. What should the nurse suggest?
2. That a mild analgesic be administered
3. An epidural
4. A local anesthetic block
5. Nonpharmacologic methods of pain relief

Page Ref: 529

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss the nurse's role in supporting pharmaceutical pain relief measures in labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do?
2. Remove the epidural catheter and apply a Band-Aid to the injection site.
3. Offer the client a cool cloth and let her know the itching is temporary.
4. Recognize that this is a common side effect, and follow protocol for administration of Benadryl.
5. Call the anesthesia care provider to re-dose the epidural catheter.

Page Ref: 543

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A client has just been admitted for labor and delivery. She is having mild contractions lasting 30 seconds every 15 minutes. The client wants to have a medication-free birth. When discussing medication alternatives, the nurse should be sure the client understands which of the following?
2. In order to respect her wishes, no medication will be given.
3. Pain relief will allow a more enjoyable birth experience.
4. The use of medications allows the client to rest and be less fatigued.
5. Maternal pain and stress can have a more adverse effect on the fetus than would a small amount of analgesia.

Page Ref: 530

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. C. 8. Recognize that patient expectations influence outcomes in management of pain or suffering. | A A C N Essentials Competencies: Ⅸ. 21. Engage in caring and healing techniques that promote a therapeutic nurse-patient relationship. | N L N Competencies: Relationship-Centered Care: Respect the patient's dignity, uniqueness, integrity, and self-determination, and his or her own power and self-healing process. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss the nurse's role in supporting pharmaceutical pain relief measures in labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of anesthesia?
2. Spinal
3. Pudendal
4. General
5. Epidural

Page Ref: 547

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 5 Summarize possible complications of regional anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. Toward the end of the first stage of labor, a pudendal block is administered transvaginally. What will the nurse anticipate the client's care will include?
2. Monitoring for hypotension every 15 minutes
3. Monitoring F H R every 15 minutes
4. Monitoring for bladder distention
5. No additional assessments

Page Ref: 548

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. Narcotic analgesia is administered to a laboring client at 10:00 a.m. The infant is delivered at 12:30 p.m. What would the nurse anticipate that the narcotic analgesia could do?
2. Be used in place of preoperative sedation
3. Result in neonatal respiratory depression
4. Prevent the need for anesthesia with an episiotomy
5. Enhance uterine contractions

Page Ref: 531

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. After nalbuphine hydrochloride (Nubain) is administered, labor progresses rapidly, and the baby is born less than 1 hour later. The baby shows signs of respiratory depression. Which medication should the nurse be prepared to administer to the newborn?
2. Fentanyl (Sublimaze)
3. Butorphanol tartrate (Stadol)
4. Naloxone (Narcan)
5. Pentobarbital (Nembutal)

Page Ref: 534

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Describe the use of systemic analgesics to promote pain relief during labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse has presented a session on pain relief options to a prenatal class. Which statement indicates that additional teaching is needed?
2. "An epidural can be continuous or can be given in one dose."
3. "A spinal is usually used for a cesarean birth."
4. "Pudendal blocks are effective when a vacuum is needed."
5. "Local anesthetics provide good labor pain relief."

Page Ref: 549

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 1 Discuss the nurse's role in supporting pharmaceutical pain relief measures in labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. What is the major adverse side effect of epidural anesthesia?
2. Maternal hypotension
3. Decrease in variability of the F H R
4. Vertigo
5. Decreased or absent respiratory movements

Page Ref: 539

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅰ. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Summarize possible complications of regional anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which position?
2. On her right side in the center of the bed with her back curved
3. Lying prone with a pillow under her chest
4. On her left side with the bottom leg straight and the top leg slightly flexed
5. Sitting on the edge of the bed

Page Ref: 540

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 1 Discuss the nurse's role in supporting pharmaceutical pain relief measures in labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The laboring client brought a written birth plan indicating that she wanted to avoid pain medications and an epidural. She is now at 6 c m and states, "I can't stand this anymore! I need something for pain! How will an epidural affect my baby?" What is the nurse's best response?
2. "The narcotic in the epidural will make both you and the baby sleepy."
3. "It is unlikely that an epidural will decrease your baby's heart rate."
4. "Epidurals tend to cause low blood pressure in babies after birth."
5. "I can't get you an epidural, because of your birth plan."

