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Homework answers / question archive / Chapter 13: Promoting Patient Comfort During Labor and Birth MULTIPLE CHOICE 1)The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort? Amniotomy Correct use of breathing methods Fetus in an occiput anterior position Positional changes during active labor     2

Chapter 13: Promoting Patient Comfort During Labor and Birth MULTIPLE CHOICE 1)The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort? Amniotomy Correct use of breathing methods Fetus in an occiput anterior position Positional changes during active labor     2

Nursing

Chapter 13: Promoting Patient Comfort During Labor and Birth

MULTIPLE CHOICE

1)The perinatal nurse explains to the student nurse that which of the following may increase labor discomfort?

    1. Amniotomy
    2. Correct use of breathing methods
    3. Fetus in an occiput anterior position
    4. Positional changes during active labor

 

 

2.         The perinatal nurse is caring for a woman in early labor with a fetus in the occiput posterior position. What action should the nurse perform to increase the womans comfort?

A.        Assist the woman into a hands-and-knees position.

B.        Encourage the woman to assume a sitting position.

C.        Have the woman walk to the bathroom and void.

D.        Provide soothing music as a distraction technique.

 

 

3.         The perinatal nurse suggests that a laboring woman may wish to use the birth ball. The patient questions the rationale for this suggestion. The best answer by the nurse is that use of the birth ball will facilitate what action?

A.        Decreased maternal anxiety

B.        Decreased transmission of pain

C.        Fetal descent

D.        Increased number of opioid receptors

 

 

4.         The perinatal nurse observes a woman entering the transition phase of labor while she uses a patterned breathing method to cope with the increasing strength of contractions. She complains of light-headedness and tingling in her fingers. The most appropriate intervention by the nurse is to assist the patient in doing which of the following?

A.        Breathing more slowly and taking a cleansing breath

B.        Cupping her hands and breathing into them

C.        Putting her head between her knees

D.        Returning to bed and lying on her left side

 

 

5.         The perinatal nurse is aware that a 25-year-old woman with gestational hypertension in labor would benefit most from which pharmacological pain relief medication?

A.        Epidural bupivacaine

B.        Fentanyl intravenously

C.        Morphine intrathecally

D.        Secobarbital sodium per mouth

 

 

6.         The perinatal nurse prepares the laboring woman for an epidural anesthesia insertion. What action is best to help prevent maternal hypotension?

A.        Administer an intravenous infusion of 500 mL of normal saline.

B.        Assess vital signs every 5 minutes after the epidural insertion.

C.        Assist the woman to lie down in a supine position.

D.        Encourage frequent cleansing breaths during the procedure.

 

 

7.         The perinatal nurse understands that the purpose of combining an opioid with a local anesthetic agent in an epidural is primarily for which of the following?

A.        Decrease the number of side effects

B.        Increase the intensity of the block

C.        Increase the total anesthetic volume

D.        Preserve more maternal motor function

 

8.         A woman has just given birth to an infant weighing 9 lb, 15 oz (4,350 g) with the assistance of forceps and an episiotomy. The patient received a pudendal block 12 minutes before the birth. The perinatal nurse would expect which of the following responses to the block?

A.        Appropriate for adequate pain relief

B.        Too close to birth; causing fetal depression

C.        Too early and probably worn off

D.        Too late to provide anesthesia

 

 

9.         A woman is being prepared for an elective cesarean birth. The perinatal nurse assists the anesthesiologist with the spinal block and then positions the patient in a supine position. The patients blood pressure drops to 90/52 mm Hg and there is a decrease in the fetal heart rate to 110 beats/minute. Which response by the nurse is best?

A.        Administer naloxone (Narcan) per protocol.

B.        Discontinue the patients intravenous infusion.

C.        Have ephedrine ready for administration.

D.        Place a wedge under the patients left hip.

 

 

10.       The perinatal nurse is caring for a Native American woman in labor with her first baby. The patient asks about the possibility of burning sweet grass, a part of her cultural tradition, during labor. Which of the following is the best response by the nurse?