Page Ref: 542

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. C. 14. Appreciate shared decision-making with empowered patients and families, even when conflicts occur. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. Upon the client's admission to the birthing unit, the nurse performs a careful assessment to determine whether the client has a history of physical dependence on narcotics. For which complication related to analgesic administration is the nurse preparing?
2. Respiratory depression
3. Urinary retention
4. Fetal depression
5. Pruritis

Page Ref: 534

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 2 Identify how opioid abuse, dependence, and addiction affects women's options for pharmacologic pain relief in labor and birth.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. During a labor and delivery class, a client asks the nurse, "Why would I be placed under general anesthesia during delivery?" What should the nurse include in the response?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Perceived lack of time for regional anesthesia
2. Contraindications for regional anesthesia
3. Failure of regional anesthesia
4. Refusal of regional anesthesia
5. Provider preference over regional anesthesia

Page Ref: 550

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Describe the indication for the use of general anesthesia in labor and birth.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse knows that which of the following are advantages of spinal block?

Note: Credit will be given only if all correct answers and no incorrect answers are selected.

Select all that apply.

1. Intense blockade of sympathetic fibers
2. Relative ease of administration
3. Maternal compartmentalization of the drug
4. Immediate onset of anesthesia
5. Larger drug volume

Page Ref: 546

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅰ. A. 3. Demonstrate comprehensive understanding of the concepts of pain and suffering, including physiologic models of pain and comfort. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. For what common side effects of epidural anesthesia should the nurse watch?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Elevated maternal temperature
2. Urinary retention
3. Nausea
4. Long-term back pain
5. Local itching

Page Ref: 543

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Summarize possible complications of regional anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A client dilated to 5 c m has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her B P?
2. Epinephrine
3. Terbutaline
4. Ephedrine
5. Epifoam

Page Ref: 545

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 7. Initiate effective treatments to relieve pain and suffering in light of patient values, preferences, and expressed needs. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Summarize possible complications of regional anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A client received epidural anesthesia during the first stage of labor. The epidural is discontinued immediately after delivery. This client is at increased risk for which problem during the fourth stage of labor?
2. Nausea
3. Bladder distention
4. Uterine atony
5. Hypertension

Page Ref: 544

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 5 Summarize possible complications of regional anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. When general anesthesia is necessary for a cesarean delivery, what should the nurse be prepared to do?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Administer an antacid to the client.
2. Place a wedge under the client's thigh.
3. Apply cricoid pressure to the client during anesthesia intubation.
4. Preoxygenate the client for 3-5 minutes before anesthesia.
5. Place a Foley catheter in the client's bladder.

Page Ref: 550

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 1 Discuss the nurse's role in supporting pharmaceutical pain relief measures in labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The client at 39 weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate intervention?
2. The baby's hands and feet are blue at 1 minute after birth.
3. The fetal heart rate is 70 prior to making the skin incision.
4. Clear fluid is obtained from the baby's oropharynx.
5. The neonate cries prior to delivery of the body.

Page Ref: 551

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Describe the nurse's role in caring for a woman experiencing major complications of general anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse is providing preoperative teaching to a client for whom a cesarean birth under general anesthesia is scheduled for the next day. Which statement by the client indicates that she requires additional information?
2. "General anesthesia can be accomplished with inhaled gases."
3. "General anesthesia usually involves administering medication into my I V."
4. "General anesthesia will provide good pain relief after the birth."
5. "General anesthesia takes effect faster than an epidural."

Page Ref: 550

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Describe the indication for the use of general anesthesia in labor and birth.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A cesarean section is ordered for a pregnant client. Because the client is to receive general anesthesia, what is the primary danger with which the nurse is concerned?
2. Fetal depression
3. Vomiting
4. Maternal depression
5. Uterine relaxation

Page Ref: 550

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 7 Describe the nurse's role in caring for a woman experiencing major complications of general anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A cesarean section is ordered for the laboring client with whom the nurse has worked all shift. The client will receive general anesthesia. The nurse knows that potential complications of general anesthesia include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Fetal depression that is directly proportional to the depth and duration of the anesthesia
2. Poor fetal metabolism of anesthesia, which inhibits use with preterm infants
3. Uterine relaxation
4. Increased gastric motility
5. Itching of the face and neck