A.        Burning any type of substance is not allowed by policy in the hospital. Is there something else that I can do that would be similar?

B.        Can you explain to me a bit more about this custom and what it means to you so that I can understand it better?

C.        I need to confer with the charge nurse. I want to know if this practice can be allowed so I will ask to see if it is possible.

D.        I understand that this cultural practice is important to you; however, I am unable to accommodate your request at this time.

 

 

11.       The perinatal nurse prepares to assess the labor of a patient who is in the triage area with her partner. She is contracting every 5 to 7 minutes and is very fearful about going home due to extreme fatigue and the distance to her house. The perinatal nurse determines that the patient is a fingertip dilated and50% effaced, and the cervix is anterior. The nurse might anticipate an order for what medication?

A.        Diphenhydramine (Benadryl)

B.        Lorazepam (Ativan)

C.        Promethazine (Phenergan)

D.        Secobarbitol sodium (Seconal)

 

12.       A patient in labor complains of a pain rating of 7 on a 1-to-10 scale. On assessing the patient further, the nurse finds her vital signs to be within normal limits, the patient is calm and cooperative, and she voided 400 mL 30 minutes ago. What action by the nurse is best?

A.        Delay treating the pain until physical signs are present.

B.        Reassess the woman in 1 hour for changes in vital signs.

C.        Tell her she can have medication when the pain is unbearable.

D.        Treat the womans pain according to the treatment plan.

 

13.       A nursing instructor is explaining the differences between the somatic and visceral pain felt by women in labor to a class of nursing students. Which statement about these two types of pain is inconsistent with thorough knowledge of these two types of pain?

A.        Somatic pain is more intense, sharp, and burning.

B.        Somatic pain is usually only felt in the third stage.

C.        Visceral pain is most often felt during contractions.

D.        Visceral pain usually occurs in the first stage of labor.

 

 

14.       A laboring woman has the nursing diagnosis of fear related to incomplete childbirth education. What assessment would best indicate that actions to decrease fear have been successful?

A.        Better knowledge

B.        Chooses analgesia

C.        Decreased pain

D.        Increased pulse

 

15.       The perinatal nurse explains to the new graduate nurse that fear and anxiety have physiological consequences in labor. The nurse is referring to what physiological process?

A.        Diminished effectiveness of contractions

B.        Faster, more intense labor and delivery

C.        Increased release of maternal endorphins

D.        More tissue trauma due to hurrying the delivery

 

 

16.       A woman is using a birth ball to promote comfort and fetal descent. The nurse observes the woman rocking back and forth while sitting on the ball. What action by

the nurse is most appropriate?

A.        Assess her response to the birth ball and document.

B.        Document that she is using the modality.

C.        Explain that she should move the ball in a circle.

D.        Instruct her to only use the birth ball for 10 minutes.

 

 

17.       A nurse is coaching a woman in labor in patterned breathing. To use the slow-paced breathing method, which instruction is best?

A.        Blow like you are blowing out a candle at the end of your breath.

B.        I will count to 4 while you inhale and again when you exhale.

C.        Take a deep cleansing breath when the contraction ends.

D.        You need to breathe at half of your normal rate in this pattern.

 

 

18.       The woman in labor is complaining of severe back pain. What action should the nurse suggest to the birth partner?

A.        Apply counterpressure

B.        Give a hand massage

C.        Perform effleurage

D.        Provide therapeutic touch

 

 

19.       A patient in labor has internal fetal monitoring and normal vital signs. All fetal signs are reassuring. She wishes to try whirlpool bath hydrotherapy as a comfort measure. Which action by the nurse is best?

A.        Assist the woman into the tub so she doesnt fall.

B.        Ensure the water temperature does not exceed 101F (38.3C).

C.        Inform her that she is not able to participate in this method.

D.        Remove the fetal monitor wires prior to the patients getting in the tub.

 

 

20.       A woman is preparing for whirlpool bath hydrotherapy. To ensure patient safety, what action by the nurse is best?

A.        Allow the woman to remain in the tub for no more than 20 minutes.

B.        Maintain water temperature no higher than 100.4F (38C).

C.        Obtain informed consent prior to allowing the woman in the tub.

D.        Use a wheelchair to transport the woman to the hydrotherapy tub.

 

 

21.       A nurse receives a handoff report on a newborn who is jaundiced. The off-going nurse states that the mother received some sort of sedative during the intrapartum period. The nurse should check the mothers chart for what medication?

A.        Diphenhydramine (Benadryl)

B.        Hydroxyzine (Vistaril)

C.        Promethazine (Phenergan)

D.        Secobarbital sodium (Seconal)

 

 

22.       A woman received butorphanol (Stadol) IV for labor pain. Thirty minutes later, the patients respiratory rate is 8 breaths/minute. What action by the nurse is best?

A.        Administer naloxone (Narcan) per protocol.

B.        Call the perinatal rapid response team.

C.        Reduce the next dose of Stadol by half.

D.        Hold the next dose of Stadol and notify the provider.

 

 

23.       What nursing intervention would be most important for a postpartum woman who received spinal anesthesia?

A.        Assess vital signs.

B.        Facilitate bonding.

C.        Monitor urine output.

D.        Promote breastfeeding.

 

 

24.       A woman is 1 hour postpartum with an epidural block and wishes to get up to go to the bathroom. What action by the nurse is most appropriate?

A.        Assess sensation in the lower extremities.

B.        Check the maternal vital signs.

C.        Confer with the health-care provider.

D.        Offer the woman the bedpan first.

 

 

25.       A post-anesthesia care nurse is receiving a report on a patient who was delivered under general anesthesia. The operating room nurse states that the patient received a dose of metoclopramide (Reglan) IV in the operating room. The nurse explains to a student nurse the purpose of giving this drug is to do which of the following?

A.        Allow rapid anesthetic induction

B.        Increase the speed of gastric emptying

C.        Promote muscle relaxation

D.        Reduce stomach acid production

 

 

26.       A woman is having a planned cesarean birth. The nurse explains to the student that which of the following would not be an appropriate choice of anesthesia for this woman?

A.        Epidural block

B.        General anesthesia

C.        Pudendal block

D.        Spinal block

 

 

27.       A nurse is caring for a pregnant woman scheduled to have an epidural block. The nurse reviews the womans admission laboratory results and finds the following: white blood count (WBC) 6,500/ mm3, hemoglobin 14 mg/dL, hematocrit 38%, platelet count 98,000, and international normalized ratio (INR) 4.2. What action by the nurse is best?

A.        Document the findings in the womans chart.

B.        Ensure a signed consent form is in the chart.

C.        Notify the health-care provider immediately.

D.        Start a peripheral IV of normal saline (NS).

 

 

28.       A labor and delivery nurse explains to the student that the most common complication following a spinal anesthesia block is which of the following?

A.        Fetal depression

B.        Hematoma

C.        Maternal hypotension

D.        Severe pruritus

 

 

29.       A woman in labor receives a dose of hydromorphone hydrochloride (Dilaudid) at 11:30 a.m. She gives birth at 12:45 p.m. What action by the nurse takes priority?

A.        Assess the neonate frequently for respiratory depression.

B.        Encourage the woman to void every 2 hours postpartum.

C.        Perform a head-to-toe assessment on the neonate.

D.        Promote skin-to-skin contact and bonding as soon as possible.

 

 

30.       A pregnant woman is asking about a combined spinal- epidural analgesia for labor pain. What information about this method of analgesia should the nurse provide?