Page Ref: 550

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 12. Create a safe environment that results in high-quality patient outcomes. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 7 Describe the nurse's role in caring for a woman experiencing major complications of general anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The client with a normal pregnancy had an emergency cesarean birth under general anesthesia 2 hours ago. The client now has a respiratory rate of 30, pale blue nail beds, a pulse rate of 110, and a temperature of 102.6°F, and is complaining of chest pain. The nurse understands that the client most likely is experiencing which of the following?
2. Pulmonary embolus
3. Pneumococcal pneumonia
4. Pneumonitis
5. Gastroesophageal reflux disease

Page Ref: 550

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Knowledge and Science: Value evidence-based approaches to yield best practices for nursing. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 7 Describe the nurse's role in caring for a woman experiencing major complications of general anesthesia.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse is inducing the labor of a client with severe preeclampsia. As labor progresses, fetal intolerance of labor develops. The induction medication is turned off, and the client is prepared for cesarean birth. Which statement should the nurse include in her preoperative teaching?
2. "Because of your preeclampsia, you are at higher risk for hypotension after an epidural anesthesia."
3. "Because of your preeclampsia, you might develop hypertension after a spinal anesthesia."
4. "Because of your preeclampsia, your baby might have decreased blood pressure after birth."
5. "Because of your preeclampsia, your husband will not be allowed into the operating room."

Page Ref: 551

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Identify contraindications to specific types of analgesia and anesthesia for high-risk mothers.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse is caring for a laboring client with thrombocytopenia. During labor, it is determined that the client requires a cesarean delivery. The nurse is preparing the client for surgery, and should instruct the client that the recommended method of anesthesia is which of the following?
2. General anesthesia
3. Epidural anesthesia
4. Spinal anesthesia
5. Regional anesthesia

Page Ref: 552

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 4. Communicate effectively with all members of the healthcare team, including the patient and the patient's support network. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse is performing an assessment on a client admitted to the birthing unit. Which assessment finding(s) contraindicate(s) an epidural block?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Maternal refusal
2. Local infection of the skin on the lower back
3. Coagulation disorder
4. Long-term N S A I D use
5. Previous back surgery

Page Ref: 540

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Identify contraindications to specific types of analgesia and anesthesia for high-risk mothers.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A patient is labor is prescribed to receive nalbuphine 10 m g/70 k g intravenously now. The patient weighs 198 l b s. How many m g of medication should the nurse provide this patient? (Round to the nearest tenth decimal point.)

Page Ref: 534

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation; Nursing Process.

Learning Outcome: 3 Describe the use of systemic analgesics to promote pain relief during labor.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse is preparing to instruct a patient in the third trimester of pregnancy on various methods to control pain during labor, and selects the following diagram. For which type of pain control is the nurse planning to instruct the client?

1. Lumbar spinal block
2. Pudendal block
3. Lumbar epidural block
4. Local infiltration

Page Ref: 536

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Teaching/Learning.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A patient in labor is being prepared for an epidural. Where should the nurse indicate the location of the epidural space on the diagram below?

1. A
2. B
3. C
4. D

Page Ref: 538

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation; Teaching/Learning.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. The nurse is reviewing the procedure for a continuous lumbar epidural block with a patient in the 3rd trimester of pregnancy. When reviewing this information what does the following diagram demonstrate to the patient?

1. Preparation of the skin prior to the insertion of the catheter
2. Status of the vertebra when the patient is in the correct position
3. The length of the needle to be inserted in the subarachnoid space
4. Vertebrae rotated forward when the patient is side-lying without a pillow

Page Ref: 541

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.

1. A patient is having the following anesthesia provided. What is the purpose of this type of anesthesia?

1. Repair of an episiotomy
2. Delivery of the placenta
3. Insertion of a urinary catheter
4. Intrapartum vaginal examination

Page Ref: 549

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Planning: Nursing Process.

Learning Outcome: 4 Compare the major types of regional analgesia and anesthesia, including the area affected, advantages, disadvantages, techniques, and nursing implications.

M N L L O: Demonstrate understanding of pharmacologic pain management for the laboring woman.