A.        Cannot be used if a cesarean birth is required

B.        Causes a total loss of muscle control

C.        Associated with a delayed onset of good pain control

D.        Associated with an increased risk of infection and headache

 

 

MULTIPLE RESPONSE

 

1.         The perinatal nurse is assessing a 36-year-old woman at term who is in early labor. The nurse assesses for findings that indicate pain, including which of the following? (Select all that apply.)

A.        Blood pressure: 100/64 mm Hg

B.        Frequent voiding in small amounts

C.        Increased irritability related to repeated questions

D.        Pulse rate of 106 beats per minute

E.        Verbalizing concern with coping ability

 

 

2.         While providing a hospital tour, the perinatal nurse shows the compact disc player stored in the birthing room. The nurse explains that music is encouraged during labor because it does which of the following? (Select all that apply.)

A.        Decreases the production of catecholamines

B.        Increases maternal distraction

C.        Increases maternal oxygen demands

D.        Increases the production of endorphins

E.        Increases the womans ability to focus

 

 

3.         The perinatal nurse explains to the student nurse that the effects of the H1 receptor antagonists include which of the following? (Select all that apply.)

A.        Block histamine action at the receptor sites

B.        Decrease nausea and vomiting

C.        Decrease anxiety and promote sleep or rest

D.        Lead to more efficient contractions earlier in labor

E.        May decrease fetal heart rate variability

 

 

4.         The perinatal nurse assesses a patient who is immersed in a water-filled tub during active labor. The assessments that indicate the hydrotherapy has been effective include which of the following? (Select all that apply.)

A.        Decreased fetal heart rate

B.        Increased maternal blood pressure

C.        Increased maternal temperature

D.        Increased uterine activity

 

    1. Patients report of less pain

 

5.         The perinatal nurse is directing a student nurse in giving intravenous fentanyl citrate (Sublimaze) to a woman in labor. Which actions by the student would require the registered nurse to intervene?

A.        Administers the medication between contractions

B.        Administers the medication during a contraction

C.        Checks the three rights prior to administration

D.        Injects the medication rapidly

E.        Injects the medication slowly

 

 

6.         The perinatal nurse is caring for a woman with a postdural puncture headache. What interventions does the nurse include in this womans care plan? (Select all that apply.)

A.        Bedrest

B.        Caffeine

C.        Decreased fluid intake

D.        Light therapy

E.        Position sitting upright

 

 

7.         The OB clinic nurse is giving a pregnant woman information on different types of anesthesia and pain control for use during labor. What information does the nurse provide about spinal anesthesia block? (Select all that apply.)

A.        Anesthesia occurs after only a 10- to 15-minute delay.

B.        It can be used for both vaginal and cesarean births.

C.        It causes decreased maternal level of consciousness.

D.        It may increase the chance of an operative birth.

E.        It provides excellent muscular relaxation.

 

 

8.         A nurse is teaching a woman about pain management strategies during labor. The woman expresses great fear about the experience. Which of the following statements by the nurse would help to ease the womans fears? (Select all that apply.)

A.        Dont worry about the pain; at least its not from illness.

B.        Keep in mind there is an end to the pain with the birth.

C.        Pain during labor is normal and expected, and helps you to give birth.

D.        We can anticipate your labor pain and plan for it.

E.        You have to expect some amount of pain during labor.

 

 

9.         A nurse is caring for a woman who is going to have an epidural block. The physician orders that an IV be started. Which of the following solutions would be appropriate for the nurse to choose? (Select all that apply.)

A.        D5 (5% dextrose) with 0.45 normal saline (NS)

B.        D5 and water (D5W)

C.        Lactated Ringers (LR) solution

D.        Normal saline (NS)

E.        Normal saline (NS) with 10% dextrose

 

 

10.       A nursing faculty member is explaining potential complications from epidural anesthesia to a class of nursing students. Which information does the nurse include? (Select all that apply.)

A.        Bizarre behavior

B.        Increased need for oxytocin (Pitocin)

C.        Lengthened duration of labor

D.        Shiver response

E.        Urinary incontinence

 

 

 

 

 

 

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